Anti-Epileptic Drugs Flashcards Preview

RUSVM PHARMACOLOGY- Pharm Final Sp 2017 > Anti-Epileptic Drugs > Flashcards

Flashcards in Anti-Epileptic Drugs Deck (12):
1

Seizures are excessive synchronous neural activity usually occuring in the _______. They are complex and incompletely understood

Cerebral Cortex

2

Seizure causes:

1) Intracranial lesion (symptomatic)
2) Extracranial insult (reactive)
3) Primary disorder (idiopathic)

3

What are the 7 traits of the ideal anti-epileptic drug (AED)

1) effective --> broad spectrum
2) Safe --> risk vs benefit
3) limited drug-drug interactions
4) Long half life (SID or BID dosing)
5) Anti-epileptogenic effects
6) enteral and parenteral formulations
7) affordable/sustainable for long term

4

What are the two "Old AEDs"

1) Phenobarbital
2) Bromide

5

Phenobarb
-ROA
-Class
-MoA

Oral and IV
-Most common first line AED for chronic therapy
-Class: Barbiturate (long acting) - drug class IV
-MoA: classic barbiturate mechanism: GABA-A agonist/potentiator; potentiates the inhibitory effects of GABA by binding and prolonging opening of Cl- channels

6

Phenobarbital Pharmacokinetics

-Crosses BBB
-Good oral bioavailability (~90%), wide distribution
-Extensively plasma protein (albumin) bound
-Metabolized by liver --> potent inducer of hepatic microsomal enzymes, and is metabolized through that system (P450).

7

Is tolerance more likely to develop in bromide or phenobarbital?

phenobarbital

8

Precautions/Adverse Effects of Phenobarb

PU/PD/PP
-Sedation (transient)
-Elevated liver enzymes (induced alkaline phosphatase- ALP)
-Less commonly: paradoxical hyperexcitability, hepatoxicity, pancytopenia (reversible)

9

Bromide
-RoA
-Use
-Class

-Oral Only
-1' add on anticonvulsant for dogs NOT CATS
-Class: anticonvulsant: Salt/Chemical powder - alters chloride transport across neuronal cell membranes

10

Bromide pharmacokinetics

-Good oral absorption, excreted unchanged by kidneys
-changes in serum chloride ion concentration can significantly interfere with bromide levels --> keep salt intake from diet stable

11

Bromide Precautions/Adverse Effects

-Interferes with chloride on serum chemistry -> reads falsely high (bromide recognized as Cl-)
-GI upset (vomiting), sedation (can be severe during loading)
-25-50% of cat may show asthma-like pulmonary changes (CONTRAINDICATED)
-Toxicity with overdose is termed "bromism- severe sedation and neurological signs (tx with.9% NaCl to promote bromine excretion)
-Pancreatitis is also possible -> range of GI signs from vomit, regurg, GI ulcers, abdominal pain, inappetence

12

Name the 3 New AEDs

1) Levetiracetam (Kepra)
2) Zonisamide
3) Imeption