Antiseizure/Status Epilepticus Flashcards Preview

Question 1

1

When do you initiate anti seizure drug therapy in patients?

Answer

2+ unprovoked seizures

Question 2

2

When do you consider discontinuing ASD therapy

Answer

1. Seizure free for 2-4 years
2. Complete seizure control within one year of onset
3. Onset of seizure between 2-35 years of age
AND normal neurologic exam/EEG

Question 3

3

List the 3 MOA of ASDs

Answer

1. Increase GABAeric inhibitory transmission
2. Decrease Glutamatergic excitatory transmission
3. Modify ionic conductance-nerve impulse propagation

Question 4

4

List the presynaptic voltage gated Na+ channel drugs

Answer

1. Phenytoin
2. Carbamazepine
3. Lamotrigine
4. Lacosamide

Question 5

5

List the presynaptic voltage gated Ca++ channel drugs

Answer

1. Ethosurimide
2. Lamotrigine
3. Gabapentin
4. Pregabalin

Question 6

6

List the presynaptic voltage gated K+ channel drug

Answer

Retigabine

Question 7

7

list the synaptic vesicle protein (SV24) drug

Answer

Levetiractam

Question 8

8

List the two postsynaptic drugs

Answer

1. AMPA Receptors
2. NMDA receptors

Question 9

9

What drugs block the AMPA receptor

Answer

1. Phenobarbital
2. Topiramate
3. Lamotrigine
4. Perampanel

Question 10

10

List the GABA A receptor drug

Answer

Benzodiazepines
-Diazepam
-Lorazepam

Question 11

11

Absence treatment

Answer

1. Ethosuximide
2. Lamotrigine
3. Valproic acid

Question 12

12

Ethosuximide MOA

Answer

1. Decrease VG-Ca++ currents
2. Decrease glutamate

Question 13

13

Ethosuximide clinical application (what sz tx?)

Answer

Generalized Absence

Question 14

14

Ethosuximide SEs

Answer

1. Headache
2. Blood dyscrasias

Question 15

15

Lamotrigine (Lamictal) MOA

Answer

1. Blocks Na+ and Ca++ channels
2. Decreases glutamate

Question 16

16

Lamotrigine (Lamictal) MOA clinical applications

Answer

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
5. Generalized Absence

Question 17

17

Lamotrigine (Lamictal) SE's

Answer

1. Black box warning: Serious skin rash-start low and go slow
2. Diplopia

Question 18

18

Valporic acid (Depakote) MOA

Answer

Alters synthesis and degradation of GABA

Question 19

19

Valporic acid (Depakote) clinical application

Answer

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
5. Generalized Absence

Question 20

20

Valporic acid (Depakote) SEs

Answer

1. Heptatotoxicity
2. Pancreatitis
3. Teratogenic-Don't give to women of child bearing age
4. Alopecia

Question 21

21

Clonazepam MOA

Answer

Enhance GABAA receptor responses

Question 22

22

Clonazepam clinical application

Answer

1. Generalized Absence
2. Focal or Generalized
3. Myoclonic
4. Infantile spasms

Question 23

23

Clonazepam SEs

Sedation

Answer

1. Generalized tonic-clonic
2. Generalized absence
3. Focal aware/impaired
4. Migraine

Answer

1. Cognitive slowing
2. Confusion

Answer

1. Carbamazepine
2. Vigabatrin
3. Gagapentin
4. Tiagabin

Answer

1. Phenytoin
2. Phenobarbital

Answer

1. Lamotrigine
2. Levatriacetam
3. Perampanel

Answer

Topiramate (Topimax)

Answer

Binds synaptic protein

Answer

1. Behavioral problems
2. HA

Answer

1. Blocks voltage-gated Na+ channels
2. Decreases glutamate release

Answer

1. Serious dermatologic reaction: TEN & SJS
2. Asians: Aplastic anemia and agranulocytosis

Answer

1. Hyponatremia
2. Metabolic Bone Dz (MBD)
3. Ataxia
4. Diplopia

Answer

EKG changes- small increase in PR interval

Answer

Blocks voltage-gated Na+ channels

Answer

CV risk associated with rapid infusion

Answer

1. Nystagmus-often the first sx of toxicity
2. Gingival hyperplasia
3. Hirsutism
4. Folate deficiency (supplement with folate)
5. Neuropathy

Answer

1. Intellectual blunting
2. MBD
3. Behavior changes

Answer

Idiosyncratic- reactionspecific to pt

Answer

Patient will die

Answer

1. Somnolence-"Brain fog'
2.Ataxia
3. Weight gain

Answer

1. Somnolence-"Brain fog'
2.Ataxia
3. Weight gain

Answer

Permanent vision loss

Answer

Serious psychiatric and behavioral rxn

Answer

1. Concentration and attention difficulties
2. Behavioral disturbances
3. Increased appetite

Answer

blocks Na+ channel

Answer

1. Cognitive slowing
2. Rash-Sulfa based drug
3. Paresthesia
4. Kidney stones
5. Oligohydrosis

Answer

Interacts with oral contraceptives
-Consider IUD or patch

Answer

Check serum level of Carbamazepine because this drug is induces it's own metabolism

