NSG 233 MED SURG 2 EXAM 2 QUESTIONS AND
ANSWERS ()
What differentiates a seizure, convulsion, and epilepsy? - ANSWER-Seizure - brief episode of
abnormal electrical activity in nerve cells of the brain
Convulsion - involuntary spasmodic contractions of any or all voluntary muscles throughout the body
Epilepsy - chronic, recurrent pattern of seizures
What is a generalized onset seizure? - ANSWER-Neuronal activity that originates simultaneously in the
gray matter of both hemispheres
Ex. tonic-clonic, absence
What is a focal onset seizure? - ANSWER-Neuronal activity that originates in a localized or focal region
of the brain
What is a status epilepticus seizure? - ANSWER-Multiple seizures that occur with no recovery (doesn't
end for 5+ minutes)
Why is antiepileptic therapy not recommended after a single seizure event? - ANSWER-only a 40%
chance that a seizure will happen again
What are the general pharmacologic effects of anti epileptics? - ANSWER--reduce nerve's ability to be
stimulated (block sodium/calcium channels)
-suppress transmission of impulses from one nerve to the next (increase GABA, decrease Glutamate)
-Decrease the speed of nerve impulse conduction within a neuron
Cerebyx versus Celebrex - ANSWER-Medication alert! Sound alike/look alike!
Cerebyx is an AED
Celebrex is an NSAID
As of 2008, the FDA put a black box warning on AEDs for which adverse effect? - ANSWER-Suicidal
thoughts and behaviors
Phenytoin (Dilantin) is an AED that has what pharmacologic effect? - ANSWER-Stabilizes nerve cells by
blocking sodium channels
As a nurse, it is important to understand a client's diet when they are taking Phenytoin. Why? -
ANSWER-Phenytoin is a highly protein bound drug. If a patient is malnourished, it can cause drug
toxicity in the blood
What is gingival hyperplasia and what drug causes it? - ANSWER-Overgrowth of gums related to
phenytoin (Dilantin)
What is the therapeutic level of Phenytoin (Dilantin)? - ANSWER-10-20 mcg/mL
Phenytoin (Dilantin) has a narrow therapeutic range. What does this mean? - ANSWER-Very small
window between therapeutic level and toxic level
,At what rate should you push Phenytoin (Dilantin)? - ANSWER-50 mg/min
Push SLOWLY into a large vein
If you push too fast, could cause cardiac depression and collapse
Hydantoins, like phenytoin (Dilantin) and Cerebyx, should never be mixed with: - ANSWER-D5W
Can mix with propylene glycol for drug stability
What is the pharmacologic effect of Cerebyx? - ANSWER-Converted to phenytoin in the body, which
then blocks sodium channels and stabilizes nerve cells
What is the pharmacologic effect of Carbamazepine (Tegretol)? - ANSWER-Sodium channel blocker,
stabilizes nerve cells
What is the therapeutic level of Carbamazepine? - ANSWER-4-12 mcg/mL
What should you avoid when taking Carbamazepine? - ANSWER-Grapefruit juice
Why should you always monitor the therapeutic level of Carbamazepine? - ANSWER-Autoinduction
Can cause auto induction of hepatic enzymes, which enhance its own metabolism, leading to lower
than expected drug levels in the body
What is the pharmacological effect of Valproic Acid (Depakene, Depakote, Depacon)? - ANSWER-
Blocks sodium channels
Increases GABA
What are the adverse effects of Valproic Acid? - ANSWER--Hepatotixicity
-Pancreatitis
What is the expected pharmacologic effect of Phenobarbital (anticonvulsant)? - ANSWER-Potentiates
the effects of GABA
What is the therapeutic level of Phenobarbital? - ANSWER-10-40 mcg/mL
Phenobarbital is an inducer of hepatic enzymes, meaning: - ANSWER-it causes the rapid clearance of
some drugs
What level of controlled substances are benzodiazepines? - ANSWER-Schedule IV
Which is the drug of choice for the treatment of status epilepticus? - ANSWER-Benzodiazepines,
