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Pharmacology Exam III > Anti-Convulsants > Flashcards

Anti-Convulsants Flashcards

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1
Q

Seizures defined

A

transient episodes of brain dysfunction and altered behavior due to ABNORMALLY EXCESSIVE, SYNCHRONOUS, AND RHYTHMIC FIRING of certain HYPEREXCITABLE NEURONS

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2
Q

Seizures Underlying Causes (3 primarily)

A

CNS injury

Congenital abnormalities

Genetic factors

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3
Q

Epilepsy defined

Two main subtypes?

A

CHRONIC NEUROLOGICAL DISORDER characterized by RECURRENT SEIZURES

Primary idiopathic
Secondary

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4
Q

Two main subtypes of Seizures?

A

PARTIAL - affect only parts of the brain

GENERALIZED - affect large areas and multiple areas of the brain

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5
Q

Partial Seizure IMPORTANT CHARACTERISTIC

A

ONLY PART OF THE BRAIN is involved

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6
Q

Partial Seizure Types (3)

A

Simple
Complex
Partial becoming generalized

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7
Q

Simple Partial Seizure

A

MINIMAL SPREAD OF ABNORMAL DISCHARGE

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8
Q

Complex Partial Seizure

A

STARTS IN SMALL BRIAN AREA but QUICKLY SPREADS TO OTHER AREAS

AUTOMATISMS

most common

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9
Q

Partial becoming generalized seizure

A

SPREAD THROUGHOUT BRAIN AND PROGRESS TO GENERALIZED

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10
Q

Generalized Seizures characteristic

two types?

A

involve THE ENTIRE BRAIN with global EEG change and BILATERAL MANIFESTATIONS

Petit mal (absence)
Grand mal (tonic clonic)
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11
Q

Petit mal seizures

A

sudden onset, abrupt cessation

BRIEF LOSS OF CONSCIOUSNESS

typically observed in CHILDREN

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12
Q

Grand mal seizures characteristics

A

TONIC SPASMS AND MAJOR CONVULSIONS OF ENTIRE BODY

LOSS OF CONSCIOUSNESS

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13
Q

Grand mal seizures four phases

A

Aura
Tonic
Clonic
Stuporous state and sleep

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14
Q

Status epilepticus

A

CONTINOUS OR VERY RAPID RECURRING SEIZURES

MEDICAL EMERGENCY REQUIRING IMMEDIATE THERAPY

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15
Q

3 Stages of Mechanisms Generating Epileptic Seizures

A

Initiation
Synchronization of surrounding
Propagation - recruitment of normal neurons

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16
Q

EPSP

A

excitatory post-synaptic potential

temporary depolarization and excitation of post-synaptic membranes caused by flow of positively charged ions into the cell

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17
Q

Epilepsy Treatment Options

A

Anti-epileptic meds
Surgery
Vagus nerve stimulation

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18
Q

Anti-epileptic medication goal

A

RESTORE NORMAL PATTERNS OF ELECTRICAL ACTIVITY

inhibit seizures

partially effective at prophylaxis

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19
Q

Cyclic Ureides (5)

A 
Phenytoin
Fosphenytoin
Primidone
Phenobarbital
Ethosuximide
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20
Q

Tricyclics (2)

A

Carbamazepine

Oxcarbazepine

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21
Q

Benzodiazepines (2)

A

Diazepam

Lorazepam

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22
Q

GABA Derivatives (2)

A

Gabapentin

Pregabalin

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23
Q

Other Anti-Seizure Drugs (5)

A 
Valproic acid
Lamotrigine
Acetazolamide
Tiagabine
Topiramate
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24
Q

Drugs for Partial Seizures with or without secondary generalized (3)

