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608 Pharmacology > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

seizure

A

clinical manifestation of excessive hypersynchronous neuronal activity

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2
Q

Two major excitatory NTs

A

aspartate and glutamate

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3
Q

Two major inhibitory NTs

A

GABA and glycine

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4
Q

epilepsy

A

enduring disorder characterized by recurrent seizures - a SYMPTOM

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5
Q

cluster

A

2+ seizures in 24 hours

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6
Q

status epilepticus

A

5+ minute seizure OR 2 or more seizures without return to consciousness

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7
Q

refractory epilepsy

A

pharamcoresistant

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8
Q

generalized

A

bilateral involvement, loss of consciousness

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9
Q

tonic

A

increased muscle tone

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10
Q

clonic

A

shaking/paddling

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11
Q

focal

A

unilateral/regional signs, electric impulses from opposite hemisphere

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12
Q

3 Components of a Seizure

A
  1. Preictal
  2. Ictal
  3. Postictal
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13
Q

Etiology Based Seizure Classification

A
  1. Idiopathic
  2. Structural
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14
Q

What % of epilepsy patients are pharmacoresistant?

A

~25%

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15
Q

4 Reasons Seizure Treatment May Be Required

A
  1. Identifiable Structural Lesion or prior hx of brain dz/injury
  2. Acute repetitive seizures or status epilepticus
  3. Two or more isolated events within a six month period
  4. Prolonged, severe, or unusual post-ictal events
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16
Q

Objective of Anticonvulsant Therapy?

A

decrease the frequency, duration, and intensity of seizure (by about 50% or more)

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17
Q

Are anti-convulsants lipid soluble?

A

yes, they need to cross the BBB

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18
Q

Anticonvulsant MOAs

A

increase inhibition [of GABA or glycine] or decrease excitation [of aspartate and glutamate]

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19
Q

Benzos are what schedule drug?

A

Schedule IV (controlled)

20
Q

Benzo MOA

A

targets postsynaptic GABA receptors to increase about of GABA in the synapse

21
Q

Benzo Examples

A

diazepam, clorazepam, midazolam, clorazepate, lorazepam

22
Q

Benzo Metabolism

A

liver

23
Q

Most common anticonvulsant in vet med?

A

phenobarbital

24
Q

At what level does phenobarb cause hepatotoxicity?

A

greater than 35 ug/mL

25
Q

3 Bloodwork Changes in Phenobarb Patients

A
  1. Increased ALP
  2. Low T4/High TSH
  3. Hypertriglyceridemia
26
Q

Autoinduction

A

induces hepatic microsomal enzymes (P450) which reduces the half-life over time –> increased dosing or frequency may be required

27
Q

Can you use potassium bromide in cats?

A

NO

28
Q

Can you use phenobarb in cats?

A

yes

(also autoinduction not a problem in cats)

29
Q

Bromide MOA

A

unclear but competes with chloride in the synapse to keep the membrane hyperpolarized

30
Q

Metabolism of Potassium Bromide occurs in what organ?

A

kidney!

31
Q

Do bromide and phenobarb have a wide or narrow therapeutic index?

A

narrow (monitor)

32
Q

psuedohyperchloremia

A

fake increase in serum chloride from benchtop analyzers because it can misidentify bromide as chloride

33
Q

Effect of Sodium on Bromide Therapy

A

high sodium diet means the patient will pee out all the bromide

34
Q

Side Effect of Bromide in Cats?

A

pneumonitis (irreversible)

35
Q

Bromidism

A

side effect of bromide therapy resulting in sedation, ataxia, tremors, and possibly pelvic limb paralysis

36
Q

Which anticonvulsant is a gastric irritant?

A

bromide

37
Q

Keppra MOA

A

bind to presynaptic vesicle SV2A to prevent glutamate release

38
Q

Keppra Metabolism

A

kidney

39
Q

Keppra Bioavailability?

A

100%

40
Q

Bloodwork Changes due to Keppra

A

NONE

41
Q

Side Effects of Keppra?

A

possible behavior change, transient sedation (~1 week), ataxia (in polytherapy)

42
Q

Keppra + Phenobarb

A

phenobarb will decrease the half-life of Keppra so those patients need a higher dose

43
Q

Which anticonvulsant may have an anti-kindling effect?

A

Keppra (neuroprotective properties that may decrease brain damage)

44
Q

Zonisamide MOA

A

post-synaptically increases GABA and presynaptically decreases glutamate

45
Q

Does zonisamide have a wide or narrow therapeutic index?

A

wide

46
Q

Bloodwork Changes for Zonisamide

A

none usually

can have metabolic acidosis (since it binds to carbonic anhydrase in the RBCs)

47
Q

Pregabalin and Gabapentin MOA

A

presynaptic inhibits glutamate release by decreasing Calcium influx

608 Pharmacology (13 decks)

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