specifically lorazepam (Ativan)
Which is the drug of choice for the treatment of absence seizures? - ANSWER-Ethosuximide (Zarontin)
Suppresses neurons in the thalamus that generate absence seizures
Which drugs cause Steven Johnson's Syndrome? - ANSWER-AEDs
Pregabalin (Lyrica) is a schedule V controlled substance used for: - ANSWER-Treatment of seizures as
a calcium channel blocker
Most commonly used for neuropathic brain
, What is the goal of drug selection for seizures? - ANSWER-Control seizures with minimal adverse
effects, enable patient to pursue normal daily activities
-Age
-Type of seizure
-Adverse effects
-Number of doses
IV Phenytoin should be given only with ______________ - ANSWER-Normal saline
When administering an AED medication, what client education can you give? - ANSWER--Take
regularly at the same time each day
-Take with meals to reduce GI upset
-If patient is NPO for procedure, contact prescriber regarding dosage
-Keep a journal to monitor response to AED, seizure occurrences, and adverse affects
-Wear medical alert tag
What is status epilepticus? - ANSWER-Continuous series of tonic-clonic seizures lasting 20-30 minutes
What are the top two most common degenerative diseases of neurons? - ANSWER-1. Alzheimers
2. Parkinsons Disease
What is Parkinson's disease? - ANSWER-Neurodegenerative disorder characterized by dyskensias and
akinesia
Caused by an imbalance of Dopamine and ACh
What Are The Dyskinesias Of Parkinsons Disease? - ANSWER--Tremors at rest
-Rigidity
-Postural instability
-Bradykinesia (slowed movement)
What is on-off phenomenon? - ANSWER-Rapid swings in response to levodopa
What is wearing-off phenomenon? - ANSWER-When medication (specifically dopamine) is wearing off
What are the two major categories of drug therapy for Parkinson's disease? - ANSWER-Dopaminergic
agents (direct/indirect) - most common, promote activation of dopamine receptors
Anticholinergic agents - prevent activation of ACh receptors
What are indirect acting dopaminergic agents? - ANSWER-MAO-B Inhibitors
Used in treatment for Parkinsons disease
Keeps dopamine from being broken down by MAOIs
MAOIs are used to treat depression and can have a "cheese effect" (elicit a hypertensive crisis). Why
does this not occur when treating Parkinsons? - ANSWER-Used in smaller doses - 10 mg or less -
doesn't have that effect
What is a dopamine modulator? - ANSWER-Antiviral (usually used for the flu) that can be used in the
treatment of Parkinsons
Causes releases of dopamine from storage sites
ANSWERS ()
What differentiates a seizure, convulsion, and epilepsy? - ANSWER-Seizure - brief episode of
abnormal electrical activity in nerve cells of the brain
Convulsion - involuntary spasmodic contractions of any or all voluntary muscles throughout the body
Epilepsy - chronic, recurrent pattern of seizures
What is a generalized onset seizure? - ANSWER-Neuronal activity that originates simultaneously in the
gray matter of both hemispheres
Ex. tonic-clonic, absence
What is a focal onset seizure? - ANSWER-Neuronal activity that originates in a localized or focal region
of the brain
What is a status epilepticus seizure? - ANSWER-Multiple seizures that occur with no recovery (doesn't
end for 5+ minutes)
Why is antiepileptic therapy not recommended after a single seizure event? - ANSWER-only a 40%
chance that a seizure will happen again
What are the general pharmacologic effects of anti epileptics? - ANSWER--reduce nerve's ability to be
stimulated (block sodium/calcium channels)
-suppress transmission of impulses from one nerve to the next (increase GABA, decrease Glutamate)
-Decrease the speed of nerve impulse conduction within a neuron
Cerebyx versus Celebrex - ANSWER-Medication alert! Sound alike/look alike!
