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4. Pharm III > 1- Anticonvulsants > Flashcards

1- Anticonvulsants Flashcards

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1
Q

Seizure is defined as abn discharges of electrical activity in cerebral neurons (originate in cerebral cortex). Focal, brief, no LOC is defined as what type of seizure?

A

Partial/ simple

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2
Q

How do you define a seizure that is < 2 min, ALOC/LOC, hallucinations?

A

Partial/ complex

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3
Q

Both a partial with secondary general seizure and a generalized/ tonic-clonic (grand mal) seizure have what characteristic?

A

LOC

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4
Q

How do you define a generalized/ absence (petit mal) seizure?

A

Loss of awareness

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5
Q

How do you define a seizure with brief spasm or rigidity, often secondary to other seizure disorders?

A

Generalized/ myoclonic

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6
Q

How do you define a seizure with sudden loss of all postural tone (no TX)?

A

Generalized/ atonic

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7
Q

What are the 2 main causes of seizures?

A
  1. Blockade of GABA receptors- (meds increase GABA)
  2. Activation of glutamate receptors (NMDA)- (meds decrease excitatory glutamate activity)
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8
Q

How do anticonvulsant meds increase GABA activity? (4)

A
  • Block GABA reuptake
  • Inhibit GABA metabolism
  • Stimulate GABAA receptors
  • Binds synaptic vesicular protein, SV2A
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9
Q

How do anticonvulsant meds decrease excitatory glutamate activity? (3)

A
  • Inhibition of voltage-gated Na+ channels (targets rapidly firing neurons)
  • Inhibition of thalamic Ca2+ channels
  • SV2A, K+ channels, NMDA, AMPA receptors
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10
Q

T-type Ca2+ channels are overactive in what type of seizures?

A

Absence seizures

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11
Q

What is the goal of anticonvulsant treatment?

A

Stop seizures without SEs, monitor plasma drug levels, use single dose

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12
Q

What are common SEs of anticonvulsant drugs?

A

GI, CNS disturbances, teratogenic, hypersensitivity (SJS)

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13
Q

Most anticonvulsant drugs are metabolized by what?

A

CYP450s

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14
Q

What is true regarding drug interacions and therapeutic indices of anticonvulsant drugs?

A

Many drug interactions and narrow therapeutic indices

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15
Q

Anticonvulsant drugs are teratogenic and cause what increase in the birth defect rate?

A

2x normal

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16
Q

Withdrawal of anticonvulsant drugs can cause what?

A

Rebound increase in seizure activity

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17
Q

What are the signs of overdose of anticonvulsants?

A

CNS depressant (but rarely lethal), respiratory depression (most common), increased occurrence of suicidal behavior/ thoughts

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18
Q

Overdose of anticonvulsants should not be treated with what?

A

CNS stimulants

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19
Q

SJS is an autoimmune/ hypersensitivity reaction that leads to toxic epidermal necrolysis (life threatening). It is caused by drugs that block what?

A

Na channels

(ex. Phenytoin, Lamotrigine, Carbamazepine, Valproate)

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20
Q

When there is concern for SJS, patients should be screened for what?

A

HLA-B1502

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21
Q

How do anticonvulsant medications affect contraceptives?

A

Increased failure rate (4x)

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22
Q

What are the options for a patient needing/ or on anticonvulsant medications who is pregnant?

A

Gradual withdrawal, monotherapy, lower doses, folate supplementation, vit K supplementation

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23
Q

What are the routes of administration for Phenytoin and Fosphenytoin?

A

Phenytoin = not injected

Fosphenytoin = injectable

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24
Q

What is the MOA of Phenytoin and Fosphenytoin?

