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What percentage of seizures have no identifiable cause?
What are the 3 types of partial seizures? And what are there differences?
- 1) Simple seizures
- i) Varies from person to person but person always remains alert
- 2) Complex
- i) Some loss of conscious awarness
- 3) Secondary generalized
- i) Starts on one side of the brain and then spreads to the other side.
Explain an Absence seizure (petit mal).
May be simple (just stares) or complex (stares and muscle movement
Consists of temporary lapses in consciousness that last for a few seconds.
Explain Tonic-Clonic seizures (Grand Mal).
Most commonly "seen" by observers (because patient can be SEEN falling to the ground and having convulsions for several minutes).
What is Status-Epilepticus?
- i) consciousness
- ii) 10-20% mortality rates results from anoxia
- iii) Major cause is non compliance with drug therapy
The ideal anticonvulsant would have the following characteristics:
- 1) Drug should be highly effective with a low incidence of toxicity
- 2) Drug would be long acting and non sedating
- 3) Tolerance to therapeutic effect would not develope
Name 2 types of Hydantoins.
Hydantoins - any one of a group of anticonvulsant medications
- 1) Phenytoin (Dilantin)
- 2) Fosphenytoin (Cerebyx) Prodrug of Phenytoin that was formulated to reduce problems associated with the IV use of Phenytoin
What is Phenobarbital (Luminal) used for?
Prototype barbiturate to treat epilepsy.
What is Diazepam (Valium) used for?
Used parenterally for status-epilepticus and for severe recurrent convulsive seizures.
What is Felbamate (Felbatol) used for?
Used for partial and secondary seizures refractory to other meds.
What should or should not be done with Topiramate (Topamax) and why?
Drug is bitter and should NOT be cut or crushed before administration.
What is Narcolepsy?
A condition characterized by excessive drowsiness and uncontrollable sleep attacks during the day.
What does Dextroamphetamine (Dexedrine) do?
MOA - releases norepinephrine from storage and also a direct stimulating effect on alpha and beta receptor sites.
What does Methylphenidate (Ritalin) Centrally acting do?
Action is similar to amphetamines. In patients with ADD with hyperactivity, methylphenidate reduces motor activity and increases the attention span.
What is psychoses?
Mental disorder that involves a breakdown of the personality.
What is Neuroses?
Accumulation of anxiety and tension, which leads to emotional changes and abnormal behavior.
What are some signs of Schizophrenia?
Positive symptoms include agitation, anxiety, hallucinations, poor hygiene and dress, hyperactivity, delusions, paranoia and hostility.
What are the two types of severe depression?
- 1) Exogenous - caused by external factors
- 2) Endogenous - Usually requires psychotherapy and drug treatment.
What is another name for Bipolar Mood Disorder?
What are Phenothiazines?
Treatment of psychosis, treatment of nausea, vomiting, pain, and sedation.
What is Chlorpromazine (Thorazine)?
The first phenothiazine developed; Indications: Antipsychotic, Antiemetic, hiccups.
What is Haloperido (Haldol) associated with?
Associated with significant extrapyramidal side effects (example=tremors, slurred speech, anxiety, distress, and paranoia)
What must be done when taking Clozapine (Clozaril)?
Treatment is closely monitored and either weekly or biweekly WBC tests must be performed prior to dispensing any medication.
What are the side effects of Olanzapine (Zyprexa)?
Side effects include headache, agitation, constipation, orthostatic hypotension, sedation, weight gain, and somnolence (excessive sleepiness).
What are the warnings for Tricyclic Antidepressants (TCA's)?
Patients coming our of depression are at an increased risk of committing suicide because they regain their energy to fulfill their ideations.
Imipramine (Tofranil) is what kind of antidepressant and what else is it used for?
It is a Tricyclic antidepressant and is also used for enuresis (bed wetting).
What kind of antidepressant is amitriptyline and what else is it used for?
Tricyclic antidepressant and is also used for most severe anticholinergic effects. It is also highly sedating.
What type of antidepressant is Bupropion (Wellbutrin) and what kind of inhibitor is it?
It is an Atypical Antidepressant and is a Dopamine Reuptake inhibitor.
What kind of antidepressant is Trazodone (Desyrel) and what kind of inhibitor is it?
It is an Atypical Antidepressant and is a Serotonin Reuptake Inhibitor.
What kind of antidepressant is Mirtazapine (Remeron) and what is its action.
It is an Atypical Antidepressant and is a potent serotonin receptor antagonist.
What does MAOI stand for and what line antidepressant is it?
Monoamine Oxidase Inhibitors (MAOI). Indicated as second or third line antidepressants for patients that do not respond to other antidepressants.
What are the interactions with MAOI's?
- 1) Tyramine containing foods and beverages
- 2) The major adverse reaction is the occurrence of sudden and possibly very severe hypertension that if untreated can progress to vascular collapse and fatality.
How long and it take MAOI's to reach maximal effect?
Therapeutic doses may take weeks to attain a maximal effect.
Name the 3 specific SSRI's
- 1) Fluoxetine (Prozac)
- 2) Paroxetine (Paxil)
- 3) Sertraline (Zoloft)
What drug is indicated for treatment of manic-depressive illness only (aka Bi-polar)?
What does Catecholamine refer to?
Refers to norepinephrine, epinephrine and dopamine which all are chemically related.
Name 2 direct acting cholinergics
- 1) Bethanechol (Urecholine)
- 2) Carbachol (Isopto Carbachol) - used to decrease intraocular pressure after cataract surgery and in glaucoma patients.
Name 2 Cholinergic Blockers and what they do.
- 1) Atropine - Acts by occupying receptors and preventing or reducing the response to ACh
- 2) Scopolamine (Transderm Scop) - Indicated for the treatment of irritable bowel syndrome and renal or ureteral colic, for motion sickness to prevent nausea and vomiting.
Direct Acting Adrenergics
- 1) Symptomatic relief of acute hypersensitivity reactions. Adjunct to local anesthetics.
- 2) Used to treat cardiac arrest or cardiac standstill.
- 3) Side effects are as follows - OTC inhalers contain as much as 1% EPI
Isoproterenol (Isuprel, Med haler ISO)
- 1) Nonselective beta-adrenergic drug
- 2) Relieves bronchospasm associated with bronchial asthma, pulmonary emphysema and bronchitis.
1) Short-term management of patients requiring inotropic support as in CHF or after cardiac surgery.
1) Acts by both directly and indirectly releasing norepinephrine; varied effects based on dosage.
Phenylephrine (Neo Synephrine)
Synthetic drug chemically related to epinephrine, norepinephrine and ephedrine.
Indicated for acute hypotensive states occurring with spinal anesthesia.