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Pharmacology > Anti-Seizure Drugs > Flashcards

Anti-Seizure Drugs Flashcards

(37 cards)

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1
Q

Who should be started on anti seizure drugs?

A

If a patient has had 2 or more unprovoked seizures

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2
Q

Name drugs that lower seizure threshold (5)

A
  1. Theophylline
  2. Alcohol
  3. Phenothiazines (high-dose)
  4. Antidepressants (ex. Bupropion)
  5. Street drugs
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3
Q

When to stop anti-seizure medications?

A
  1. Seizure free for 2-4 years
  2. Complete seizure control within 1 year
  3. Onset of seizures between 2-35

AND normal neuro exam + EEG

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4
Q

What are the 3 mechanisms of action for anti-seizure drugs?

A
  1. Enhance GABA (inhibitory)
  2. Turn down Glutamatergic (excitatory)
  3. Modify ion conductance
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5
Q

How do benzodiazepines (Diazepam, Lorazepam) work?

A

bind to single site on chloride-ion channel which facilitates opening

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6
Q

Flumazenil: MOA

A

reverses effects of the benzodiazepines

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7
Q

Which seizure is associated with a 3Hz spike and wave pattern on EEG?

A

Generalized Absence

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8
Q

Generalized Absence: Tx

A
  1. Ethosuximide***
  2. Lamotrigine
  3. Valproic acid
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9
Q

Ethosuximide: clinical application

A

Generalized absence only!

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10
Q

Ethosuximide: ADEs

A
  • Headache
  • Blood dyscrasias (unspecified blood abnormality)
  • *Monitor CBC**
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11
Q

Ethosuximide: MOA

A

decreases glutamate

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12
Q

Lamotrigine: MOA

A

decreases glutamate

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13
Q

Lamotrigine: Clinical applications

A
  1. Generalized Absence
  2. Generalized Tonic-clonic
  3. Focal aware
  4. Focal/Generalized myoclonic
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14
Q

Lamotrigine: ADEs

A
  1. Serious skin rash (go low and slow)***

2. Diplopia

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15
Q

Valproate/Valproic acid: MOA

A

alters GABA

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16
Q

Valproate/Valproic acid: ADEs

Study These Flashcards
A
  1. Hepatotoxicity*
  2. Teratogenic**
  3. Pancreatitis*
  4. Alopecia
17
Q

Clonazepam: MOA

Study These Flashcards
A

Enchance GABA

18
Q

Clonazepam: clinical applications

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A
  1. Generalized Absence
  2. Focal/Generalized myoclonic
  3. Infantile spasms***
19
Q

Clonazepam: ADE

20
Q

Topiramate: Clinical applications besides seizures

21
Q

Topiramate: ADEs

Study These Flashcards
A

cognitive slowing

confusion

22
Q

Which medications should be avoided as they worsen absence seizures? (4)

Study These Flashcards
A
  1. Carbamazepine
  2. Vigabatrin
  3. Gabapentin
  4. Tiagabin

(pheytoin, and phenobarbital are ineffective and old!)

23
Q

According to US Guidelines, what is the drug of choice for tonic-clonic seizures?

24
Q

What are the 3 FDA approved medications for tonic-clonic seizures?

Study These Flashcards
A
  1. Lamotrigine
  2. Levatriacetam
  3. Perampanel
25
Levetiracetam: ADE
- behavioral problems (aggression, irritable) | - Headache
26
Carbamazepine: ADE
Serious dermatologic reactions in Asians, and people with HLA-B (SJS and TEN) - Aplastic anemia - Agranulocytosis - Ataxia - Diplopia - Hyponatremia - Metabolic bone disease
27
What is interesting about Carbamazepine's pharmacokinetics?
induces own metabolism
28
Lacosamide: MOA
blocks effect of neurotrophins
29
Lacosamide: ADEs
small increase in PR interval
30
Phenytoin (Dilantin): ADEs
1. Cardiovascular risk associated with rapid infusion** 2. Nystagmus (first sign of toxicity) 3. Gingival hyperplasia 4. Hirsuitism 5. Folate deficiency
31
Phenobarbital: ADEs
- Sedation (can cause coma or death)** - Intellectual blunting - Behavioral changes (idiosyncratic - hyperactive)
32
Phenobarbital: pharmakokinetics
Long-half life and inducer of P450 (many reactions!!!)
33
What is the biggest worry you have for a patient taking Vigabatrin?
Permanent vision loss***
34
What is the biggest concern for taking Perampanel?
serious psychiatric and behavioral reactions
35
Tigabine: ADEs
1. Concentration and attention difficulties 2. Behavioral disturbance 3. Increased appetite
36
What is the 1st line treatment for Myoclonic seizures?
Levetriacetam (Keppra)
37
Levetiracetam: ADEs/interactions
minimal and rare!

Pharmacology (16 decks)

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