Answer

Lamotrigine

Question 24

24

Topiramate (Topamax) clinical application

Question 25

25

Topiramate (Topamax) SE's

Question 26

26

Drugs to avoid in absence seizures

Question 27

27

Ineffective drugs in absence seizures

Question 28

28

What are the 3 FDA approved meds to treat tonic-clonic seizures?

Question 29

29

tonic-clonic seizure US guideline treatment

Question 30

30

Levatriacetam (Keppra) MOA

Question 31

31

Levatriacetam (Keppra) SE's

Question 32

32

Carbamazepime (Tegretol) MOA

Question 33

33

Carbamazepime (Tegretol) Box warning

Question 34

34

Carbamazepime (Tegretol) ADEs

Question 35

35

Lacosamide ADE's

Question 36

36

Phenytoin (Dilantin) MOA

Question 37

37

Phenytoin (Dilantin) Box warning

Question 38

38

Phenytoin (Dilantin) ADEs

Question 39

39

Phenobarbitol ADEs

Question 40

40

What is unique about the Phenobarbitol drug reaction?

Question 41

41

What will happen if you continue to increase the Phenobarbitol dose?

Question 42

42

Gabapentin (Neurontin) ADEs

Question 43

43

Pregablin (Lyrica) ADE's

Question 44

44

Vigabatrin (sabril) box warning

Question 45

45

Perampanel (Fycompa) Box warning

Question 46

46

Tiagabine (Gabitril) ADEs

Question 47

47

Zonisamide MOA

Question 48

48

Zonisamide ADEs

Question 49

49

What do you want to consider using in a female who takes Phenytoin d/t its drug interactions?

Question 50

50

If a patient comes in who takes Carbamazepine and is having a seizure, what do you want to check first? why?

Question 51

51

Brainscape's Knowledge GenomeTM

Antiseizure/Status Epilepticus Flashcards Preview

Pharmacology- Exam #4 > Antiseizure/Status Epilepticus > Flashcards

When do you initiate anti seizure drug therapy in patients?

2+ unprovoked seizures

When do you consider discontinuing ASD therapy

1. Seizure free for 2-4 years2. Complete seizure control within one year of onset3. Onset of seizure between 2-35 years of age AND normal neurologic exam/EEG

List the 3 MOA of ASDs

1. Increase GABAeric inhibitory transmission2. Decrease Glutamatergic excitatory transmission3. Modify ionic conductance-nerve impulse propagation

List the presynaptic voltage gated Na+ channel drugs

1. Phenytoin2. Carbamazepine3. Lamotrigine4. Lacosamide

List the presynaptic voltage gated Ca++ channel drugs

1. Ethosurimide2. Lamotrigine3. Gabapentin4. Pregabalin

List the presynaptic voltage gated K+ channel drug

Retigabine

list the synaptic vesicle protein (SV24) drug

Levetiractam

List the two postsynaptic drugs

1. AMPA Receptors2. NMDA receptors

What drugs block the AMPA receptor

1. Phenobarbital2. Topiramate3. Lamotrigine4. Perampanel

List the GABA A receptor drug

Benzodiazepines-Diazepam-Lorazepam

Absence treatment

1. Ethosuximide2. Lamotrigine3. Valproic acid

Ethosuximide MOA

1. Decrease VG-Ca++ currents2. Decrease glutamate

Ethosuximide clinical application (what sz tx?)

Generalized Absence

Ethosuximide SEs

1. Headache2. Blood dyscrasias

Lamotrigine (Lamictal) MOA

1. Blocks Na+ and Ca++ channels2. Decreases glutamate

Lamotrigine (Lamictal) MOA clinical applications

1. Generalized tonic-clonic 2. Focal aware/impaired 3. Focal or Generalized 4.Myoclonic5. Generalized Absence

Lamotrigine (Lamictal) SE's

1. Black box warning: Serious skin rash-start low and go slow2. Diplopia

Valporic acid (Depakote) MOA

Alters synthesis and degradation of GABA

Valporic acid (Depakote) clinical application

1. Generalized tonic-clonic 2. Focal aware/impaired 3. Focal or Generalized 4.Myoclonic5. Generalized Absence

Valporic acid (Depakote) SEs

1. Heptatotoxicity2. Pancreatitis3. Teratogenic-Don't give to women of child bearing age4. Alopecia

Clonazepam MOA

Enhance GABAA receptor responses

Clonazepam clinical application

1. Generalized Absence 2. Focal or Generalized 3. Myoclonic4. Infantile spasms

Clonazepam SEs

Sedation

Topiramate (Topamax) clinical application

1. Generalized tonic-clonic2. Generalized absence 3. Focal aware/impaired 4. Migraine

Topiramate (Topamax) SE's

1. Cognitive slowing2. Confusion

Drugs to avoid in absence seizures

1. Carbamazepine2. Vigabatrin3. Gagapentin4. Tiagabin

Ineffective drugs in absence seizures

1. Phenytoin2. Phenobarbital

What are the 3 FDA approved meds to treat tonic-clonic seizures?

