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Dynamics II > Anti-seizure Medication > Flashcards

Anti-seizure Medication Flashcards

(132 cards)

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1
Q

What is epilepsy?

A

disturbances of mental functions or movements of the body that is due to excessive discharge of signals from brain cells

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2
Q

Epileptic seizures are an imbalance of what?

A

GABA and Glutamate neurotransmission

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3
Q

What are some causes of epilepsy?

A

idiopathic epilepsy
trauma
tumor
developmental abnormality
stroke

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4
Q

What is a partial seizure?

A

a seizure that occurs on one side of the brain

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5
Q

What is a generalized tonic-clonic seizure?

A

abnormal on both sides of the brain

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6
Q

What does a generalized absence seizure look like?

A
  • shown as a 3-Hertz spike wave on both sides of the brain
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7
Q

Absence seizures occur so quickly that ______?

A

another seizure occurs before the patient is even conscious which could lead to hypoxia which then leads to brain damage

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8
Q

What are the 4 options of treatment for Epilepsy?

A
  1. Benzodiazepine
  2. Phenytoin/fosphenytoin/valproic acid/levetiracetam
  3. Phenobarbital
  4. Propofol
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9
Q

What is the strongest treatment for epilepsy?

A

Propofol (general anesthetic)

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10
Q

What is the most common type of seizure?

A

convulsion seizures

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11
Q

What are the different types of seizures? (4)

A
  1. Convulsive Seizures
  2. Absence
  3. Myoclonic
  4. Atonic
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12
Q

Which two seizures do you lose consciousness?

A

Convulsive Seizures
Absence

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13
Q

Which two seizures do you POSSIBLY lose consciousness?

A

Myoclonic and Atonic

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14
Q

What are automatisms?

A

repetitive gestures

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15
Q

What occurs during simple partial seizures?

A

uncontrolled muscle movements
automatisms
no loss of consciousness

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16
Q

Where does simple partial seizures originate?

A

1 hemisphere

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17
Q

What are the three parts of a seizure?

A
  1. Aura
  2. Ictus
  3. Postictus
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18
Q

What is an aura?

A

sensation or mood that will help identify location of seizure

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19
Q

What is an ictus?

A

the seizure itself; “what it looks like”

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20
Q

What is a postictus?

A

the period after the seizure

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21
Q

Auras do not occur in what types of seizures?

A

absence and myoclonic seizures

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22
Q

Postictus do not occur in what types of seizures?

A

absence seizures

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23
Q

How do you dose seizure medications?

A

you begin with one drug then you increase the dose until seizures stop or toxicity occurs, if seizures do not stop add another drug therapy and slowly increase that does as well until the seizures stop or toxicity occurs

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24
Q

Why measure serum levels of anti-seizures medications? (3)

