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Psych Review by Minnie (she/her) > 92b/93b - Epilepsy and Anticonvulsants > Flashcards

92b/93b - Epilepsy and Anticonvulsants Flashcards

(47 cards)

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1
Q

Which 1st generation AEDs are enzyme inducers?

A
  • Phenobarbital
  • Phenytoin
  • Carbamazepine
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2
Q

Which AED is the drug of choice for abscence seizures?

A

Ethosuximide

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3
Q

What is the mechanism of the benzodiazepines?

Which seizures do they treat?

A

Increased frequency of Cl- channel opening

Effective for myoclonic seizures

Rescue medication for status epilepticus

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4
Q

Describe the general mechanisms of seizure generation

A
  • Too much excitation
    • Ionic: too much inward Na+, Ca2+
    • NeuroT: Too much glutamate, aspartate
  • Too little inhibition
    • Ionic: too little inward Cl-, outward K+
    • NeuroT: Not enough GABA
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5
Q

What is the mechanism of ethosuximide?

What is it used for?

A

Blocks T-type Ca2+ currents in the thalamus

Drug of choice for abscence seizures

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6
Q

What is the most concerning possible side effect of lamotrigine?

A

Steven-Johnson syndrome

  • But broadly, lamotrigine is a good broad-spectrum AED that is safe in pregnancy
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7
Q

Which AED can also be used for migraine prophylaxis and neuropathic pain?

A

Topiramate

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8
Q

Describe the signs of a myoclonic seizure

A

Myoclonic = generalized

  • Myoclonus
    • Brief, shock-like jerk of a muscle or group of muscles
    • Bilateral, synchronous
    • vs. clonus which is repeated rhythmic jerking
    • If several myoclonic jerks occur in rhythmic succession, it is a clonic seizure
  • Consciousness NOT impaired
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9
Q

Which AEDs are safe in pregnancy?

A

Lamotrigine

But need frequent adjustment in dose b/c serum levels fall in the 3rd trimester

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10
Q

Describe the signs of a tonic seizure

A

Tonic = generalized

  • Symmetric, tonic muscle contraction of extremities
  • Tonic flexion of waist and neck
  • Lasts 2-20 seconds
  • EEG
    • Sudden attenuation, generalized polyspike waves
    • (similar to atonic)
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11
Q

Which kind of epilepsy is characterized by focal seizures with impaired consciousness with automatisms?

A

Temporal lobe epilepsy

  • Automatisms = lip smacking, swallowing, fumbling, picking at clothes
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12
Q

What is the mechanism of Levetiracetam?

What is it used for?

What is its notable side effect?

A
  • Mechanism
    • Binds to synaptic vescicle protein SV2A to regulate neurotransmitter release
    • Also reduces activity through high-voltage Ca2+ channels
  • Use
    • Broad spectrum - used as monotherapy or adjunctive
  • Side effect
    • CNS depression and irritability
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13
Q

What EEG changes are associated with abscence seizures?

A

3 Hz spike-wave discharges in every channel

Lasts for 3-10 seconds

  • Abscence seizures are generalized
  • Sudden onset, sudden resolution
  • No post-ictal confusion
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14
Q

What is the mechanism of carbamazepine?

What is it used for?

A

Inhibits Na+ channels

Tricyclic

Used to treat epilepsy w/predominantly focal seizures

Will worsen abscence seizures

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15
Q

Which kind of epilepsy is characterized by seizures that originate in the hippocampus and/or amygdala?

A

Mesial temporal lobe epilepsy

  • Focal seizures evolve into a bilateral, convulsive seizure early on
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16
Q

In which populations should valproate be avoided?

A
  • Pregnant women
    • High risk of neural tube defects
  • Neonates
    • Hepatic toxicity due to elevated liver enzymes
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17
Q

Which AEDs can be used for neuropathic pain?

A

Gabapentin

Carbamazepine

Pregabalin

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18
Q

Which 1st generation AED is an enzyme inhibitor?

A

Valproate

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19
Q

What is the mechanism of zonisamide?

What is it used for?

Study These Flashcards
A

Blocks Na+ and T-type Ca2+ channels

Blocks carbonic anhydrase (-> side effect = kidney stones)

Used as add-on therapy for partial and generalized seizures

20
Q

What is the mechanism of gabapentin?

What is it used for?

Study These Flashcards
A

Interferes with GABA uptake

Add-on therapy for focal seizures

Lacks potency for seizure - used off-label for neuropathic pain

21
Q

Which AED is first line for generalized epilepsies?

What is its mechanism?

Study These Flashcards
A

Valproate

  • Broad spectrum
  • Mechanisms:
    • Enhances GABA activity
    • Inhibits Na+ current
    • Activates K+, T-type Ca2+ channels
22
Q

Which AED causes significant appetite increase and weight gain?

23
Q

What is the mechanism of topiramate?

What is it used for?

What are the major side effects?

