Anticonvulsants I Flashcards Preview

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Flashcards in Anticonvulsants I Deck (45):
1

what is the cause of seizures?

abnormally excessive and rhythmic firing of certain populations of hyper-excitable neurons in the brain

2

seizures are usually characterized by what physical manifestation?

convulsions

3

what are the underlying causes of seizures?

1. CNS injury - altered excitation thresholds
2. congenital abnormalities within brain
3. genetic factors
4. infections, hypoglycemia, hypoxia, toxic metabolites

4

definition: epilepsy

chronic neurological disorder characterized by recurrent seizures

5

what are the two types of seizures?

1. partial (focal)
2. generalized

6

what are the subtypes of partial (focal) seizures?

1. simple partial
2. complex partial
3. secondarily generalized

7

what are the subtypes of generalized seizures?

1. tonic-clonic (grand mal)
2. absence (petit mal)
3. myoclonic, atonic, clonic, tonic
4. unclassified

8

what is the most severe type of seizure?

tonic-clonic (grand mal)

9

what is the most common partial seizure?

complex partial

10

what is the most common generalized seizure?

tonic-clonic

11

is there loss of consciousness with simple partial seizures?

no

12

how does a complex partial seizure spread?

from a small area of the brain to other areas that affect alertness and consciousness

13

is there loss of consciousness with complex partial seizures?

altered with potential automatisms

14

which type of seizures affect the entire brain with global EEG change and bilateral manifestations?

generalized

15

what are the features of a petit mal (absence) seizure?

1. sudden onset and abrupt cessation
2. brief loss of consciousness
3. typically seen in children

16

what are the features of grand mal (tonic-clonic) seizures?

1. tonic spasms and major convulsions of entire body (bilateral)
2. loss of consciousness

17

what are the four stages of grand mal (tonic-clonic) seizures?

1. aura
2. tonic phase
3. clonic
4. stuporous state and sleep

18

what is status epilepticus?

continuous or very rapid recurring seizures, usually of the tonic-clonic type - medical emergency and require immediate therapy

19

what characterizes an atonic seizure? what type of seizure is it?

1. sudden loss of postural tone, often seen in children
2. subtype of generalized seizure

20

what are the three stages of the seizure mechanism?

1. initiation
2. synchonization of surounding
3. propagation - recruitment of normal neurons

21

what are the cellular and molecular factors that lead to seizure?

1. excitatory postsynaptic potentials
2. sodium influx
3. calcium currents
4. paroxysmal depolarization

22

what are the cellular and molecular factors that lead to control of seizures?

1. inhibitory postsynaptic potentials
2. potassium efflux
3. chloride influx
4. pumps
5. low pH

23

what is the goal of antiepileptic drugs?

restore normal patterns of electrical activity

24

what are the treatment options for seizures?

1. antiepileptic drugs
2. surgery
3. vagus nerve stimulation

25

when is vagus nerve stimulation indicated for seizure treatment?

for drug resistant patients with partial seizures

26

what are the anticonvulsant drug classes?

1. cyclic ureides
2. tricyclics
3. benzodiazepines
4. GABA derivatives
5. "others"

27

what are the cyclic ureide drugs?

1. phenytoin and fosphenytoin
2. primidone
3. phenobarbital
4. ethosuximide

28

what are the tricyclic anticonvulsant drugs?

1. carbamazepine
2. oxcarbazepine

29

what are the benzodiazepine anticonvulsant drugs?

1. diazepam
2. lorazepam

30

what are the GABA derivative anticonvulsant drugs?

1. gabapentin
2. pregablin

31

what are the "other" anticonvulsant drugs?

1. valproic acid
2. lamotrigine
3. acetazolamide
4. tiagabine
5. topiramate

32

which drugs are typically used for partial seizures?

1. carbamazepine
2. phenytoin
3. valproate

33

which drugs are typically used for tonic-clonic seizures?

1. carbamazepine
2. phenytoin
3. valproate

34

which drugs are typically used for absence (petit mal) seizures?

1. ethosuximide
2. valproate

35

which drugs are typically used for status epilepticus?

diazepam, lorazepam, phenytoin, fosphenytoin

36

what is the MOA for anticonvulsant agents?

inhibit firing of certain hyper-excitable cerebral neurons by

1. decreasing excitatory effects of glutamate and repetitive firing of neurons (block voltage gated sodium channels)
2. increase inhibitory effects of GABA
3. alter neuronal activation by altering movement of ions (sodium, calcium) across neuronal membrane

37

what are the presynaptic methods of diminishing glutamate release?

1. inactivation of VG sodium channels
2. inactivation of VG calcium channels
3. increase potassium channel opening

38

what are the postsynaptic methods of diminishing glutamate release?

1. blockage of AMPA receptors
2. blockage of NMDA receptors

39

what is the mechanism for anticonvulsive agents that inactivate sodium channels?

bind sodium channel in inactive state and keep it inactivated for a prolonged period of time - preventing sodium from entering cell

40

what is the mechanism for anticonvulsive agents that cause reduced activity of calcium channels?

reduce calcium influx - decrease NT release and prevent neuronal excitability

41

inactivation of which receptor type is most effective for petit mal seizures?

calcium

42

what are the targets for increasing the effect of GABA?

1. inhibit GABA transporters (block GABA reuptake)
2. inhibit GABA transaminase (block GABA metabolism)
3. potentiate activation of GABAa receptors

43

what are the general side effects of anticonvulsants?

sedation, diplopia, nystagmus, ataxia, GI upset

44

which anticonvulsant is considered safest during pregnancy?

phenobarbital

45

valproate and ethosuxamide act on which receptor to decrease seizure activity? which type of seizures are these good for? what is the MOA?

1. calcium channel
2. petit mal
2. reduce pacemaker current that underlies thalamic rhythm in spikes and waves seen in absence seizures

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