A
  1. Help prevent toxicity
  2. Insure adequate dosing
  3. Increase patient compliance
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25
What are the major mechanisms of action of for anti-seizure drugs? (3)
1. decreases sodium and calcium influx 2. increase GABA neurotransmission 3. decrease glutamate/asparatate neurotransmission
26
What are the general side effects of anti-seizures drugs?
CNS effects: fatigue, dizziness, ataxia, blurry vision, headaches GI upset alterations in blood counts potential to cause Stevens Johnson Syndrome
27
What are the comorbidities for anti-seizure drugs?
anxiety, depression,
28
How does Stevens Johnson Syndrome start?
a rash after using a seizure medication
29
What is the mechanism of action for Phenytoin (Dilantin)?
Na channel blocker; has the same mechanism as anesthetics
30
What is the drug that neurologists would not recommend?
Phenytoin (Dilantin)
31
What type of seizure is Phenytoin not used to treat?
absence and atonic epilepsy because it can exacerbate these issues
32
Why does it take phenytoin take a long time to get the brain?
because it has high protein binding
33
What are the two ways that Phenytoin can be administered?
oral or IV
34
What is a side effect of phenytoin that occurs in children?
Gingival Hyperplasia
35
What is Gingival Hyperplasia?
abnormal amount of collagen
36
What is a side effect of phenytoin?
Hirsutism
37
What is Hirsutism?
abnormal amount of facial hair
38
What does Phenytoin induce?
CYP3A4, CYP2C, and UGT
39
When taking Phenytoin patients should be treated with _______ to prevent _____ ?
1. vitamin K supplements 2. bleeding
40
What type of drug is Fosphenytoin?
prodrug
41
How is Fosphenytoin administered?
IM
42
What is the difference between phenytoin and fosphenytoin (Cerebyx)?
less hypotension risk
43
What is the enzyme that converts fosphenytoin to phenytoin?
phosphatases
44
What is the mechanism of action for Carbamazepine (Tegretol)?
blockage of Na channels
45
What are the uses of Carbamazepine (Tegretol)? (3)
generalized and partial seizures trigeminal neuralgia (facial pain) bipolar disorder
46
What does Carbamazepine induce?
CYP1A2, CYP2C, CYP3A, UGT
47
True or False: Carbamazepine do not induce their own metabolism with the rate of metabolism increasing in the first 4-6 weeks of therapy
False: they do induce their own metabolism
48
What is carbamazepine (Tegretol) metabolized to?
10,11 - epoxide which is pharmacologically active
49
What are the side effects of Carbamazepine (Tegretol)?
weight gain Steven-Johnson syndrom Hyponatremia Liver toxicity
50
With what types of seizures are carbamazepines contraindicated?
in absence seizures
51
What is the mechanism of action of Ethosuximide?
calcium channel blocker
52
What is the indication of Ethosuximide?
absence seizures ONLY
53
What are the side effects of Ethosuximide?
GI irritation blood dyscrasias
54
What is the mechanism of action for Phenobarbital (Luminal)?
binds to the GABA receptor and then enhances GABA mediated chloride flux and prolongs opening of GABA channel
55
What are the indications associated with Phenobarbital (Luminal)?
status epilepticus
56
Can phenobarbital be used for veterinary medications?
No
57
In what type of seizures is Phenobarbital (Luminal) contraindicated?
in absence seizures because of the cognitive effect
58
What are the 2nd line uses for phenobarbital (luminal)?
generalized tonic-clonic epilepsy partial seizures
59
What does phenobarbital (luminal) induce?
induction of CYP450 enzymes
60
What are the side effects of phenobarbital (luminal)?
nystagmus highly sedating ataxia, cognitive impairment
61
What is the mechanism of action of Primidone (Mysoline)?
facilitates GABA, Block Na channels
62
What are the metabolites of Primidone (Mysoline)?
Phenobarbital and PEMA
63
What are the indications of Primidone (Mysoline)?
partial seizure and tonic-clonic
64
What are the side effects of Primidone (Mysoline)?
nystagmus highly sedating ataxia, cognitive impairment
65
What is the mechanism of action for Divalproex (Depakote)?
elevates brain levels of GABA by inhibition of degradation potentiates inhibitory effects of GABA Blockage of Na and Ca channels
66
What are the side effects of Divalproex (Depakote)?
alopecia and weight gain
67
What are the different formulations of Divalproex (Depakote)?
Valproic acid Divalproex sodium
68
What are the indications of Divalproex (Depakote)?
absence seizures refractory to ethosuximide generalized and partial seizures bipolar disorder prophylaxis of migrains (broad spectrum)
69
What does Divalproex (Depakote) inhibit?
CYP450, UGT, and Epoxide Hydrolase
70
What are the drug interactions with Divalproex (Depakote)? (2)
1. Displaces phenytoin from plasma proteins 2. Inhibits hepatic oxidative metabolism of carbamazepine, phenobarbital, and phenytoin
71
What is the mechanism of action of Lorazepam (Ativan)?
enhances GABA activity by binding allosterically to the GABA receptor
72
What are the uses of Lorazepam (Ativan)?
IV agent in status epilepticus
73
What are the side effects of Lorazepam (Ativan)?
sedation anteroprade amnesia ataxia withdrawal seizures following abrupt cessation
74
What are the benzodiazepines that are for chronic treatment of seizures?
1. Clorazepate (Tranxene) 2. Clonzepam (Klonopin)
75
What is Clorazepate metabolized to?
Diazepam
76
What is the type of seizure that Clonazepam treats?
absence seizure
77
What does Clobazam treat?
adjunctive for Lennox-Gastaut in patients 2 years of age or older
78
What are the BDZ Nasal Sprays?
