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Boards Pharm 02: Neuro > 3. Epilepsy > Flashcards

3. Epilepsy Flashcards

(44 cards)

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1
Q

Phenytoin - MOA

A
  • Use dependent block of Na channels
  • Increase refractory period
  • Inhibition of glutamate release from excitatory presynaptic neurons.
  • Decrease seizure activity
  • Use Fosphenytoin for parenteral use
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2
Q

Phenytoin - Clinical Use

A
  • Simple partial seizures
  • Complex partial seizures
  • 1st line for tonic-clonic seizures
  • 1st line prophylaxis for status epilepticus
  • Also a Class IB antiarrhythmic
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3
Q

Phenytoin - Toxicities

A
  • Nystagmus, ataxia, diplopia, sedation, SLE-like syndrome
  • Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (decreased folate absorption)
  • Induces P-450
  • Teratogenic (Fetal hydantoin syndrome)
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4
Q

Carbemazepine - MOA

A
  • Increase Na channel inactivation
  • Increase refractory period
  • Decrease seizure activity
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5
Q

Carbemazepine - Clinical Use

A
  • 1st line for simple partial seizures
  • 1st line for complez partial seizures
  • 1st line for tonic-clonic seizures
  • 1st line for trigeminal arthralgia
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6
Q

Carbemazepine - Toxicities

A
  • Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, tertogenesis,
  • Induction of cytochrome p450,
  • SIADH,
  • Stevens-Johnson
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7
Q

Lamotrigine - MOA

A
  • Blocks voltage gated Na channels
  • Decrease seizure activity
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8
Q

Lamotrigine - Clinical Use

A
  • Simple partial seizures
  • Complex partial seizures
  • Tonic-clonic seizures
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9
Q

Lamotrigine - Toxicities

A
  • Stevens-Johnson syndrome
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10
Q

Gabapentin - MOA

A
  • Designed as GABA analog but primarily inhibits HVA Ca channels
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11
Q

Gabapentin - Clinical Use

A
  • Simple partial seizures
  • Complex partial seizures
  • Tonic-clonic seizures
  • Peripheral neuropathy
  • Bipolar disorder
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12
Q

Gabapentin - Toxicities

A
  • Sedation, ataxia
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13
Q

Topiramate - MOA

A
  • Block Na channels, increase GABA action
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14
Q

Topiramate - Clinical Use

A
  • Simple partial seizures
  • Complex partial seizures
  • Tonic-clonic seizures
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15
Q

Topiramate - Toxicities

A
  • Sedation, mental dulling, kidney stones, weight loss
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16
Q

Barbiturates - Available Drugs

A
  • Phenobarbital
  • Pentobarbital
  • Thiopental
  • Secobarbital
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17
Q

Barbiturates - MOA

A
  • Facilitate GABAa action by increasing duration of Cl channel opening and thereby decreasing neuron firing (Benzos, Barbiturates, and EtOH all bind GABAa receptor which is a ligand gated Cl channel)

“BarbiDURATe = increase Cl channel DURATion”

[Phenobarbital, Pentobarbital, Thiopental, Secobarbital]

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18
Q

Barbiturates - Clinical Use

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A

1st line in children for seizures

  • Simple partial seizures (Phenobarbital)
  • Complex partial seizures (Phenobarbital)
  • Tonic-clonic seizures (Phenobarbital)
  • Sedative for anxiety
  • Insomnia
  • Induction of anesthesia (Thiopental)

[Phenobarbital, Pentobarbital, Thiopental, Secobarbital]

19
Q

Barbiturates - Toxicities

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A
  • Dependence
  • Additive CNS depression with alcohol (Benzos, Barbiturates, and EtOH all bind GABAa receptor which is a ligand gated Cl channel)
  • Respiratory or Cardiac depression - can be fatal
  • p450 induction
  • CI in porphyria
  • Overdose treated symptomatically
  • —- Assist respiration, Increase BP[Phenobarbital, Pentobarbital, Thiopental, Secobarbital]
20
Q

Valproic Acid - MOA

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A
  • Increase Na channel inactivation
  • Increase GABA concentration
21
Q

Valproic Acid - Clinical Use

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A
  • Simple partial seizures
  • Complex partial seizures
  • 1st line for Tonic-clonic seizures
  • Absence seizures
  • Myoclonic seizures
22
Q