A

Prolongs inactivation of Na+ channels = ↓ glutamate activity

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25
What are the uses for Phenytoin and Fosphenytoin?
Partial seizures, generalized tonic-clonic seizures, NOT absence seizures
26
How are Phenytoin and Fosphenytoin eliminated at low doses?
1st order elimination
27
How are Phenytoin and Fosphenytoin eliminated at therapeutic/ higher doses?
Zero order elimination
28
What are the SEs of Phenytoin and Fosphenytoin? (not long term)
Drug interactions (CYP450s), visual disorders, **gingival hyperplasia, teratogenic, SJS**
29
What are the long term SEs/ complications of Phenytoin and Fosphenytoin?
Coarsening of facial hair, mild peripheral neuropathy, abn vit D metabolism
30
What is the MOA of Carbamezepine?
Blocks Na channels, ↓ glutamate activity
31
What is the use of Carbamezepine?
**DOC partial seizures**, bipolar disorder, trigeminal neuralgia
32
Carbamezepine induces what? (drug interactions)
CYP450s (3A4)
33
What increases that metabolism of Carbamezepine?
Phenobarbital, phenytoin
34
What inhibits the metabolism of Carbamezepine?
Valproic acid, cimetidine, fluoxetine
35
Carbamezepine leads to increased metabolism of what?
Multiple anticonvulsants, haloperidol, oral contraceptives
36
What are the SEs of Carbamezepine?
**SJS**, diplopia, ataxia, GI sxs, drowsiness, aplastic anemia, agranulocytosis
37
What are the contraindications of Carbamezepine?
Pregnancy, + HLA-B\*1502 gene
38
What is the MOA of Lamotrigine?
Inactivates Na+ channels, ↓ glutamate activity
39
What is the use of Lamotrigine?
Partial seizures, bipolar disorder
40
What are the important pharmacokinetics of Lamotrigine?
CYP450 inducers, t1/2 doubled by valproic acid
41
What are the SEs of Lamotrigine?
CNS, GI, SJS, pregnancy category C
42
What is the MOA of Topiramate?
Blocks Na channels, ↓ glutamate activity
43
What is the use of Topiramate?
Partial and generalized tonic clonic seizures, migraine prevention
44
Topiramate leads to increased metabolism rate of what?
Contraceptives
45
What are the SEs of Topiramate?
**Acute myopia/ glaucoma**, dizzieness, sedation, nervousness, confusion
46
What is the MOA of Levetiracetam?
Binds SVA2
47
What is the use of Levetiracetam?
Partial, myoclonic, tonic-clonic seizures
48
What are the pharmacokinetics of Levetiracetam?
Rapid oral absorption, peaks at 1-2 hours
49
In what population is the t1/2 of Levetiracetam longer?
Elderly
50
What are the SEs of Levetiracetam?
Dizziness, somnolence, ataxia, asthenia
51
What is the MOA of Gabapentin?
GABA analog
52
What is the use of Gabapentin?
Adjuct for partial and generalized tonic-clonic seizures, **neuropathic pain**, bipolar disorder
53
How is Gabapentin eliminated/ excreted?
1st order elimination, excreted unchanged by kidney
54
What are the SEs of Gabapentin?
Sleepiness, dizziness, ataxia, fatigue, tremor, HA, pregnancy category C
55
What are the drug interactions of Gabapentin?
Negligible
56
What is the MOA of Pregabalin?
GABA analog, binds to voltage-gated Ca channels → inhibits excitatory NT release
57
What is the use of Pregabalin?
Generalized anxiety disorder, pain (neuropathic, fibro, post op)
58
What are the SEs of Pregabalin?
Teratogenic, peripheral edema, dizziness, fatigue, weight gain, xerostomia, ataxia, blurred vision, GI
59
What are the pharmacokinetics of Pregabalin?
Few adverse drug interactions, t1/2 ~ 6 hrs
60
What is the MOA of Tiagabine?
Inhibits reuptake of GABA (GAT-1) → enhances GABA activity
61
What is the use of Tiagabine?
Adjunct tx for partial seizures
62
What are the pharmacokinetics of Tiagabine?
Short t1/2 shortened by CYP450 inducers (few drug interactions)
63
What are the SEs of Tiagabine?
Nervousness, difficulty concentrating, depression, dizziness, tremor, rash, pregnancy category C
64
What is the MOA of Vigabatrin?
Irreversibly inhibits GABA transaminase (GABA-T) → decreases GABA metabolism and enhances activity
65
What is the use of Vigabatrin?
Refractory complex partial seizures, infantile spasm (West syndrome)
66
What are the pharmacokinetics of Vigabatrin?
Drug effects are longer than t1/2 (6-8hrs) and don't correlate
67
What are the SEs of Vigabatrin?
Visual field problems/ retinal damage, agitation, confusion
68
What is the MOA of Ethosuximide?
Inhibits low-threshold T-type Ca2+ channels
69
What is the use of Ethosuximide?
DOC for absence seizures
70
What are the pharmacokinetics of Ethosuximide?
Metabolized by liver, metabolism inhibited by valproic acid
71
What are the SEs of Ethosuximide?
Hiccups, GI, lethargy/ fatigue, HA, dizziness
72
What is the MOA for Valproic Acid?
Blocks Ca and Na channels
73
What is the use of Valproic Acid?
Monotherapy, absence and general tonic-clonic seizures, bipolar disorder, migraine prophylaxis
74
What are the pharmacokinetics of Valproic Acid?
Absorptions prolonged by food, inhibits own metabolism at low doses
75
Valproic Acid inhibits metabolism of what?
Phenytoin, phenobarbital, carbamazepine
76
What are the SEs of Valproic Acid?
Hepatotoxic (liver function monitoring required), GI, heartburn, weight gain, sedation, tremor, alopecia, ↑ risk spina bifida
77
What is the contraindication of Valproic Acid?
Pregnancy

4. Pharm III (16 decks)

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