Midazolam (Nayzilam) and diazepam (Valtoco)
79
What is Diastat Acudial?
rectal administration
80
When is Diastat Acudial used?
optional treatment for long lasting seizure
81
What are the advantages of Second Generation Antiepileptics?
1. fewer side effects 2. little or no need for serum monitoring 3. fewer drug interactions
82
What is the mechanism of action for Gabapentin (Neurontin)?
Analong of GABA and inhibits Ca channels *may increase the release of GABA from neurons
83
What are the uses of Gabapentin (Neurontin)?
1. partial seizure 2. postherpetic neuralgia 3. migraine, chronic pain, bipolar disorder 4. alcohol and opiate withdrawal
84
What patient population is Gabapentin (neurontin) best for?
the elderly
85
What is a side effect of Gabapentin?
somnolence, weight gain
86
When is the best time to take Gabapentin?
in the evening because it causes sedation
87
What is the mechanism of action Pregabalin (Lyrica)?
binds calcium channels and decreases glutatmate activity
88
What are the side effects of Pregabalin (Lyrica)?
Somnolence and weight gain
89
Is Pregabalin (Lyrica) metabolized in the liver?
no
90
What are the indications for Pregabalin (Lyrica)?
1. adjunctive therapy for partial onset seizures 2. diabetic neuropathic pain 3. postherpetic neuralgia 4. fibromyalgia
91
What is the mechanism of action for lamotrigine (lamictal)?
inhibits voltage-sensitive Na and Ca channels and inhibits glutamate/aspartate release
92
What are the uses of lamotrigine (Lamictal)?
broad spectrum: treatment of partial and generalized seizures and absence seizures and bipolar disorder
93
What are the side effects of Lamotrigine (Lamictal)?
skin rash, higher risk of Stevens-Johnson and higher risk of children
94
What age group should not use Lamotrigine (Lamictal)?
< 16 years old
95
What is the metabolism of Lamotrigine (Lamictal) decreased by?
CYP inhibitors (valproic acid)
96
What is the metabolism of Lamotrigine (Lamictal) increased by?
CYP inducer (phenytoin and CBZ)
97
What is the mechanism of action of Topiramate (Topamax)?
inhibits voltage-dependent Na channels potentiates GABA neurotransmission blocks glutamate neurotransmission
98
What are the indications of Topiramate (Topamax)?
partial and generalized seizures migraine prophylaxis alcoholsim
99
What are the side effects of Topiramate (Topamax)?
Nephrolithiasis (kidney stones) Metabolic acidosis Weight loss Oligohydrosis (reduced perspriation)
100
What is the mechanism of action of Levetiracetam (Keppra)?
unknown
101
What is the use of Keppra?
partial and generalized seizures
102
is Keppra metabolized by CYP450?
no; therefore, it is good for patients with hepatic disease
103
What is a side effect of Keppra?
mood changes
104
What are the uses of Keppra?
antiseizures, bipolar disorder, and migraine prophylaxis
105
Oxcabazepine does not induce its own metabolism
true
106
What is the MOA of Oxcabazepine (Trileptal)?
blocks voltage dependent Na channels
107
What patient population has an increased risk oof SJA?
asian populations
108
What is the indication of Oxcabazepine?
partial seizure
109
What type of drug is Oxcabazepine?
prodrug
110
What is the active metabolite of Oxcabazepine?
eslicarbazepine
111
What is the drug that is used with patients that haven't responded well to other medications?
Vigabatrin (Sabril)
112
What is the mechanism of action of Vigabatrin (Sabril)?
inhibition of GABA transaminase induces CYP2C9
113
What is the use of Vigabatrin (Sabril)?
reduction of partial seizure (refractory patients)
114
What is the side effects of Vigabatrin (Sabril)?
drowsiness, dizziness, weight gain, suicide, and permanent vision loss
115
What is the mechanism of action of Peramapanel (Fycompa)?
AMPA receptor antagonist
116
What are the adverse effects of Peramapanel (Fycompa)?
psychiatric aggressive behavior psychosis suicidal ideation
117
How is Permapanel (Fycompa) contraindicated?
patients with preexisting psychiatric illness/psychosis
118
What is Lennox-Gaustaut Syndrome?
is a multitude of seizures
119
How do you treat Lennox-Gaustaut Syndrome?
poly-drug approach
120
What is the mechanism of action of Felbamate (Felbatol)?
blocks activation NMDA receptors blocks Na and Ca channels Enhances GABA
121
What is Felbamate (Felbatol) recommended for?
patients who respond inadequately to alternative treatments and whose epilepsy is very severe
122
What is the drug that requires consent from a parent?
Felbamate (Felbatol)
123
What are the side effects of Felbamate (Felbatol)?
1. acute liver failure 2. aplastic anemia
124
When do you use Epidiolex?
for treatment resistant seizures
125
What is the mechanism of action of Epidiolex?
seritonin and glycine receptors
126
What are non-pharmacological therapy that treats seizures?
1. Ketogenic Diet 2. Vagus Nerve Stimulation
127
how do you treat Epilepsy in pregnancy?
1. monotherapy 2. folic acid supplementation before/during pregnancy
128
What are the ways that folic acid supplementation helps with baby growth?
1. DNA synthesis 2. RBC production 3. Developmental of brain, spinal cord 4. Helps prevent birth defects and low birth weight
129
What are the 3 drugs to avoid to treat epilepsy in pregnant women?
1. Phenytoin 2. Carbamazepine 3. Phenobarbital
130
What does phenytoin cause in children?
cleft palate and poor cognition
131
What does carbamazepine cause in children?
cleft palate
132
What does phenobarbital cause in children?
cardiac malformations and poor cognition

Dynamics II (6 decks)

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