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Chapter 22 Anticonvulsants
Terms in this set (78)
What are seizures?
Brief, abnormal neuronal discharges in the brain that occur repeatedly and without warning.
Anticonvulsants are used to reduce____________?
The number and/or severity of seizures in patients with epilepsy.
What is epilepsy?
The recurrence of unprovoked seizures, is characterized by sudden attacks of altered consciousness, motor activity, or sensory impairment.
Treatment of seizures is based on?
Type, severity, and causes
Less than one half of epileptic seizures have an?
Seizures may sometimes be associated with?
Cerebrovascular disease, cerebral trauma, intracranial infection or fever, brain tumor, intoxication, or chemical imbalance.
What are the categories of seizure disorders?
Generalized, partial, and atypical or unclassified
Generalized seizures are further classified as?
Convulsive or nonconvulsive.
Convulsive seizures are classified as?
Tonic, clonic, and tonic-clonic.
Nonconvulsive seizures are classified as?
Absence, myoclonic, and atonic.
Generalized seizures are?
Bilaterally symmetrical and without local onset.
Partial seizures are also known as?
Temporal lobe or psychomotor seizures.
The onset of partial seizures are limited to one?
Cerebral hemisphere and involve no loss of consciousness(simple) or loss of consciousness(complex symptomatology).
There is insufficient data to classify?
Atypical or unclassified seizures.
Treatment failure of seizures can be the result of?
Inappropriate selection of an anti-convulsant for the specific type of seizure.
Carbamazepine is used to treat many types of seizures; however it is well known to aggravate?
Myoclonic and absence seizures.
Generalized seizures occur in about _________________?
40% of patients with epilepsy.
Tonic pertains to?
Tension or contraction, particularly muscle contraction.
Tonic-clonic seizures are characterized by?
An abrupt loss of consciousness, falling, with tonic extension of trunk and extremities (tonic phase), followed by synchronous, contractions of the muscles (clonic phase).
Tonic clonic seizures usually last?
Two to five minutes and urinary and fecal incontinence may occur.
During the recovery from tonic-clonic seizures patients are?
Confused and sleepy and may complain of a headache.
Initial treatment of generalized seizures consists of?
Preventing injury by removing any objects that could cause trauma, cushioning the head and turning it to the side, loosening tight clothing, and do not try and open the mouth or force anything between the teeth.
What is status epilepticus?
It is when seizures are so frequent that the patient does not regain consciousness (by more than 30 minutes) between seizures and is considered to be a true neurologic emergency.
The treatment of choice for status epilepticus is________________?
IV lorazepam (Ativan) administered slowly and simultaneous loading with IV phenytoin or fosphenytoin is also recommended.
What is absence epilepsy?
Formerly called petit mal, and is so called because of the absence of convulsions.
Absence epilepsy is characterized by?
10-20 second loss of consciousness with no falling and usually occurs initially in children.
What are febrile seizures?
The most common of childhood seizure disorders occurring in 3% of children ages 6 months to 6 years.
Febrile seizures may signify a serious?
Underlying acute infection such as sepsis or bacterial meningitis.
Partial seizures account for up to?
60% of the new cases of epilepsy.
Partial seizures are caused by?
A lesion in the temporal lobe of the brain and is limited to one hemisphere.
Most partial seizures last?
From 10 seconds to 5 minutes.
Complex symptoms of partial seizures include?
Confusion, impaired understanding and judgment, staggering, purposeless movemenst, bizarre behavior, and unintelligible sounds, but no convulsions.
Prophylactic treatment of generalized and partial seizures when indicated should be started with a single drug such as?
valproate, lamotrigine, levetiracetam, carbamazepine, oxcarbamazepine, or phenytoin.
The dosage of medication for prophylactic treatment of generalized and partial seizures should also be?
Titrated to achieve seizure control or until the maximally tolerated dose is reached.
The aim of therapy of generalized and partial seizures is to?
Prevent seizures without oversedation, and the dosage is adjusted according to individual patient response and serum drug levels when available.
Side effects of phenytoin (Dilantin) include?
Sedation, ataxia, dizziness, headache, blurred vision, nystagmus, diplopia, gingivitis, GI distress, and a rash.
Containdication or extreme caution with phenytoin applies to?
Kidney or liver disease, diabetes, heart failure, pregnancy and lactation.
The FDA has alerted healthcare professionals to the fact that all patients beginning treatment with anticonvulsants or currently receiving such treatment should be?
Closely monitored for emerging or worsening suicidal thoughts/behavior or depression.
Routine treatment of febrile seizures involves?
Searching for the cause of the fever and taking measures to control the fever like with antipyretics.
If a febrile seizure lasts longer than 5 minutes then the child may be treated with?
Rectal diazepam gel.
A decision to use prophylactic antiepileptic drugs (AED) for children with complex febrile seizures should be made?
On an individual basis taking into account underlying risk factors for recurrence.
The drug of choice for the management of absence epilepsy is often?
ethosuximide (Zarontin), which is effective only for this type of epilepsy and lacks the idiosyncratic hepatotoxicity of valproic acid.
Second generation anticonvulsants include?
gabapentin(Neurontin), lamotrigine(lamictal), levetiracetam(Keppra), and topiramate(Topamax).
Second generation anticonvulsants are used for?
Adjuvant treatment of partial (psychomotor) and generalized seizures
Second generation anticonvulsants are not considered superior in efficacy to the first-generation drugs in terms of seizure control, but these agents usually do not?
