Antiseizure drugs [3] Flashcards Preview

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Flashcards in Antiseizure drugs [3] Deck (17):
1

Seizure vs convulsion

seizure: excessive neuronal discharge
- where antiseizure drugs target - broader

Convulsion: violent involuntary contraction due to excessive electrical activity

2

Drug to tx partial seizures (focal)

Levetiracetam

(carbamazepine, lamotrigine)

note* simple and complex seizures fall under partial seizures

- more difficult to tx than generalized seizures

3

Drugs to tx generalized seizures

1. Absence:
Ethosuximide, Valproate

2. Grand mal (tonic clonic)
Levetiracetam (keppra), Valproate, Phenytoin, Carbamazepine
(Lamotrigine)

4

Broad spectrum antiseizure med

Phenobarbitol
Diazepam (valium)
Valproate (depakene)
Divalproex (depakote)

5

Tx for status epilepticus

Diazepam (valium) - IV
Lorazapam (ativan)
Midazolam (versed)

ADRs: somnolence

6

Mechanism of Generalized Tonic-clonic vs Generalized Absence seizures

Generalized Tonic-clonic:
- intiation → loss of GABA tone
- propagation → loss of GABA tone over large areas, plus ↑ response to glutamate and Na+ channel excitation

Generalized Absence seizures
- oscillatory stimulation of thalamic-cortical circuitry - activation of low threshold T- type Ca2+ channels

7

Why arent Z drugs good against convulsions (bc they do have anti-convulsant properties)

bc you are asleep (hypnotic) before you get the anticonvulsant effects
- BDZ are good

8

MOA
- Ethosuximide
- Lamotrigine
- Levetiracetam

Ethosuximide
- blocks the low-threshold T-type Ca2+ channels in thalamocortical pathways

Lamotrigine
- blocks high voltage VSCC (that is involved in reg of Glu release)
- blocks VSSC (suppress repetitive APs)

Levetiracetam
- Inhibits synaptic vesicle protein SV2A
- impairs Ca2+ mediated NT release

9

MOA
Valproic acid
Diazepam
Phenytoin
Carbamazepine

Valproic acid
- enhancement of Gaba activity

Diazepam
- enhancement of GABA activity

Phenytoin
- blocks VSSC (suppress repetitive AP)

Carbamazepine
- blocks VSSC (suppress repetitive AP)

10

Which antiseizure can cause gingival hyperplasia. List its MOA

Phenytoin
- blocks VSSC (suppress repetitive AP)

11

Agranulocytosis

Clozapine

12

1st line tx in generalized tonic clonic

Levetiracetam (keppra)

(others: Valproate, Phenytoin, Carbamazepine
(Lamotrigine))

13

Do we have a higher incidence of anxiety disorders or major depressive disorders?

anxiety

14

incidence of bipolar mania and depression

15

Black box warnings for Carbamazapine and Valproate (depakote)

Hepatic failure --> death
- monitor Liver Function Test

16

Classic enzyme inducer

phenobarbital
Broad spectrum antiseizure med
Good for difficult to tx seizures

(carbamazepine and phenobarbital also induce enzymes)

17

Anticonvulsive agents will result in additive CNS depression (increased somnolence) when given with what?

Opiod analgesics

(these are all anticonvulsives:
- phenytoin
- carbamazepine
- Phenobarbital
- Diazepam
- Levetiracetam