Valproic Acid - Toxicities

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A
  • GI distress
  • Rare but fatal hepatotoxicity - measure LFT’s
  • Tremor, weight gain
  • CI IN PREGNANCY - TERATOGENIC - neural tube defects (spina bifida)
23
Q

Ethosuximide - MOA

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A
  • Block thalamic T-type Ca channels
24
Q

Ethosuximide - Clinical Use

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A
  • 1st line in absence seizures
25
Ethosuximide - Toxicities
- GI distress, fatigue, headache, urticaria - Stevens-Johnson "EFGH - Ethosuximide, Fatigue, GI distress, Headache"
26
Benzodiazepines - Available Drugs
- Diazepam - Lorazepam - Triazolam - Temazepam - Oxazepam - Midazolam - Chlordiazepoxide - Alprazolam
27
Benzodiazepines - MOA
- Facilitate GABAa action by increasing FREQUENCY of Cl channel opening (Benzos, Barbiturates, and EtOH all bind GABAa receptor which is a ligand gated Cl channel) - Decrease REM sleep - Most have long half lives and active metabolites "FREnzodiazepines = Increase Cl channel FREquency" "SHORT acting - TOM thumb = Triazolam, Oxazepam, Midazolam" (highest addiction potential) [Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chordiazepoxide, Alprazolam]
28
Benzodiazepines - Clinical Use
- 1st line for acute status epilepticus (Lorazepam, Diazepam) - Seizures of eclampsia (Lorazepam, Diazepam) - Anxiety - Spasticity - Detoxification especially EtOH withdrawal DT's - Night terrors - Sleepwalking - General anesthetic (Amnesia, muscle relaxation) - Hypnotic (insomnia) [Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chordiazepoxide, Alprazolam]
29
Benzodiazepines - Toxicities
- Dependence - Additive CNS depression with EtOH (Benzos, Barbiturates, and EtOH all bind GABAa receptor which is a ligand gated Cl channel) - Less risk of respiratory depression and coma than with barbiturates - Treat overdose with Flumazenil (competitive antagonist at GABA benzodiazepine receptor) [Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chordiazepoxide, Alprazolam]
30
Tiagabine - MOA
- Inhibit GABA reuptake
31
Tiagabine - Clinical Use
- Simple partial seizures - Complex partial seizures
32
Vigabatrin - MOA
- Irreversibly inhibits GABA transaminase --\> increase GABA levels
33
Vigabatrin - Clinical Use
- Simple partial seizures - Complex partial seizures
34
Levetiracetam - MOA
- Unknown, may modulate GABA and glutamate release
35
Levetiracetam - Clinical Use
- Simple partial seizures - Complex partial seizures - Tonic-Clonic seizures
36
Treatment for Simple Partial Seizures
1st Line: - Carbamazepine Other: - Phenytoin - Lamotrigine - Gabapentin - Topiramate - Barbiturates (Phenobarbital) - 1st line in children - Valproic Acid - Tiagabine - Vigabatrin - Levetiracetam
37
Treatment for Complex Partial Seizures
1st Line: - Carbamazepine Other: - Phenytoin - Lamotrigine - Gabapentin - Topiramate - Barbiturates (Phenobarbital) - 1st line in children - Valproic Acid - Tiagabine - Vigabatrin - Levetiracetam
38
Treatment for Tonic-Clonic Generalized Seizures
1st Line: - Carbamazepine - Phenytoin - Valproic Acid Other: - Lamotrigine - Gabapentin - Topiramate - Barbiturates (Phenobarbital) - 1st Line in Children - Levetiracetam
39
Treatment for Absence Generalized Seizures
1st Line: - Ethosuximide Other: - Valproic Acid
40
Treatment for Status Epilepticus Generalized Seizures
1st line for prophylaxis: - Phenytoin 1st line for acute treatment: - Benzodiazepines (Diazepam, Lorazepam)
41
Treatment of Trigeminal Neuralgia
1st line: - Carbemazepine
42
Treatment for Peripheral Neuropathy
- Gabapentin
43
Treatment of Myoclonic Seizures
- Valproic Acid
44
Treatment of Seizures of Eclampsia
1st line: - MgSO4 Other: - Benzodiazepines (Diazepam, Lorazepam)

Boards Pharm 02: Neuro (5 decks)

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