Pharm - Medications for Seizures, Guillain-Barre, and Myasthenia Gravis.

What is the prototype barbituate?

Phenobarbital

What are the two benzodiazepines we learned and need to know?

Diazepam (Valium) and Lorazepam (Ativan)

What is the prototype hydantoin?

Phenytoin (Dilantin)

What is the prototype AMPA Glutamate Receptor Antagonist?

Keppra/Levetiracetam

What do anti-seizure drugs do?

Control seizure activity - do NOT cure the underlying disorder.

What are some difficulties of antiseizure meds?

-Lack of seizure control during drug selection and titration

-Social stigma

-Adverse effects

-Drug interactions

-Switching to a generic dose will change reaction

Administration/absorption of phenobarbital

-Absorbed rapidly through the GI tract (1 hour)

-IV onset 5 minutes, lasts 6 hours

-Crosses placenta/breast milk

What are some adverse effects of phenobarbitol?

Bradycardia and hypotension (lowering/calming)

Respiratory - hypoventilation, respiratory depression, laryngospasm/bronchospasm

How are benzos given?

May be oral, IV, IM, etc. When IV, push slowly (1 mL/minute and over at least 3 minutes in children.)

What is phenytoin?

Antiepileptic drug that stabilizes the neuronal membrane. Controls tonic-clonic seizures, psychomotor seizures, etc.

What are the common side effects of phenytoin?

CNS depression

Gingival hyperplasia (overgrowth of gum tissue)

What is a potential long-term side effect of phenytoin?

Osteoporosis --> affects Vitamin D metabolism.

What should you assess when giving phenytoin?

IV site - IV form is highly irritating

Also vitals and CNS (duh)

What is levetiracetam/Keppra given for?

Anti-seizure med. Oral or IV.

What are some common side effects of Keppra?

Drowsiness, dizziness, fatigue.

ALSO:

double vision, amnesia, anxiety, ataxia, emotional lability, hostility, nervousness

What's the difference between lorazepam/diazepam and other anti-seizure meds?

Benzodiazepines work QUICKLY!! Think 1-5 minutes.

What two drugs are given for GB?

IGIV and Plasma exchange.

What meds are given for MG?

Mestinon, Regonol, Vyvgart, Atropine

IGIV

treatment consisting of donated blood containing healthy antibodies

plasma exchange

removal of blood's plasma from the client's body and separation from the rest of blood cells

What are some considerations for a patient with GB who is getting IGIV and/or plasma exchange?

-ECG monitoring

-watch for tachycardia and hypertension

What do cholinergic drugs do?

INCREASE secretions, sweat, saliva

SLOW heart rate, BP

CONSTRICT pupils

INCREASE GI and GU

(think everything opposite of an anticholinergic crisis)

What two drugs are different forms of pyridostigmine?

Mestinon and Regonol

What does pyridostigmine do?

Inhibits destruction of acetylcholine, stimulating skeletal muscle contraction and reversing severe muscle weakness.

What is very important when taking pyridostigmine?

TAKE ON TIME!!! Can result in cholinergic crisis?

When should pyridostigmine drugs be given?

30-45 minutes before meals

What is the antidote for cholinergic crisis?

Atropine

What are some indications of a cholinergic crisis?

Severe muscle weakness. Bradycardia. Blurred vision. Bronchoconstriction, bronchospasm, increased secretions.

Vyvgart (efgartigimod alfa-fcab)

Weird Lord of the Rings-sounding one. Given for patients who are anti-acetylcholine receptor antibody positive. Reduces the autoantibodies and alleviates muscle weakness.

What are some common side effects of VYVGART?

respiratory tract infections, headache, UTIs, fatigue, nausea

How is vyvgart given?

IV 1x a week for 4 weeks.