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Insomnia, restless leg syndrome, narcolepsy, ADHD

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vitohuxo's version from 2016-06-21 03:36

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Question Answer
for insomnia nonbenzos are preferred over benzos due to decreased risk of phsyical dependence and daytime cognitive effects
what is restless leg syndrome?urge to move the lower legs...worse at night and relieved with movement
restless leg syndrome thought to be due to:dysfunction dopamine in brains ganglia circuit
narcolepsy isexcessive daytime sleepiness with sudden loss of muscle tone.
simple partial sezuireno loss of consciousness and starts one hemisphere brain
complex partial seizureloss consciousness and starts in one hemisphere brain
generalized seizuresbegin in both hemispheres and result in loss consciousness
status elipepticusseizures lasting longer than 5 mins or 2 or more seizures between which patient not regain concsiouness= medical emergency
what give first if status elepticuslorazepam...longer duration of action...diazepam has half life shorter
diazepam rectal gel make suredose dialed correctly and locked prior to dispensing
status ellepticus follow benzo treatment withphenytoin max rate 50mg/min or fosphenytoin max rate 150mg PE/min
most common side effects for seizure drugssomnolence, fatigue, congitive impairment
worst antipileptic for pregnancyvalproic acid-highest risk of fetal harm
pregnancy category D for epilepsy...otherwise the otehrs are Ccarbamazepine, clonazepam, phenobarb, primidone, phentyoin, fosphenytoin, topiramate, valproic acid
antiepileptics that are enzyme inducers arecarbamazepine, eslicarbazepine, oxcarbazepine, fosphenytoin, perampanel, phenytoin, phenobarb, primidone, topiramate. supllement these patients with vitD and calcium
all antiepileptics require medguides due torisk of suicidality
AED always titrate and never dc abruptly
therapeutic range carbamazepine4-12 mcg/ml
therapteutic range valporic acid/divalprox50-100 mcg/ml
therapeutic range phenytoin10-20 mcg/ml
thereputic range phenobarb 20-40 mcg/ml adults, 15-40 children
ADHD stimulants do whatraise NE and dopamine levels
innatention ADHDsix or more symptoms up to age 16 or five or more ages 17 to adult
hyyperactivity and impulsiviity ADHD6 or more symptoms up to age 16 or five or more age 17
in addition to inattention or hyperactivity in ADHD needsymptoms were present before age 12 and in 2 or more settings
first line drug therapy for ADHD isstimulants. when no work well enough (tried 2-3 agents) , strattera can be tried next or will be used first line by doc no want a stimulant.
guanfacine and clonidine are used most commonly asadjuncts to stimulants. help with sleep in evening as they are sedating. can also be used alone
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