You are on page 1of 52


Epilepsy - Recurrence of
— Symptoms depend on type of seizure
— Include blackout, fainting spells, sensory
disturbances, jerking body movements,
temporary loss of memory
Seizures - Disturbances of
Electrical Activity in the Brain
— May affect consciousness, motor
activity, sensation
— Caused by abnormal or uncontrollable
neuronal discharges in the brain
— Electroencephalogram (EEG) measures
this activity
— All seizures are not convulsions
Convulsions - Involuntary,
Violent Spasms of Large
Skeletal Muscles
— Face, neck, arms, and legs
— All convulsions are seizures
Causes of Seizure Activity
— Acute Infectious Diseases
— Trauma
— Metabolic Disorders
— Vascular Disorders
— Respiratory hypoxia, in oxygenation
— Hypotension
— Pediatric Disorders - Rapid Increase in Body
Neoplastic Disease - Rapidly Growing Brain
— Medications
— Eclampsia During Pregnancy
— Low Tolerance to Environmental Triggers
— Sleep deprivation
— Exposure to strobe or flickering lights
— Small fluid and electrolyte imbalances
— Idiopathic - No Known Cause
Atonic Seizures
— Last for seconds
— Patient stumbles or falls for no reason
Tonic-Clonic Seizures - Most
Common Type in All Age
— Last 1 to 2 minutes
— Preceded by an aura - a warning
D Described as a spiritual feeling
D A flash of light
D Special noise
— Tonic phase - intense muscle contractions
D Hoarse cry - air forced from lungs
D Temporary loss of bladder and bowel control
D Breathing shallow or stops momentarily
Drugs that Reduce Seizure
Activity by Intensifying GABA
— Examples
D Barbiturates - phenobarbital (Luminal),
amobarbital (Amytal)
D Benzodiazepines - clonazepam (Klonopin),
clorazepate (Tranxene), diazepam
D Miscellaneous drugs - gabapentin
(Neurontin), tiagabine (Gabitril)
Succinimides Delay the Influx
of Calcium into the Neuron
— Examples - ethosuximide (Zarontin)
— Mechanism of action - block calcium channels
in neuron membrane which increases the
electrical threshold of neurons which
decreases abnormal firing of neurons
— Primary uses - absence seizures, myoclonic
seizures, akinetic epilepsy
— Adverse effects - hiccups, epigastric pain,
drowsiness, increased bleeding time
Coagulation-Modifier Drugs
— Anticoagulants
— Thrombolytics
— Hemostatics
Anticoagulants - Prevent the
Formation of Clots
— Inhibiting specific clotting factors in the
coagulation cascade
— Diminishing the clotting action of
— Both ways increase the time to form
— Dissolve life-threatening clots
— Promote formation of clots
— Inhibit removal of fibrin
Anticoagulants Prevent the
Formation and Enlargement of
— Examples - heparin (Heplock), warfarin
— Mechanism of action - inhibit specific clotting
factors which interfere with coagulation
cascade in order to prevent formation or
enlargement of clot
— Primary use - thromboembolic disease;
prevent formation of clots in veins
— Adverse effects - abnormal bleeding
Antiplatelet Agents Prolong
Bleeding Time by Interfering with
Platelet Aggregation
— Example - ticlopidine (Ticlid)
— Mechanism of actions
D Aspirin: inhibits thromboxane2, which prevents
aggregation of platelets
D ADP receptor blockers: interfere with platelet
plasma membrane, which prevents platelet
D Glycoprotein IIb/IIIa inhibitors: glycoprotein IIb/IIIa
enzyme inhibited which prevents platelet
Thrombolytics Are Used to
Dissolve Existing Clots
— Example - alteplase (Activase)
— Mechanism of action - convert plasminogen to plasmin
which causes fibrin to degrade, then preexisting clot
— Primary uses - acute MI, pulmonary embolism, acute
ischemic CVA, DVT, arterial thrombosis, coronary
thrombosis, clear thrombi in arteriovenous cannulas
and blocked IV catheters
— Adverse effects - abnormal bleeding; contraindicated
in patients with active bleeding or recent trauma
Hemostatics Are Used to
Promote the Formation of Clot
— Example - aminocaproic (Amicar)
— Mechanism of action - prevent fibrin from
dissolving, which enhances stability of
the clot
— Primary use - prevent and treat
excessive bleeding from surgical sites
— Adverse effects - none listed
Disorders Associated with
Heart Failure
— Mitral stenosis
— Myocardial infarction
— Chronic hypertension
— Coronary artery disease
— Diabetes
First-Choice Drugs - ACE
Inhibitors and Diuretics
— Given first
— Reduce most symptoms of mild to
moderate heart failure
— Fewer side effects
Second-Choice Drugs -
Phosphodiesterase inhibitors,
vasodilators, and beta-
adrenergic blockers
— Used in severe heart failure
— First-choice drugs not effective
