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2014-03-27 16:10:58

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  1. why are periodic blood test needed for use of many of the medications for seizures:
    • drug levels may be done to help tailor the dose and to keep the drug within an often narrow therapeutic range
    • (easy to overdose)
  2. a clinically detectable sing of epilepsy is a disturbance of electricl activity in the brain that may affect consciousness, motor activity, and sensation.

    caused by abnormal or uncontrolled neuronal dischargers:
    a seizure
  3. involuntary, violent spasms of large skeletal muscles of the face, neck, arms, and legs are called:
  4. list the known causes of seizures: (10)
    • acute infections: meningitis
    • chemcial trauma: presence of toxic substance or ingestion of poision
    • hypoglycemia
    • hyponatremia
    • water intoxication
    • respiratory hypoxia
    • carbon monoxide poisoning
    • rapid increase in body temp (febrile seizure)
    • tumors
  5. most antiseizure drugs are pregnancy category:

    which antiseizure med is not in the same pregnancy category as the rest:

    what are the effects of antiseizure meds on birthcontrol:
    pregnancy category: D

    • ethosuximide (zarontin)
    • pregnancy category: C

    effects on birthcontrol: decrease the effectiveness of hormonal contraceptives
  6. once an antiseizure med is selected how is the proper dose selected:
    • pt is placed on a low dose initally
    • the amount is gradually increased until seizure control is acheived
  7. if the current antiseizure med is not effective, how is the transition to a new med performed:
    the new med is added in small-dose increments, while the dose of the 1st drug is slowly reduced.

    b/c seizures are likely to occur if antiseizure drugs are abruptly withdrawn
  8. effective seizure managment can be obtained using only a single drug.

    two antiseizure meds may be need in some cases, what should be considered:
    • unwanted side effects
    • compatability
  9. what are the 3 general mechanisms by which antiseizure meds act:
    • stimulating an influx of chloride ions (an effect associated with the NT GABA)
    • delaying an influx of sodium
    • delaying an influx of calcium
  10. in general, how do drugs that potentiate GABA act:
    • the drugs mimic the effects of GABA (the primary inhibitory NT) by stimulating an influx of chloride ions that interact with the GABA receptor
    • when the receptor is stimulated, chloride ions move into the cell and suppress the firing of the neurons
    • predominate effect of GABA potentiation is CNS depression
  11. list the drugs in the follwoing classes that reduced siezures by intensifitying GABA action:



    non barbitutate/benodiazepins:
    • barbiturates
    • phenobarbital

    • benzodiazepines
    • lorazepam (ativan)
    • diazepam (valium)

    • non barbitutate/benodiazepins:
    • topiramate (topamax)
  12. the barbiturate that is still commonly prescribed for seizures is called:

    list the advantages of this drug:


    • advantages
    • suppress abnormal neuronal discharge, without sedation
    • inexpensive
    • long acting
    • low incidence of adverse effects

    • disadvantage
    • several weeks to produce optimum effects
  13. pt. care with long term use of barbiturates (phenobarbitol) of seizure control should include assesment of: (3)
    • respiratory disorders
    • decreased level of consciousness
    • respiratory depression
  14. what is part of the reason barbiturates are contraindicated with pregnancy:
    barbiturates decrease folic acid and thus can cause neural tube disorders
  15. which 2 vitamins can be decreased when using phenobarbitol:

    list the results of each decrease:
    • decrease in vitamin D
    • osteoporosis may develop or worse

    • decrease in vitamin K
    • bleeding is more likely
  16. why should antiseizure meds never be stopped abruptly?
    a seizure can result
  17. There are many rx-rx rxns that can occur from the use of phenobarbitol, describe why:
    increased metabolism from enzyme induction,  and thus decrease the effect of other drugs
  18. what is the effect of phenobarbitol (a barbiturate) on the following pts:

    pts with severe pain:
    • children: become more hyperactive
    • pts with severe pain: increases pain sensation
  19. phenorbarbitol (a barbiturate) should be avoid administering in the following..