Cerebyx is an AED
Celebrex is an NSAID
As of 2008, the FDA put a black box warning on AEDs for which adverse effect? - ANSWER-Suicidal
thoughts and behaviors
Phenytoin (Dilantin) is an AED that has what pharmacologic effect? - ANSWER-Stabilizes nerve cells by
blocking sodium channels
As a nurse, it is important to understand a client's diet when they are taking Phenytoin. Why? -
ANSWER-Phenytoin is a highly protein bound drug. If a patient is malnourished, it can cause drug
toxicity in the blood
What is gingival hyperplasia and what drug causes it? - ANSWER-Overgrowth of gums related to
phenytoin (Dilantin)
What is the therapeutic level of Phenytoin (Dilantin)? - ANSWER-10-20 mcg/mL
Phenytoin (Dilantin) has a narrow therapeutic range. What does this mean? - ANSWER-Very small
window between therapeutic level and toxic level
,At what rate should you push Phenytoin (Dilantin)? - ANSWER-50 mg/min
Push SLOWLY into a large vein
If you push too fast, could cause cardiac depression and collapse
Hydantoins, like phenytoin (Dilantin) and Cerebyx, should never be mixed with: - ANSWER-D5W
Can mix with propylene glycol for drug stability
What is the pharmacologic effect of Cerebyx? - ANSWER-Converted to phenytoin in the body, which
then blocks sodium channels and stabilizes nerve cells
What is the pharmacologic effect of Carbamazepine (Tegretol)? - ANSWER-Sodium channel blocker,
stabilizes nerve cells
What is the therapeutic level of Carbamazepine? - ANSWER-4-12 mcg/mL
What should you avoid when taking Carbamazepine? - ANSWER-Grapefruit juice
Why should you always monitor the therapeutic level of Carbamazepine? - ANSWER-Autoinduction
Can cause auto induction of hepatic enzymes, which enhance its own metabolism, leading to lower
than expected drug levels in the body
What is the pharmacological effect of Valproic Acid (Depakene, Depakote, Depacon)? - ANSWER-
Blocks sodium channels
Increases GABA
What are the adverse effects of Valproic Acid? - ANSWER--Hepatotixicity
-Pancreatitis
What is the expected pharmacologic effect of Phenobarbital (anticonvulsant)? - ANSWER-Potentiates
the effects of GABA
What is the therapeutic level of Phenobarbital? - ANSWER-10-40 mcg/mL
Phenobarbital is an inducer of hepatic enzymes, meaning: - ANSWER-it causes the rapid clearance of
some drugs
What level of controlled substances are benzodiazepines? - ANSWER-Schedule IV
Which is the drug of choice for the treatment of status epilepticus? - ANSWER-Benzodiazepines,
specifically lorazepam (Ativan)
Which is the drug of choice for the treatment of absence seizures? - ANSWER-Ethosuximide (Zarontin)
Suppresses neurons in the thalamus that generate absence seizures
Which drugs cause Steven Johnson's Syndrome? - ANSWER-AEDs
Pregabalin (Lyrica) is a schedule V controlled substance used for: - ANSWER-Treatment of seizures as
a calcium channel blocker
Most commonly used for neuropathic brain
, What is the goal of drug selection for seizures? - ANSWER-Control seizures with minimal adverse
effects, enable patient to pursue normal daily activities
-Age
-Type of seizure
-Adverse effects
-Number of doses
IV Phenytoin should be given only with ______________ - ANSWER-Normal saline
When administering an AED medication, what client education can you give? - ANSWER--Take
regularly at the same time each day
-Take with meals to reduce GI upset
-If patient is NPO for procedure, contact prescriber regarding dosage
-Keep a journal to monitor response to AED, seizure occurrences, and adverse affects
-Wear medical alert tag
What is status epilepticus? - ANSWER-Continuous series of tonic-clonic seizures lasting 20-30 minutes
What are the top two most common degenerative diseases of neurons? - ANSWER-1. Alzheimers
2. Parkinsons Disease
What is Parkinson's disease? - ANSWER-Neurodegenerative disorder characterized by dyskensias and
akinesia
Caused by an imbalance of Dopamine and ACh
What Are The Dyskinesias Of Parkinsons Disease? - ANSWER--Tremors at rest
-Rigidity
-Postural instability
-Bradykinesia (slowed movement)
What is on-off phenomenon? - ANSWER-Rapid swings in response to levodopa
What is wearing-off phenomenon? - ANSWER-When medication (specifically dopamine) is wearing off
What are the two major categories of drug therapy for Parkinson's disease? - ANSWER-Dopaminergic
agents (direct/indirect) - most common, promote activation of dopamine receptors
Anticholinergic agents - prevent activation of ACh receptors
What are indirect acting dopaminergic agents? - ANSWER-MAO-B Inhibitors
Used in treatment for Parkinsons disease
Keeps dopamine from being broken down by MAOIs
MAOIs are used to treat depression and can have a "cheese effect" (elicit a hypertensive crisis). Why
does this not occur when treating Parkinsons? - ANSWER-Used in smaller doses - 10 mg or less -
doesn't have that effect
What is a dopamine modulator? - ANSWER-Antiviral (usually used for the flu) that can be used in the
treatment of Parkinsons
Causes releases of dopamine from storage sites
