A/33. Antiepileptics used in absence seizures. “Broad spectrum” antiepileptic drugs. Drugs used for treatment of status epilepticus Flashcards
1
Q
Drugs need to know in this topic
A
ethosuximide
valproate
lamotrigine
clonazepam
levetiracetam
diazepam
2
Q
Ethosuximide
A
Inhibits T-type Ca2+ channels
Oral
∙no dependence
∙no enzyme induction
∙1st choice for absence seizures w/ minimal sedation
- GI distress (nausea, vomiting, abdominal pain)
- Headache, dizziness, lethargy
3
Q
Valproic acid
A
increase GABA turnover,
Na channel inhibition,
decrease NMDA receptor
Oral
Inhibitor of cytochrome P450 enzymes
- Seizures (broad-spectrum; including absence seizures)
- Bipolar disorders
- Migraine
Side effects:
- GI distress (nausea, vomiting, abdominal pain)
- Hepatotoxicity
- Thrombocytopenia – requires monitoring of PLT count
- Pancreatitis
- Alopecia
- Weight gain
- Teratogenicity → neural tube defects (spina bifida)
4
Q
Lamotrigine
A
- Glutamate antagonist
(AMPA receptor) - Inhibition of axonal Na+ channels
Oral
- Broad-spectrum
- Partial seizures
- Adjunct therapy for generalized tonic-clonic seizures
* *Side effects:** - Stevens-Johnson syndrome (exfoliative dermatitis)
- Hepatotoxicity
- Dizziness, headache, diplopia
5
Q
Clonazepam
A
- Anxiety, panic, and phobic disorders
- Bipolar disorders
- Seizures
6
Q
Diazepam
A
Oral, IV
acute absence seizures
7
Q
Levetiracetam
A
Interferes with synaptic release of glutamate
Oral
- Broad-spectrum
- Partial seizures
- Generalized tonic-clonic seizures
* *Side effects:** - Nervousness, dizziness
- Depression
8
Q
Management of status epilepticus
A
- Assess ‘ABC’ (airway, breathing, circulation)
- Assess metabolic state (glucose, electrolytes)
- Lorazepam/Midazolam (preferentially IV, give IM if venous access is not secured) – bolus administration
- Phenytoin/Levetiracetam (IV) – continuous infusion over 5-20 min’