    IM (intramuscular) or IV:
    with other sedatives:

    describe why:
    • IM or IV:
    • extravascaton can cause tissue necrosis

    • with other sedatives
    • life theratening respiratory depression can occur
  20. in general, how do benzodiazepines (drugs that potentiate GABA) act:
    • decreases nerve activity in the limbic system and this decreases impulses going to the RAS
    • their action on GABA receptors also increases chloride movement into nerve cells, hyperpolarizing them and thus suppressing abnormal nerve discharges that could cause a seizure
  21. how long do benzodiazepines (barbiturates) usually take to acheive siezure control:
    1-2 weeks
  22. what are the indications for the use of benzodiazepines (barbiturates):
    • absence seizures
    • myoclonic seizures
    • status epilepticus: IV diazepam
  23. list the benzodiapzepins (barbiturates) used to tx seizures:
    • lorazepam (ativan)
    • diazepam (valium)
  24. because tolerance may being to develop after only a few months of therapy with benzodiazepines, seizures may recur unless the does is periodically adjusted

    what is the primay use of benzodiazepines:
    • short term seizure control
    • rarely used long term
  25. pt. care for the use of benzodiazepines should include a good assesment of the following:
    • is the pt. on other antiseizure meds
    • if they have ever used other antiseizure meds, and why they didnt work
    • check for all other meds pt is taking (including herbal and OTC)
  26. how much alcohol a pt. consumes should be assesed when using benzodiazepines, describe why:
    alchohol is also a sedative and when taken with benzodiazepines could cause significant impairment
  27. if benzodiazepines are giving with other CNS depressants, excess drowsiness should be monitored... especially in which 2 situations:
    • with elderly pts.
    • when given IV
  28. is respiratory depression a reason to stop the use of benzodiazepines during the tx of a status epilepticus (IV diazepam)?:

    the pt. is usually intubated
  29. describe the mechanism of action for hydantoins:
    they work by delaying Na+ (sodium) movement across the cell membrane
  30. what is the most commonly prescribed hydantoin:

    what type of seizures is this useful for:
    most commonly prescribed: phenytoin (dilantin)

    • useful for: all types of seziures except absence seizures
  31. what advantage do the hydantoins have over benodiazepines and barbiturates for seizure disorders:
    hydantoins do not cause drowsiness or have any potential for abuse
  32. pts. on phenytoin, should have blood serum levels frequently checked as the therapeutic range is narrow and there is great variance in its metabolism.

    in regards to pt. care, if serum levels are out of range...:
    anticipate a dose change
  33. list (7) side effects of phenytoin:
    • arrythmias: bradycardia, a fib
    • hypotension: decreased BP
    • hyperglycemia: increased blood sugar
    • ataxia
    • confusion
    • slurred speech
    • paradoxical nervousness with twitching and insomnia
  34. list the 2 blood dyscrasias ("bad mixtures") that can occur with the use of phenytonin:
    • agranulocytosis
    • aplastic anemia
  35. list 4 severe skin rxns that can occur as an advese effect of phenytonin:
    • exfoliative dermatitis
    • steven-johnson syndrome

    lupus erythematosus (connective tissue rxn)

    gingival hypertrophy
  36. list 3 contraindications for phenytonin (a hydantoin):
    • seizures due to hypoglycemia
    • pre-existing bradycardia
    • heart block
  37. what is the mechanism of action for succinimiedes:

    what type of seizure are succimimides only used for:
    • block Ca++ chaneels thus making nerve depolarization less likely
    • only used for: absence seizures
  38. what is the most commonly prescribed succimimide:
    ethosuximide (zarontin)
  39. the pt. care for the use of ethosuximide (a succimimide) should include mood changes including:

    and also increased bleeding or fatigue, resulting from: 
    euphoria, depression, suicidal thoughts/plans/ideations

    bone marrow suppression
  40. list 2 contrainidcations of ethosuximide (a succimimide):
    • severe liver or kidney disease
    • age < (less than) 3
  41. describe how long term use of barbiturates effects the following:

    chronic use:
    blood clotting:
    bone tissue:
    • chronic use:
    • stimulates liver microsomal enzymes, which increases the breakdown of many drugs and itself
    • tolerance, and cross tolerance to other CNS depressants can develop 

    blood clotting: decreases vitamin K, so bleeding is more likely

    bone tissue: decreases vitamin D, so osteoporosis may develop or worsen