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Neuro II Exam 2 > Anticonvulsant Drugs - Kinder > Flashcards

Anticonvulsant Drugs - Kinder Flashcards

1
Q

epilepsy

A

2 unprovoked seizures - separated 24 hours

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2
Q

path of epilepsy

A

hyperexcitable and hypersynchronous neurons

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3
Q

partial seizures

A

focal - localized onset

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4
Q

simple partial seizure

A

patient retains awareness

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5
Q

complex partial seizure

A

patient lose consciousness

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6
Q

secondary generalized seizure

A

from partial - to both hemispheres

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7
Q

generalized seizure

A

both brain hemispheres

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8
Q

tonic clonic seizure

A

generalized - grand mal

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9
Q

absence seizure

A

generalized - blank stare

young children and adolescents

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10
Q

myoclonic jerking

A

brief shock-like movement - wide variety of seizurs

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11
Q

atonic seizures

A

loss of postural control - slumping

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12
Q

anti-epileptic drugs

A

suppress seizures

-do not cure or prevent epilepsy

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13
Q

tx of epilepsy

A

monotherapy preferred

increase dose gradually
monitor treatment regularly

compliance essential - warn patient not to stop taking med

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14
Q

AED MOAs

A

1 affect ion channel kinetic - delay Na channel recovery

2 augment inhibitor neurotransmission - GABA increase

3 modulate excitatory neurotransmission - decreased glutamate

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15
Q

AEDs protein bound

A

all - except

phenytoin
tigabine
valproic acid

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16
Q

adverse of AEDs

A

neurotoxic - sedation, dizzy, double vission

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17
Q

phenytoin MOA

A

bind and prolong inactivated state of Na channel

also decreased glutamate and increased GABA

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18
Q

phenytoin PK

A

don’t give IM - may precipitate

can give fosphenytoin (prodrug) IV or IM

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19
Q

phenytoin DDI

A

inhibits affects of warfarin

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20
Q

phenytoin ADR

A

diplopia, ataxia, nystagmus, sedation

gingival hyperplasia**
osteomalacia

hypotension, bradycardia, arrhythmia - so give slowly

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21
Q

gingival hyperplasia

A

ADR of phenytoin

22
Q

carbamazepine MOA

A

prolong inactivation state of Na channels

inhibit high frequency firing rate

23
Q

autoinduction

A

with carbamazepine

induces own metabolism

half life decreases over time - so levels fall

need to increase dose

24
Q

asian patient with HLA V1502 allele

A

10x higher steven johnson syndrome with carbamazepine

25
Q

gabapentin MOA

A

analog of GABA
-modify synaptic and non-synaptic release of GABA

bind alpha2delta subunit of voltage Na channels - decrease Ca entry - and decrease glutamate release

26
Q

gabapentin ADR

A

HA and tremor

27
Q

lamotrigine MOA

A

prolong inactivation state of Na channel

suppress rapid firing

28
Q

lamotrigine ADR

A

skin rash, HA, dizzy, ataxia

29
Q

lamotrigine DDI

A

concentration decrease with use of OCP

can also lead to contraceptive faliure

30
Q

levetiracetam MOA

A

bind synaptic vesicle protein SV2A

-modified release of glutamate and GABA

31
Q

levetiracetam ADR

A

serious mood and behavior change

32
Q

topiramate MOA

A

block voltage Na channels, increase Cl opening by binding GABA receptors, reduce Ca currents

33
Q

tipiramate ADR

A

paresthesia, weight loss

34
Q

migrain tx

A

topiramate

35
Q

ethosuximide MOA

A

reduce Ca threshold - T type current

-this current provide pacemaker current in thalamus for absence attacks

36
Q

lennes-gestaut syndrome

A

childhood onset epilepsy

-frequent seizures of different types

37
Q

ethosuximide ADR

A

gastric distress - so can’t do 1x/day

38
Q

valproic acid MOA

A

prolong Na channel inactiviation
block NMDA
increased GABA

39
Q

high level valproic acid

A

see tremor

40
Q

valproic acid ADR

A

hepatotoxicity

need to monitor liver function when initiating valproic acid

41
Q

diazepam MOA

A

bind GABA receptor - enhanced Cl influx

stimulate inhibitor membrane potentials

42
Q

lorazepam vs. diazepam

A

lorazepam - less lipophilic

-longer duration of action

43
Q

tx status epilepticus

A

diazepam and lorazepam

44
Q

DOC for partial seizures and secondary generalized

A

carbamazepine
lamotrigine
oxcarbazepine
levetiracetam

45
Q

DOC for primary generalized tonic-clonic seizures

A

valproate
lamotrigine
levetiracetam

46
Q

DOC for absence seizures

A

ethosuximide

valproate

47
Q

DOC for atypical absence, myoclonic, atonic seizures

A

valproate
lamotrigine
levetiracetam

48
Q

increased suicide

A

patients on AEDs

49
Q

mother taking AED

A

increased risk congenital malformations

50
Q

16yo F, convulsion, to ER, grand mal in ER

drug choice?

A

carbamazepine - 1st line

phenytoin - side effects - coarse facial features, gingival hyperplasia, hirsutism, osteomalacia

51
Q

60yo F - warfarin therapy, complex partial seizures
-first on carbamazepine - switched to levetracetam

get epistaxis

why?

A

carbamazepine - enzyme induction - so had increased warfarin dose

when stopped drug - also needed to decrease warfarin dose

52
Q

25yo M, ER, status epilepticus

  • on carbamazepine
  • drug tx?
A

lorazepam - long acting - compared to diazepam

also IV phenytoin, benzo, phenobarb

Neuro II Exam 2 (20 decks)

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