1. Lamotrigine2. Levatriacetam3. Perampanel

tonic-clonic seizure US guideline treatment

Topiramate (Topimax)

Levatriacetam (Keppra) MOA

Binds synaptic protein

Levatriacetam (Keppra) SE's

1. Behavioral problems2. HA

Carbamazepime (Tegretol) MOA

1. Blocks voltage-gated Na+ channels2. Decreases glutamate release

Carbamazepime (Tegretol) Box warning

1. Serious dermatologic reaction: TEN & SJS2. Asians: Aplastic anemia and agranulocytosis

Carbamazepime (Tegretol) ADEs

1. Hyponatremia2. Metabolic Bone Dz (MBD)3. Ataxia4. Diplopia

Lacosamide ADE's

EKG changes- small increase in PR interval

Phenytoin (Dilantin) MOA

Blocks voltage-gated Na+ channels

Phenytoin (Dilantin) Box warning

CV risk associated with rapid infusion

Phenytoin (Dilantin) ADEs

1. Nystagmus-often the first sx of toxicity2. Gingival hyperplasia 3. Hirsutism4. Folate deficiency (supplement with folate)5. Neuropathy

Phenobarbitol ADEs

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1. Seizure free for 2-4 years
2. Complete seizure control within one year of onset
3. Onset of seizure between 2-35 years of age
AND normal neurologic exam/EEG

1. Increase GABAeric inhibitory transmission
2. Decrease Glutamatergic excitatory transmission
3. Modify ionic conductance-nerve impulse propagation

1. Phenytoin
2. Carbamazepine
3. Lamotrigine
4. Lacosamide

1. Ethosurimide
2. Lamotrigine
3. Gabapentin
4. Pregabalin

1. AMPA Receptors
2. NMDA receptors

1. Phenobarbital
2. Topiramate
3. Lamotrigine
4. Perampanel

Benzodiazepines
-Diazepam
-Lorazepam

1. Ethosuximide
2. Lamotrigine
3. Valproic acid

1. Decrease VG-Ca++ currents
2. Decrease glutamate

1. Headache
2. Blood dyscrasias

1. Blocks Na+ and Ca++ channels
2. Decreases glutamate

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
5. Generalized Absence

1. Black box warning: Serious skin rash-start low and go slow
2. Diplopia

1. Generalized tonic-clonic
2. Focal aware/impaired
3. Focal or Generalized 4.Myoclonic
5. Generalized Absence

1. Heptatotoxicity
2. Pancreatitis
3. Teratogenic-Don't give to women of child bearing age
4. Alopecia

1. Generalized Absence
2. Focal or Generalized
3. Myoclonic
4. Infantile spasms

1. Generalized tonic-clonic
2. Generalized absence
3. Focal aware/impaired
4. Migraine

1. Cognitive slowing
2. Confusion

1. Carbamazepine
2. Vigabatrin
3. Gagapentin
4. Tiagabin

1. Phenytoin
2. Phenobarbital

1. Lamotrigine
2. Levatriacetam
3. Perampanel

1. Behavioral problems
2. HA

1. Blocks voltage-gated Na+ channels
2. Decreases glutamate release

1. Serious dermatologic reaction: TEN & SJS
2. Asians: Aplastic anemia and agranulocytosis

1. Hyponatremia
2. Metabolic Bone Dz (MBD)
3. Ataxia
4. Diplopia

1. Nystagmus-often the first sx of toxicity
2. Gingival hyperplasia
3. Hirsutism
4. Folate deficiency (supplement with folate)
5. Neuropathy

1. Intellectual blunting
2. MBD
3. Behavior changes

1. Somnolence-"Brain fog'
2.Ataxia
3. Weight gain

1. Somnolence-"Brain fog'
2.Ataxia
3. Weight gain

1. Concentration and attention difficulties
2. Behavioral disturbances
3. Increased appetite

1. Cognitive slowing
2. Rash-Sulfa based drug
3. Paresthesia
4. Kidney stones
5. Oligohydrosis

Interacts with oral contraceptives
-Consider IUD or patch