King Klonopin

Ah, finally back to the swing of things. I apologize for making you all sit through my photos, but I needed to show SOMEONE how awesome Japan was. That is nowhere near the amount of photos we took either.

Anyway, back to business as usual. Things are going well with the internship. I have slipped to second place as of this week, but I have an ace or two up my sleeve. Part of me wonders if I was passed because of my advice, although the other interns probably have way better ideas anyway.

So, we are back with the 'Drug of the Week' feature. This week I decided to take a look at some of the resources that are found on www.rateadrug.com (the link there is for Klonopin itself). It has been nice being able to refer to that stuff when I need to. After looking on that list for about 2 secs I found a medication that I have seen used many times in my work at the hospital. That med is Klonopin. I have seen it used, but like so many of the other 'DotW' features I have no idea how it works.
You have certainly already guessed that this weeks feature shall be: Klonopin.

Old tricks are usuall the best, so here goes the organic molecule (actually I forgot this and had to come back, can you believe it? How many of these drugs posts have I done now, and I forgot? Silly).
Ah, that is better.
I thought this was kind of cool too, these are the pills themselves. Each tablet is 5mg, this is obviously the brand name version because the big K's and the fact that the pills say Roche, or the pharmaceutical company that makes Klonopin, on them.
Klonopin is part of a class of drugs known as benzodiazepines. Some of the drugs that belong to this class that I might also be featuring in the next little while are Ativan - another relaxant or anti-seizure medication - and one that most people are familiar with Valium.
(http://www.drugs.com/klonopin.html)

Clonazepam is a potent AED [Anti-Epileptic Drug] and the drug of choice for myoclonic seizures and subcortical myoclonus. It also is effective in generalized convulsions and, to a lesser extent, in partial epilepsies. It rarely is used as adjunctive treatment of refractory epilepsy because of its sedative effect and tolerance, which are similar to those of other benzodiazepines. It is very effective in the emergency treatment of status epilepticus, like diazepam, and can be given IV or rectally. Withdrawal from clonazepam may induce status epilepticus or exacerbation of seizures.
(http://emedicine.medscape.com/article/1187334-overview)

A seizure reflects an imbalance between excitatory and inhibitory activity in the brain, with an increment of excitation over inhibition. The most important inhibitory neurotransmitter in the brain is GABA....GABA has 2 types of receptors, GABA-A and GABA-B. When GABA-A receptor is stimulated, chloride channels open to allow the influx of negative ions (ie, chloride) into the neuron and cause hyperpolarization, moving the membrane potential further from the cell-firing threshold. The GABA-B receptor is linked to a potassium channel....The GABA-A receptors have multiple binding sites for benzodiazepines...
(http://emedicine.medscape.com/article/1187334-overview)

Essentially, Klonopin works, like all other benzodiazepines, by interacting with GABA-A and altering the sodium channel in the neuron, making in negatively charged so it moves farther away from the 'cell-firing threshold' and decreases the activity of the seizure.

This is a simplified mechanism of how the alteration of GABA-A and GABA-B affect seizure activity.

Klonopin is also known as Clonazepam, which I did not know. I have seen various movies and television programs where people are taking Clonazepam. Usually the characters are taking it to help them 'relax'. Sometimes in a clinical sense, and sometimes in a recreational sense.

It also seems that any form of barbituate will have a negative effect with Klonopin. On the www.rateadrug.com page that shows the comments made about Klonopin someone stated that they had problems with alcohol abuse and Klonopin really threw them for a loop. That makes sense, if Klonopin is a moderate to high-end relaxant or anti-anxiety drug then a barbituate like alcohol would really cause some problems.

The other list of counter-indications or medications that might cause problems with Klonopin is as follows (http://www.drugs.com/klonopin.html):

• propantheline (Pro-Banthine);

• an antifungal medication such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), or voriconazole (Vfend);

• an antidepressant such as amitriptyline (Elavil, Etrafon), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), and others;

• a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), pimozide (Orap), or thioridazine (Mellaril).

And, this is a list of common and not so common side-effects
(http://www.drugs.com/klonopin.html):

• confusion, hallucinations, unusual thoughts or behavior;

• hyperactivity, agitation, hostility;

• unusual or involuntary eye movements;

• weak or shallow breathing;

• depressed mood, thoughts of suicide or hurting yourself;

• chest tightness, fast or pounding heartbeats;

• painful or difficult urination, urinating more or less than usual;

• pale skin, easy bruising or bleeding; or

• new or worsening seizures.

Less serious Klonopin side effects may include:

• drowsiness, dizziness, spinning sensation;

• memory problems;

• tired feeling, muscle weakness, lack of balance or coordination;

• slurred speech;

• drooling or dry mouth, sore gums;

• runny or stuffy nose;

• loss of appetite, nausea, diarrhea, constipation;

• blurred vision;

• headache;

• nervousness, sleep problems (insomnia);

• skin rash; or

• weight changes.

Personally, I have seen Klonopin administered after a patient has had a prolonged seizure. It certainly seems to be effective. It is interesting the more I learn about various medications, the more I am interested in Pharmacology. I can't wait to move on with my education!
Thanks for staying tuned in, look forward to another discussion next week!