Nervous System Drugs 1
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What is a seizure?
- period of altered brain function
- may lose consciousness, have abnormal movements, or behavior, or other neurological changes
What are some other names for serizures?
Are seizures always dangerous? Should we be concerned about seizures?
- not always dangerous
- we should be concerned because of underlying causes, potential problems caused by seizures, and the general unpleasantness of the whole thing.
Apart from the underlying cause of a seizure, how can a seizure itself be dangerous to the patient?
- patient can fall down and get hurt
- can get into a bad position and be unable to breathe
- may vomit and aspirate
- may be unable to escape from enemies
- may have a long enough seizures to cause severe hyperthermia due to excessive muscle contractions
- hypoxia due to lack of ventilation
List 5 general causes of seizures
- metabolic: hypoxia, hypocalcemia, hypoglycemia, heatstroke
- infectious: canine distemper virus
- toxicity: lead, strychnine, organophosphates, ethylene glycol
- physical: head trauma, brain tumors
- idiopothic epilepsy: unknown cause
Is it always easy to identify causes of seizures?
Is idiopathic epilepsy more common in dogs or in cats?
List and describe the 3 phases of a seizure.
- pre-ictal: before the seizure - panting, anxious, behavior changes
- ictus: the seizure itself - many different forms
- post-ictal: after the seizure - behavior changes
Define idiopathic epilepsy
epilepsy of unknown cause
Define generalized seizure
- whole body seizure
- paddling, leg extension, opisthotonus
Define grand mal seizure
generalized, whole body seizures (older term)
Define partial seizure (focal seizure)
involving only part of the body
Define petit mal seizure
- brief loss of consciousness
- a type of partial seizure (older term)
Define behavioral seizures
characterized by abnormal behavior - aggression, snapping at flies, etc.
Define status epilepticus
severe prolonged seizures - emergency - leads to hypoxia, acidosis, and hyperthermia
abnormal position characterized by extreme head, neck, and forelimb extension
What is the overall goal of seizure therapy?
to identify and correct the underlying cause to "cure" the patient
If we cannot correct the cause of the patient's seizures, what 3 things are we trying to accomplish with seizure therapy?
- to reduce the frequency
- and severity of the patient's seizures
Should we promise the owner that we can cure his pet's seizures?
Should every pet with seizures be put on seizure medication? Why or why not?
- it partly depends on how often, long, and bad the seizures are, partly on the owner's tolerance for mild seizures, or on the owner's ability to medicate the pet regularly enough. an owner may euthanize or give away an epileptic pet because she cannot deal with it
How are drugs administered for a seizure in progress?
IV or rectal - suppository
How are drugs administered for a patient that has occasional seizures? (The patient is not having a seizure at the moment, but we would like to reduce frequency, severity, and duration of recurrent seizures)
Once seizure medication is started, is it OK to skip doses? Why or why not?
- skipping a dose may precipitate a seizure
Is it OK to give acepromazine to a patient who is prone to seizures? Why not?
- lowers the seizure threshold, may cause the patient to have a seizure
List 2 main categories of drugs that should be avoided or used cautiously in seizure patients.
- CNS stimulatns (doxapram, yohimbine)
- large doses of local anesthetic (lidocaine)
List 2 drugs used IV for a seizure in progress
- diazepram - Valium
What is the drug of choice to use IV during a seizure in progress?
diazepam - Valium
Can diazepam be administered by a route other than IV during a seizure in progress? If so, name it
yes - rectally or by suppository
What is the advantage of being able to administer diazepam rectally during a seizure in progress?
may not be able to achieve an IV injection - rectal is easier
Do we expect a single IV injection of valium to be effective for a relatively short time (20 minutes) or a relatively long time (hours)?
If a seizing patient starts having seizures again shortly after the initial IV injection of diazepam, can we give more?
- yes - we can give repeated doses
- can be given continuous IV drip or constant rate infusion
What other drug can be used IV for longer-term control of prolonged, severe seizures?
List 7 drugs discussed in class that are used PO for long term recurrent seizure control.
- potassium bromide
- valproic acid
What is the PO drug of choice for long term control of recurrent seizures?
Why is it usually necessary to gradually increase the dose of phenobarbital in an epileptic patient to prevent seizures from occurring?
phenobabital induces its enzyme system, speeding up its metabolism, it excreted faster, so need higher dose
Are barbiturates significantly protein-bound?
What effect does hyoproteinemia have on blood levels of free phenobarbital? Why?
- phenobarbital is highly protein-bound, if less plasma protein is available to bind the phenobarbital, there will be more free phenobarbital - free to affect the patient
Should the phenobarbital dose in a hypoproteinemic animal be increased or decreased?
Should we look up interactions of phenobarbital with other drugs?
Why is it important to monitor blood levels of phenobarbital?
dosage is variable, need to make sure blood levels are in the therapeutic range, change if necessary
What are the clinical signs of phenobarbital OD - overdosage?
- maybe PU/PD
Should we expect a certain "normal" increase in serum liver enzymes - SAP or ALP, ALT - with use of phenobarbital?
Why is it common for a patient to be lethargic for the first few days of phenobarbital therapy?
does not metabolize drug well at first, then gets better
List 3 PO seizure drugs discussed in class that are not used much in veterinary medicine
What does primidone metabolize to in the body?
What is the main problem with phenytoin?
drug induced hepatopathy, can be fatal
What type of drug is clonazepam? What is its main problem?
- benzodiazepam - related to diazepam
- clonazepam is expensive and inconvenient to use
If oral phenobarbital alone is not adequately controlling seizures, what 3 other drugs discussed in this class can be added to phenobarbital (not all at once!) for seizure control?
potassium bromide - KBr, valproic acid, felbamate
For what purposes are CNS stimulants used?
stimulate respiration and reverse CNS depression in sedated or anesthetized patients
List 3 specific CNS stimulants
What is the CNS stimulant active ingredient in coffee and soft drings?
What is the CNS stimulant active ingredient in chocolate?
Who should get the caffeine and the theobromine - the veterinary patient or the veterinary technician?
the veterinary technician
How many standard sized chocolate bars does it take to cause toxicity in a 10 pound dog?
2 or 3
How much unsweetened baking chocolate does it take to kill a 10 pound dog?
one ounce (a square)
What is doxapram used for?
- stimulate respiration in sedated or anesthetized patients, including neonates delivered by Caesarian section
- cardiopulmonary arrest
How can you give doxapram to a newborn puppy who has respiratory depression caused by drugs given to its mother?
under the tongue, or in the umbilical vein
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