Study These Flashcards
A

Carabamazepine
Phenytoin
Valproate

25
Drugs for Tonic-clonic seizures (3)
Carbamazepine Phenytoin Valproate
26
Drugs for Absence seizures (petit mal)
Ethosuximide | Valproate
27
Drugs for myoclonic seizures (2)
Clonazepam | Valproate
28
Drugs for Status Epilepticus (4)
Diazepam Lorazepam Phenytoin Fosphenytoin
29
Anti-Convulsant General MOA 3 options
INHIBIT FIRING Decrease excitatory effects - BLOCK VOLTAGE GATED Na channels Increase inhibitory effects of GABA Alter neuronal activation by altering ion movement across membrane - INHIBITION OF VOLTAGE GATED Ca channels
30
Inactivation of Na Channels causes
DECREASE IN SUSTAINED, HIGH FREQUENCY, REPETITIVE DISCHARGE prolongs inactivation
31
Reduced calcium influx causes
DECREASED NEUROTRANSMITTER RELEASE prevent neuronal excitability
32
Anti-convulsant side effects
``` Sedation Diplopia Nystagmus Ataxia GI Upset ```
33
Anti-convulsant important considerations
AVOID ABRUPT WITHDRAWAL DECREASE EFFICACY OF ORAL CONTRACEPTIVES TERATOGENIC PHENOBARBITAL - safest during pregnancy
34
Fosphenytoin unique
newer, more soluble PRODRUG OF PHENYTOIN used for parenteral routes**
35
Phenytoin absorption
VARIABLE FORMULATION DEPENDENT
36
Phenytoin pharmacokinetics
Metabolized in LIVER DOSE-DEPENDENT - ZERO ORDER elimination CAN BE SATURATED
37
Phenytoin MOA
blocks and prolongs INACTIVATED STATE OF Na Channels Enhances GABA release Prevents seizure PROPAGATION
38
Phenytoin clinical uses (3)
Generalized tonic-clonic Partial seizures Status epilepticus
39
Phenytoin Idiosyncratic Side Effects
``` Hirsutism GINGIVAL HYPERPLASIA Osteomalacia Megaloblastic Anemia Fetal hydantoin syndrome ```
40
Carbamazepine MOA
INHIBITION OF VOLTAGE GATED Na Channels blocks high frequency firing decreases glutamate release
41
Carbamazepine Metabolism
INDUCES P450 enzymes induces it's own metabolism
42
Oxacarbazepine
NEWER drug similar to carbamazepine ACTIVE METABOLITE HAS LONGER DURATION, fewer drug interactions
43
Carbamazepine clinical uses
TONIC CLONIC SEIZURES PARTIAL SEIZURES drug of choice for TRIGEMINAL NEURALGIA
44
Carbamazepine Important Side effects (2)
SIADH - syndrome of inappropriate ADH secretion teratogenic --> SPINA BIFIDA
45
Barbiturates (phenobarbital) MOA Important clinical use?
Enhances GABA-A RECEPTOR RESPONSES increases opening time of Cl- channel STATUS EPILEPTICUS
46
Primidone
metabolized by LIVER to PHENOBARBITAL and PEMA
47
Ethosuximide MOA Primary clinical use?
BLOCKS PRE-SYNAPTIC Ca Channels ABSENCE SEIZURES - drug of choice***
48
Valproic acid MOA
INHIBITION OF Ca Channels Inhibition of GABA transaminase Absence Seizures - drug of choice*** bipolar disorder as well
49
Valproic acid adverse effects
HEPATOTOXIC SYNDROME - d/t toxic metabolite TERATOGENIC - spina bifida
50
Diazepam MOA Great choice clinically for?
POTENTIATES GABA-A RESPONSE increases Cl- channel opening STATUS EPILEPTICUS
51
Diazepam vs Lorazepam
Diazepam effects are MUCH SHORTER - cannot be used by itself Lorazepam has LONGER DURATION OF ACTION - can be used by itself
52
Gabapentin MOA Clinical uses (2)
GABA analog BLOCKS PRE-SYNAPTIC Ca Channels PARTIAL SEIZURES TONIC-CLONIC SEIZURES NEUROPATHIC PAIN***
53
Pregabalin
similar to gabapentin GABA Analog
54
Lamotrigine MOA Important side effect?
BLOCKS PRE-SYNAPTIC VOLTAGE GATED Na and Ca channels Stevens-Johnson Syndrome
55
Felbamate MOA
BLOCKS Na Channels and GLUTAMATE RECEPTORS
56
Tiagabine MOA
specifically designed as GABA UPTAKE INHIBITOR
57
Centrally Acting Muscle Relaxants (2)
Baclofen | Benzodiazepine
58
Baclofen MOA
GABA-B AGONIST increased K conduction, decrease Ca influx results in HYPERPOLARIZATION Reduction in excitatory transmitter release

Pharmacology Exam III (11 decks)

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