Anti-Convulsants

Question 1

What is a partial seizure

Answer 1

Seizure in one hemisphere

Question 2

Simple partial seizure:
Consciousness
Progress to what

Answer 2

No loss of consciousness

Auras (loss of consiousness)

Question 3

Complex partial seizure

Answer 3

Impairment of consciousness

Question 4

If a partial seizure becomes generalized, it is called what?
The process that leads to this

Answer 4

Secondarily generalized seizure.

Kindling

Question 5

Generalized seizures originate where

Answer 5

Both cerebral hemispheres

Question 6

Two types of generalized seizure

Answer 6

Convulsive

Non-convulsive

Question 7

The one convulsive seizure type

Answer 7

Tonic-clonic

Question 8

Tonic clonic:
Onset
Which phase first? Describe. Length?
Which phase second? Describe

Answer 8

Abrupt
Tonic first: Contractions with arm and legs becoming extended. Lasts 10-20 secs

Clonic second: Muscle relaxation due to exhaustion

Question 9

Three non-consulsive types

Answer 9

Absence
Myoclonic
Atonic

Question 10

Absence seizure:
Describe
Consciousness
EEG pattern 
Atypical version difference

Answer 10

Sudden onset with brief seizures (zoning out)
Lose consciousness
3 Hz Spike and wave pattern
Less defined onsets/offsets

Question 11

Myoclonic
Describe
Consciousness

Answer 11

Shock-like muscle contractions

No loss of consciousness

Question 12

Atonic
Describe
Consciousness
2 other names

Answer 12

Loss of muscle tone
Loss in postural muscle tone (seem frozen)
Consciousness impaired
Drop attacks or astatic seizures

Question 13

Status epilepticus?

Answer 13

Seizures with 30 mins or less frequency

Question 14

Therapeutic goal of treating these

Answer 14

Control the seizures

Question 15

When to use polypharmacy to treat?

Answer 15

After trying 3 other drugs first

Question 16

When can you start to end anti-seizure meds?

Answer 16

After 3 years or more of being seizure free

Question 17

How to taper off anti-seizure meds?

Answer 17

Slowly one at a time.

Question 18

3 goals of treating seizures

Answer 18

1. Treat the focal seizure
2. Prevent seizure from spreading
3. Treat underlying cause

Question 19

3 ways to inhibit seizures

Answer 19

1. Enhance inhibitory like through GABA
2. Diminish excitatory like calcium channels
3. Sodium channel blockade

Question 20

When to figure out therapeutic blood levels

Answer 20

blood level of drug when patient has favorable response

Question 21

3 early signs of toxicity of anti-seizure med

Answer 21

Sedation
Ataxia
Nystagmus

Question 22

8 other toxic changes from anti-seizure meds

Answer 22

Teratogenic
Hepatic toxicity
Renal toxicity
Behavioral changes
Coag disorder
Weight change
Osteoporosis
Hyponatremia

Question 23

5 Sodium Channel blockers

Answer 23

1. Phenytoin
2. Fosphenytoin
3. Carbamazepine
4. Lamotrigine
5. Felbamate

Question 24

Phenytoin/Fosphenytoin (Phone tow-truck)
Should you use generics?
Kinetics at therpeutic plasma levels

Answer 24

No

Zero order

Question 25

``` Phenytoin 5 side effects 3 seizure indications 1 non-seizure indication 2 Contra-I's Interactions (2) ```

Answer 25

SE: Nystagmus, Ataxia, gingival hyperplasia, hirsutism, p neuropathy Seizure: Tonic-clonic, All partials, Status epilepticus Non-seizure: Cardiac Contra-I's: Absence and Myoclonic Interactions: Protein binding and biotransformation

Question 26

Fosphenytoin Difference from phenytoin: Different admin (2): One problem

Answer 26

DIff: Water soluble with fast onset Admin: IM or parenteral Name gets confused, drug dispensing error

Question 27

``` Carbamazepine (Car bomb) Non-seizure use (2) Three organs affected Primary indication Other One requirement when using this drug ```

Answer 27

Mood stabilizer for mania and bipolar + Anti-psychosis Liver, kidney, bone marrow Primary: Partial Seizure Other indication: Tonic-clonic Requirement: Have to check renal, hepatic, BM function

Question 28

Less toxic form of carbazepine

Answer 28

Derivative of carbamazepine

Question 29

Lamotrigine (Lamborghini) Similar to what Two different SE's

Answer 29

Phenytoin | Stevens-Johnson rash + epidermal necrolysis

Question 30

Felbamate (Vegimite Fell) Use 2 Main SE:

Answer 30

Use when patient doesn't respond to anything else SE: Aplastic anemia and stevens-johnson syndrome

Question 31

``` Phenobarbital/Primidone Primary mech Biotransformation unique feature Use similar to Contra-I? ```

Answer 31

Na channel blockade dominates Auto-induction Use similar to phenytoin Do NOT use in absence or myoclonic epilepsy

Question 32

``` Primidone Mech (2) Biotransformed to (2) High primidone: PB ratio indicates what ```

Answer 32

Block inactive Na channels + Enhance GABA inhib PHenobarbital + PEMA indication of poor compliance with normally low phenobarbital accumulation

Question 33

``` Valproic Acid Special title Mech (3) Protein binding fact Seizure use Toxicity 3 interactions ```

Answer 33

Best seizure drug probably Mech: GABA enhance, Block Na+, Block Ca+, Protein binding: Near saturation Use: All seizures Toxicity: Very toxic below the diaphragm (liver, alopecia, pancreas, teratogenic) Interactions: Bio-T, PB, Clonazepam

Question 34

``` Topiramate Similar to Extra mechanism Indicated for Non-seizure use Drug Interaction special feature ```

Answer 34

``` Similar to valproic Also is carbonic anhydrase All seizures Migraines Low incidence of drug interactions ```

Question 35

Benzodiazepines 3 drugs Mech (2) Special feature in terms of anti-epileptic activity

Answer 35

3 drugs: Diazepam, Lorazepam, Clonazepam Mech: GABA inhib and sodium blocking Feature: Can all of the sudden stop being anti-convulsant

Question 36

``` Ethosuximide Special feature Mechanism Best for what seizure Safety ```

Answer 36

The drug for absence epilepsy Blocks T calcium currents Absence epilepsy Very safe at normal dose (toxic high)

Question 37

``` Zonisamide Type of drug Indicated for Mechanism Minor mechanism Half life Adverse reaction (1) ```

Answer 37

``` Sulfonamide Partial seizures Block sodium channels Inhibit carbonic anhydrase Long half life Sulfonamide allergy ```

Question 38

Lacosamide Mech Indicated for

Answer 38

Slows Inactivates volgate-gated sodium channels | Partial seizures

Question 39

Tiagabine Mech Indicated for Half life feature

Answer 39

Mech: Inhibit GABA uptake Indicated: Partial seizures Half life: Short so tough dosing

Question 40

Levetiracetam Indicated for Mechanism

Answer 40

Adjunct in all seizures | Inhibitory to kindling

Question 41

Ezogabine | Mechanism

Answer 41

a