Nonpharmacological Methods
for Controlling Heart Failure
— Stop using tobacco
— Limit salt (sodium) intake and eat foods rich in
potassium and magnesium
— Limit alcohol consumption
— Implement a medically supervised exercise
— Learn and use effective ways to deal with
— Reduce weight to an optimum level
— Limit caffeine consumption
Cardiac Glycosides Increase
the Force of Myocardial
— Example - digoxin (Lanoxin)
— Mechanism of action - 1) positive inotropic
effect: more blood ejected per beat leads to
increased cardiac output in order to meet, the
metabolic demands of tissues; 2) slow
electrical conduction through the heart, which
creates fewer beats per minute and decreases
heart rate
ACE Inhibitors Have Become
First-Line Drugs for Heart Failure
— Example - lisinopril (Prinivil)
— Mechanism of action - blocks ACE enzyme,
which lowers blood pressure, increases
cardiac output, decreases preload and
reduces peripheral edema; increased
excretion of sodium and water leads to
decreased blood volume
— primary use - heart failure and hypertension
— Important adverse effects - elevated
potassium levels, cough, taste disturbances,
Diuretics Relieve Symptoms
of Heart Failure by Reducing
Blood Volume
— Example - furosemide (Lasix)
— Mechanism of action - prevents reabsorption of
sodium by the nephron of the kidney, which increases
excretion of sodium and water; decreases blood
volume, edema, and congestion; lowers blood
pressure, and reduces workload on heart. Cardiac
output then increases
— Primary use - acute heart failure
— Important adverse effects - electrolyte imbalances
Phosphodiesterase Inhibitors Are
Used for Short-Term Therapy of
Advanced Heart Failure
— Example - milrinone (Primacor)
— Mechanism of action - blocks
phosphodiesterase enzyme, which increases
the amount of calcium available for myocardial
contraction, which then increases force of
contraction and vasodilation
— Primary use - short-term support of advanced
heart failure
— Important adverse effects - ventricular
Vasodilators Reduce Symptoms
of Heart Failure by Decreasing
Cardiac Oxygen Demands
— Example - Isosorbide (Isordil)
— Mechanism of action - relaxes vascular
smooth muscle, which leads to vasodilation,
which decreases cardiac workload and
increases cardiac output
— Primary use - cannot tolerate ACE inhibitors,
angina pectoris, hypertension
— Important adverse effects - headache,
hypotension, reflex tachycardia
Beta-Adrenergic Blockers Are
Used in Combination with Other
Drugs to Slow the Progression of
Heart Failure and to Prolong
Patient Survival
— Example - carvedilol (Coreg)
— Mechanism of action - blocks beta1, beta2, and
alpha1 receptors, which decreases heart rate
and blood pressure, decreases afterload, and
reduces the workload on the heart
Beta-Adrenergic Blockers Are
Used in Combination with Other
Drugs to Slow the Progression of
Heart Failure and to Prolong
Patient Survival (cont¶d)
— Primary use - slow progression of heart failure
and increased exercise tolerance when
combined with other heart failure drugs
— Important adverse effects - worsen heart
Hyperlipidemia - Excess
Amounts of Lipids in the Blood
— Major risk factor for cardiovascular
— Hypercholesterolemia
— Saturated fats
Three Basic Classes of Lipids
— Triglycerides
— Steroids
— Phospholipids
Three Most Common
Lipoproteins, Based on
Weight or Density:
— Low-density lipoproteins (LDL)
— High-density lipoproteins (HDL)
— Very low-density lipoproteins (VLDL)
Low-density Lipoproteins
— Highest amount of cholesterol
— Created in liver
— Build plasma membranes and produce
— Stored in tissues
— Contribute to plaque deposits and CHD
— Aka bad cholesterol
High-Density Lipoproteins
— Picks up cholesterol
— Returns it to the liver
— Becomes part of bile and excreted in
— Aka good cholesterol
Very Low-Density Lipoproteins
— Triglyceride carrier
— Converted to LDL in blood
— High levels are associated with
HMG CoA Reductase
Inhibitors (Statins)
— Drugs of first choice in reducing blood
lipid levels
— Reduce LDL, triglyceride, and VLDL
— Raise HDL levels (good cholesterol)
Drug Profile - HMG-CoA
Reductase Inhibitor (Statin)
— Atorvastatin (Lipitor)
— Actions
— Adverse effects and interactions
Newer Approaches to Treating
— Ezetimibe (Zetia)
— Fixed-dose combination therapy
— Blocks absorption of dietary cholesterol
— LDL and triglycerides are reduced
— Slight increase in HDL
— Well tolerated by patients
Two Categories of Drugs
Used to Treat
— Preventers - used prophylactically
D Antihistamines
D Glucocorticoids

