Anticonvulsant Drugs Flashcards
(14 cards)
Drugs for absence seizures
Clonazepam
Ethosuximide
Valproic Acid
Note that Dilantin is not effective for absence (petit mal) seizures.
Status epilepticus
Generalized repeating seizures lasting 5 minutes or more with no recovery between episodes. Medical emergency
Treatments for status epilepticus?
Diazepam / Valium
Lorazepam / Ativan
Phenobarbital / Phenobarb
Phenobarbitol / Phenobarb
Barbituate anticonvulsant. Used for generalized seizures. 30’ onset, 50 hour half-life! First line choice for children with seizures. Metabolized by P450 enzymes.
MOA - enhances GABA activity.
SFx - CNS depression, drowsiness, lowered IQ in children. Induction of P450 enzymes can upregulate metabolism of other drug types.
Primidone / Mysoline
Barbiturate anticonvulsant. Phenobarbitol is a metabolism byproduct of primidone. Used for all types of seizures EXCEPT absence. 48h half life!
MOA - GABA enhancement.
SFx - Nausea, anorexia, HA, vertigo, ataxia.
Category D! Do not use in pg unless absolutely necessary
Diazepam / Valium
Benzodiazepine anticonvulsant. Used for status epilepticus and grand mal seizures.
MOA - increased sensitivity of GABA receptors to GABA, causing a Cl- inclux, inhibiting nerve conduction.
SFx - Drowsiness, altered mentation, potential for abuse
Clonazepam / Klonopin
Benzodiazepine anticonvulstant. Used for absence seizures as an alternative to ethosuxamide and valproic acid. Status epilepticus. PO.
MOA - increases GABA R sensitivity to GABA, Cl- ion influx.
SFx - Drowsiness, altered mentation, abuse potential.
Phenytoin (Dilantin)
Anticonvulsant. Used for prophylaxis of all types of seizure EXCEPT absence. PO, IV, IM. Slow onset, long halflife.
MOA - reduces Na and Ca+ currents across membranes, decreasing conduction.
SFx - nystagmus, ataxia, gingival hyperplasia (often permanent), hepatotoxicity, bone marrow suppression. IV admin may cause arrhythmias and hypotension.
Carbamazepin (Tegretol)
Anticonvulsant. Used for prophylaxis of ALL seizure types and for chronic pain (Trigeminal neuralgia, post-herpetic neuralgia), schizophrenia and bi-polar disorder. Induces P450 enzyme.
MOA - like phenytoin, alters Na+ and Ca+ conductivity in nerves.
SFx - vertigo, N/V, bone marrow suppression (follow CBCs!). NEVER give to pt on MAOI; may cause hypertensive crisis.
Valproic Acid (Depakote)
Anticonvulsant. Used to tx all seizure types, especially absence seizures. Also used for BPD and chronic pn. PO, IV. Has additive effects when combined with other anticonvulsants.
SFx - Nausea, insomnia, anxiety, severe hepatotoxicity, folic acid antagonist. Category D! Do not give to female pts trying for pg - increases risk of birth defects 3x-10x.
Ethosuximide (Zarontin)
Anticonvulsant. Used especially for absence seizures.
MAO - unknown. Possibly T-type Ca+ channels.
SFx - increases blood levels of phenytoin if taken concurrently. HA, N/V, blurred vision, confusion, skin rashes, ataxia, insomnia, gingival hyperplasia, drug induced lupus!
Gabapentin (Neurontin)
Anticonvulsant and atypical analgesic. Used for adjunctive tx of partial seizures and chronic pn syndromes. Also for migraine HA.
MOA - potentiates GABA and affects N-type Ca+ channels.
SFx - somnolence, dizziness, ataxia, HA, CNS effects.
NOTE: may be used to decrease withdrawal from meth or coke.
Lamotrigine (Lamactil)
Anticonvulsant. Used for tonic-clinic seizures, complex partial seizures, and refractory seizures resistant to other tx. PO.
MOA - unknown. May decrease neuronal sensitivity to excitatory signals from glutamate and apartate.
SFx - Dizziness, HA, rash, diplopia, somnolence, ataxia.
NOTE: First new drug approved to tx type I BPD since lithium 30 years ago.
Levitracetam (Keppra)
Anticonvulsant. Used for tonic-clonic seizures refractory to other tx.
MOA - unknown. May stabilize neurons by inhibition of Ca+ movement.
SFx - generally well-tolerated but may cause unsteady gait, incoordination, mood changes, skin pigment changes, vomiting, diarrhea or constipation.