Require drug level monitoring, have fewer adverse effects, fewer drug interactions, and may improve adherence with once or twice daily dosing.
Patients taking anticonvulsant medication should be instructed regarding?
Caution with driving or operating machinery; Reporting of any side effects such as rash, staggering, or slurred speech; Careful oral hygiene due to tender gums; Always taking medication on time and never omitting doses; Wearing Medic-Alert tag or bracelet; Taking medication with food or milk to lessen stomach upset; Do not significantly alter ingestion of grapefruit juice while on carbamazepine(Tegretol) because of potentiation of effect; Parents and teachers should be cautioned to observe and report changes in cognitive function, mood, and behavior in children receiving anticonvulsants.
What is Parkinson's disease?
A chronic neurological disorder characterized by fine, slowly spreading muscle tremors, rigidity and weakness of muscles, and shuffling gait.
As parkinson's disease advances, patients develop?
Dementia, confusion, psychosis, sleep disturbances, and declining cognitive function.
The treatment goal for Parkinson's is to?
Relieve symptoms and maintain mobility
What serves as the foundation of treatment for Parkinson's disease?
Normal dopamine activity as it relates to acetylcholine is diminished, and relative overactivity of cholinergic output results.
Levodopa crosses the?
Blood-brain barrier where it is converted to dopamine.
What does carbidopa do?
Augments the penetration of levodopa into the brain, increasing the therapeutic effect of dopamine in the CNS and reducing its adverse reactions.
Sinemet is a?
Combination of levodopa and carbidopa and is most often used for long-term treatment of Parkinson's disease and is recommended as initial drug treatment for those over 70 years of age and those with dementia.
Dopamine agonists are used in_____________?
Conjunction with levodopa to delay the onset of levodopa caused motor complications.
Parlodel, Mirapex, and Requip, which are dopamine agonists are recommended for?
Initial monotherapy in patients less than 70 years old.
MAO type B inhibitors like Eldepryl and Azilect are sometimes prescribed as monotherapy for early PD or after?
Levodopa has been used for several years and begins to "wear-off" or become less effective.
An orally disintegrating tablet (ODT) formulation of ?
selegilene(Zelapar) is available as an adjunct to levodopa.
Selegilene ODT is absorbed through ?
The buccal membrane, avoiding first-pass hepatic metabolism, which results in a faster onset of action, lower dose, and fewer amphetamine metabolites.
Currently, what is the only MAO type B inhibitor approved as initial monotherapy for PD?
Which drugs were first used for tremors associated with PD and are still useful in early stages of the disease in younger patients and for drug-induced parkinsonism?
Drugs wih anticholinergic and antihistaminic actions.
Anticholinergic agents restore?
The cholinergic-dopaminergic balance in PD.
Synthetic atropine-like drugs such as Cogentin and trihexyphenidyl.
What antiviral agent is used to treat parkinsonism (extrapyramidial reactions) associated with prolonged use of phenothiazines, carbon monoxide poisoning, or cerebral arteriosclerosis in the older adult?
Which drugs block the enzyme responsible for metabolizing levodopa?
Catechol-O-methyl-transferase (COMT) inhibitors such as Comtan and Tasmar.
Patients taking antiparkinsonian drugs should be instructed regarding?
Administration on a regular basis, take with food to lessen GI distress, give carbidopa/levodopa witha low-protein meal if food is necessary to offset nausea; Avoiding abrupt withdrawl of medication: Several weeks sometimes required before benefit is apparent; Caution with CNS drugs, alcohol, or antihypertensives; Caution with driving or operation of machinery; Report side effects; Reporting any signs that drug is no longer effective after proonged use, Maintaining physical activity, self-care, and social interaction; Rising slowly
What is Restless Leg Syndrome (RLS)?
A sensorimotor neurologic disorder characterized by a distressing urge to move the legs, often accompanied by a marked sense of discomfort in th elegs.
RLS is triggered by?
Rest or inactivity and is temporarily relieved by movement.
Primary RLS involves the ?
CNS and the dopaminergic pathway.
Which drugs are FDA approved to treat RLS as well as PD?
Mirapex and Requip
Doses of the PD drugs used to treat RLS are cut down to?
10-20% of those used to treat PD and are usually given 1-3 hours before bedtime as a single daily dose.
Secondary causes of RLS may include?
Iron deficiency, renal failure, diabetes, rheumatoid arthritis, fibromyalgia, hypothyroidism, and pregnacy.
What is Alzheimer's disease or dementia of the Alzheimer's type?
It is characterized by a devastating progressive decine in cognitive function, having a gradual onset, usually beginning between 60 an 90 years of age, followed by increasingly severe impairment in social and occupational functioning.
What are the first agents shown to be efficacious for symptom delay in Alzheimer's disease?
What do cholinesterase inhibitors do?
They prevent the breakdown of acetylcholine in the synaptic left, Thereby improving cognitive function, but do not cure the disease.
What was the first cholinesterase inhibitor approved?
Cognex(tacrine) but is associated with hepatotoxicity and is rarely used today.
What cholinesterase inhibitors are not associated with hepatotoxicity?
Aricept, Razadyne, and Exelon
What is the first N-methyl-D-aspartate (NMDA) antagonist approved for the treatment of moderate to severe dementia of the Alzeimer's type?
Memantine is thought to selectively block?
The excitotoxic effects with abnormal transmission of the neurotransmitter glutamate while allowing for the physiological transmission associated with normal cell functioning.
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