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pharm quiz 4.4
Anti-Epilepsy Drugs (AEDs)
| Question | Answer |
|---|---|
| Approx. what percent of the U.S. population has epilepsy? | 0.6% have epilepsy |
| Approx. how many are responsive to treatment? | 2/3 are responsive to treatment |
| What are things to consider when prescribing AEDs? | select the one that is most tolerable, lowest potential for harm, and least negative impact on quality of life |
| Before 1990, how many AEDs were available on the market? | 6 AEDs |
| Causes of seizures besides epilepsy include: -12 | Congenital abnormalities, Hypoxia(lack of O2)@ birth,Alcohol or Benzodiazepine withdrawal, Uremia,Hypo/Hyperglycemia,Head trauma, Cancer/brain tumors, Clots,Alzheimer’s, Infectious diseases (Meningitis, Herpes encephalitis, etc), Febrile seizures children |
| T or F: a single seizure constitutes a diagnosis of epilepsy | False, If the underlying cause of the seizure is permanent epilepsy may result |
| What does a seizure look like? -10 | Change in alertness, cannot remember event, changes in Mood, sensation of the skin, & Vision, Falling, sudden loss of muscle control, Muscle twitching or tightness causing twisting of the body, Shaking of entire body, Tasting a bitter or metallic flavor |
| Seizure First Aid "Do's" -6 | protect from injury- clear area, cushion head, loosen tight clothing, turn on person on side, look for medical ID bracelet, stay with them until he/she recovers |
| Seizure First Aid "DO NOT's" -5 | restrain the person, place something between the person's teeth, move the person, try to stop them from convulsing, give medications by mouth during convulsions |
| What are reasons to call 9-1-1 when a person is having a seizure? -8 | Lasts more than 2-5 min, person does not awaken or have normal behavior after, another seizure begins after the 1st ends, 1st time the person has had a seizure, happened in water, pregnant, diabetes, no med ID, different than seizures before. |
| Status Epilepticus medical treatment includes: -5 | maintenance of airway, dextrose IV, & IV lorazepam or IV or rectal diazepam, and a prophylactic agent (phenytoin or fosphenytoin) |
| Therapeutic Goals for Management of Epilepsy? -5 | Decrease seizure frequency to functional level, chose appropriate medication, avoid non-compliance, newer AEDs may be better tolerated, improve quality of life |
| Info regarding AED-induced Rash? | must be evaluated by MD to make sure it's not SJS, may be mild allergic reaction, SJS or TEN develops quickly- stop AED immediately |
| General Adverse Effects of AEDs? -9 | drowsiness, sedation, lethargy, confusion, nystagmus (eye tremor), diplopia (double vision, ataxia (movement awkwardness), vertigo, and dizziness osteoporosis with chronic use drug-induced rash including mild rash, SJS, TEN (some more so than others) |
| General drug interactions of AEDs? | most have cytochrome p450 drug-drug interactions, possible synergistic with CNS depressants |
| Drugs to know for AEDs *examples* -6 | Phenobarbital, Phenytoin (Dilantin), Fosphenytoin (Cerebyx), Valproic Acid/ Valproate (Depakene, Depakote), Gabapentin (Neurontin) & Pregabalin (Lyrica) |
| Drugs to recognize as AED but not know specifics: -7 | Carbamazepine (Tegretol) Oxcarbazepine (Trileptal) Topiramate (Topamax) Zonisamide (Zonegran) Lamotrigine (Lamictal) Levetiracetam (Keppra) Primidone (Mysoline®) |
| Mechanism of action for Phenobarbital? | Enhances effects & binding of naturally produced GABA and direct GABA agonist |
| Other adverse effects specific to Phenobarbital? -6 | Anemia, granulocytopenia, agranulocytosis, thrombocytopenia Paradoxical responses (Some kids may become irritable & hyperactive. Some elderly may become confused & agitated) Respiratory depression |
| Drug interaction with Phenobarbital? | Additive respiratory depressant effects with other respiratory depressants |
| Adverse effects specific to Phenytoin (Dilantin)? -8 | Anemia, granulocytopenia, agranulocytosis, thrombocytopenia Hepatotoxicity Folate deficiency Gingival hyperplasia (20%) Hirsutism – thickening of facial hair |
| How is Fosphenytoin (Cerebyx) related to Phenytoin (Dilantin)? | A water soluble pro-drug of phenytoin |
| Adverse Effects specific to Valproic Acid, Valproate (Depakene, Depakote)? -12 | Anemia, granulocytopenia, agranulocytosis, thrombocytopenia N/V, dyspepsia, anorexia (10%), diarrhea, weight gain (10%), alopecia (15 – 20%) Hepatotoxicity, pancreatitis |
| Newer AEDs | Gabapentin (Neurontin) & Pregabalin (Lyrica) |
| Mechanism of Action for Gabapentin (Neurontin) & Pregabalin (Lyrica®) | Enhances GABA activity and blocks opening of calcium channels |
| Adverse effects for Gabapentin (Neurontin) & Pregabalin (Lyrica®)? -3 | Weight gain, peripheral edema (caution heart failure) Paradoxical responses in children & elderly |
| Drug interactions for Gabapentin (Neurontin) & Pregabalin (Lyrica®): | Excreted unchanged in the urine, no cytochrome p450 drug interactions |
| Other Therapeutic uses of AEDs: -3 | management of pain, neuromuscular disorders, psychiatric indications |
| Types of pain AEDs are used for: (6) | Neuropathic pain diabetic neuropathy, Post-herpetic neuralgia, Trigeminal neuralgia, HIV-neuropathy, Migraine prophylaxis, and Fibromyalgia |
| Neuropathic pain diabetic neuropathy | gabapentin, pregabalin, carbamazepine, oxcarbazepine, phenytoin, valproate, lamotrigine |
| Post-herpetic neuralgia | gabapentin, pregabalin, carbamazepine, valproate |
| Trigeminal neuralgia | carbamazepine is DOC; oxcarbazepine, valproate, lamotrigine |
| HIV-neuropathy | gabapentin, pregabalin |
| Migraine prophylaxis | prophylaxis: valproate, topiramate, levetiracetam, gabapentin, tiagabine, zonisamide |
| Fibromyalgia | pregabalin has most evidence; tiagabine, gabapentin |
| Types of neuromuscular disorders AEDs are used with: -2 | Essential tremor and Restless leg Syndrome |
| Essential tremor | primidone has most evidence; topiramate, zonisamide, tiagabine, gabapentin, levetiracetam |
| Restless Leg Syndrome | some evidence with carbamazepine, gabapentin, oxcarbazepine |
| Types of psychiatric indications treated with AEDs: -4 | Bipolar disorder, anxiety disorders, insomnia, and impulsivity/aggression |
| Bipolar disorder | valproate, carbamazepine, oxcarbazepine; lamotrigine may be helpful in bipolar depression |
| anxiety disorders | AEDs that enhance GABA activity are being studied |
| insomnia | gabapentin, pregabalin, and tiagabine may improve sleep patterns |
| impulsivity/aggression | carbamazepine, valproate, gabapentin |
Created by:
hcress08
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