D Mast cell stabilizers

— Relievers - used to provide immediate,

temporary relief of symptoms
D Nasal decongestants - oral and intranasal
Nonsteroidal Anti-
Inflammatory Drugs (NSAIDs)
— Primary treatment for mild to moderate
— Includes aspirin, ibuprofen, and COX-2
Aspirin Treats Inflammation by
Inhibiting Cyclooxygenase
— Aspirin
— Ibuprofen is an Alternative to Aspirin
— Additional Cyclooxygenase Inhibitors
D Celecoxib, refecoxib, and valdecoxib
D Newest and most controversial class of NSAID
Drug Profile - Nonsteroidal
Anti-Inflammatory Drug
— Naproxen (Naprosyn) and naprox
sodium (Aleve, Anaprox)
— Actions and uses
— Adverse effects and interactions
— Mechanism in action
Systemic Glucocorticoids
— Effective in treating severe inflammation
— Naturally released by adrenal cortex
— Suppress histamine and prostaglandins
— Can inhibit immune system to reduce
Serious Adverse Effects
— Can suppress adrenal gland function
— Can mask infections
— Creates potential for existing infections
to grow rapidly and undetected
— Contraindicated with active infections
H1 Receptor Blockers
— Block action of histamine at H1 receptor
— Used in OTC preparations for relief of:
D Allergy symptoms
D Motion sickness

D Insomnia

— Can cause sedation

Drug Profile - Nonsedating
— Fexofenadine (Allegra) - 2nd generation
H1 receptor antagonist; nonsedating
— Actions and uses
— Adverse effects and interactions
— Used to inhibit immune response
— Primarily used to avoid tissue rejection
following organ transplant
Transplanted Organs Have
Antigens that Trigger the
Immune Response
— Transplant rejection
— Humoral response - acute response
D Antibodies destroy transplanted tissue
D Acute response occurs in days

— Cell-mediated response slower

D Starts about 2 weeks following surgery
D Chronic rejection can occur months or
years after surgery
— Dampen immune response following
organ transplants
— May be used for severe cases of
inflammatory diseases
— Very toxic to bone marrow
D Risk of infections
D Lymphomas
Drug Profile -
— Cyclosporine (Neoral, Sandimmune)
— Actions and uses
— Adverse effects and interactions
— Mechanism in action