Study These Flashcards
A
  • Mechanism
    • Blocks Na+ channels
    • Increases frequency of GABAA opening
    • Interferes with glutamate binding
  • Uses
    • Broad specturm (monotherapy or adjunctive for focal or general)
    • Also used for migraine prophylaxis, neuropathic pain, tremor
  • Side effects
    • Memory and cognitive impairment
    • Appetitie suppression and weight loss
24
Q

List the 5 types of generalized seizures

Study These Flashcards
A
  • Atonic
  • Tonic
  • Clonic
  • Tonic-clonic
    • Tonic-clonic or myoclonic
  • Abscence
25
Which AED induces its own metabolism? What is the significance?
Carbamazepine Need to start at low doses and titrate up (will be inefective if the dose isn't increased!)
26
What is the mechanism of pregabalin? What is it used for? What is its major side effect?
* Mechanism * Inhibits voltage-gated Ca2+ channels * Also reduces the release of some neurotransmitters * Uses * Neuropathic pain * Peripheral neuropathy * Fibromyalgia * Anxiety * Side effect * Appetite increase and weight gain
27
Which AEDs can be used to treat migraine?
Valproate Topiramate Zonisamide
28
Which AED is likely to cause prominent hyponatremia?
Oxcarbazepine
29
What is the difference between a focal and generalized seizure?
Where the seizure **starts** * Focal * Seizure starts from one side * May progress to affect both sides of the brain, resulting in motor activity on both sides of the body (a secondarily generalized seizure) * Generalized * Seizure start from **both** sides
30
Which AEDs can be used to treat bipolar disorder?
Lamotrigine Valproate Carbamazepine
31
What is the major difference between a focal seizure wtih impairment of consciousness and an abscence seizure?
No post-ictal confusion with abscence seizure
32
What defines epilepsy?
Recurrent (2+) seizures that are **not** provoked by systemic or acute neurological insults * This excludes seizures due to metabolic disorders or alcohol or sedative drug withdrawal or
33
What is the mechanism of phenytoin? What is it used for?
Inhibits **rapid** firing of Na+ channels Phenytoin is the most widely used AED Used extensively to treat status epilepticus
34
Which kind of epilepsy is characterized by seizures preceded by aura?
Temporal lobe epilepsy * Aura may involve epigastric sensation, deja vu, emotional feeling, perceptual distorion, autonomic
35
Which AED does not have complete absorption \>4mg?
Gabapentin
36
Describe the signs of an atonic seizure
Atonic = generalized * Sudden loss of postural tone * Severe = fall * Mild = head or jaw draw * Consciousness usually impaired * EEG * Sudden diffuse atenuation, generalized polyspike waves * Similar to tonic
37
Which AED is likely to cause a drop in IQ during therapy, memory deficits, appetite suppression, and weight loss?
Topiramate
38
What is the mechanism of oxcarbazepine? What is it used for?
Blocks Na+ channels (its basically better carbamazepine; less risk of toxic metabolite buildup) Used for monotherapy in **focal (aka partial) seizures** *Note: tends to cause prominent **hyponatremia***
39
Describe the signs of a tonic-clonic seizure
Tonic-clonic = generalized * Loss of consciousness * Post-ictal confusion, lethargy * Tonic phase * Stiffening + fall * Ictal cry * Clonic phase * Rhythmic extremity jerking * Drooling, foaming at the mouth, biting tongue * Bladder and bowel incontinence * Agitation
40
Describe the signs of an abscence seizure
Abscence = generalized * Sudden onset * Eye blinks * Brief automatic mouth or hand movments * Changes in muscle tone * **No post-ictal confusion**
41
Which AED is associated with aplastic anemia and hepatic failure?
Felbamate
42
Which AED is most likely to cause CNS depression and **irritability?**
Levetiracetam
43
What is the mechanism of phenobarbital?
Increases **duration** of GABAA Cl- channel opening Side effect: may cause CNS depression when combined with alcohol or benzos
44
What is the mechanism of lamotrigine? What is it used for?
Inhibits Na+ channels and glutamate release * Broad spectrum * Monotherapy or or adjunctive for generalized and focal seizures * Safe in pregnancy!! * But serum levels fall in 3rd trimester, needs adjustment Feared side effect = Steven-Johnson syndrome
45
Which kind of seizure is associated wtih generalized 3 Hz spike-wave discharges on EEG?
Abscence
46
Describe the seizures commonly associated with temporal lobe epilepsy
* Preceded by aura * Often a weird taste in the mouth * **Focal** seizures with **impaired consciousness** with **automatisms** * Lip smacking, swallowing, fumbling, picking at clothes Often cannot be medically controlled; opt for anteromesial temporal lobectomy
47
Which two "clinically relevant" drugs may exacerbate epileptic seizures?
Tramadol (an analgesic) Venlafaxine (an SNRI antidepressant)

Psych Review by Minnie (she/her) (40 decks)

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