Antiseizure/Status Epilepticus Flashcards Preview

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

Flashcards in Antiseizure/Status Epilepticus Deck (51)
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1

When do you initiate anti seizure drug therapy in patients?

2+ unprovoked seizures

2

When do you consider discontinuing ASD therapy

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

3

List the 3 MOA of ASDs

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

4

List the presynaptic voltage gated Na+ channel drugs

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

5

List the presynaptic voltage gated Ca++ channel drugs

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

6

List the presynaptic voltage gated K+ channel drug

Retigabine

7

list the synaptic vesicle protein (SV24) drug

Levetiractam

8

List the two postsynaptic drugs

1. AMPA Receptors
2. NMDA receptors

9

What drugs block the AMPA receptor

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

10

List the GABA A receptor drug

Benzodiazepines
-Diazepam
-Lorazepam

11

Absence treatment

1. Ethosuximide
2. Lamotrigine
3. Valproic acid

12

Ethosuximide MOA

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

13

Ethosuximide clinical application (what sz tx?)

Generalized Absence

14

Ethosuximide SEs

1. Headache
2. Blood dyscrasias

15

Lamotrigine (Lamictal) MOA

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

16

Lamotrigine (Lamictal) MOA clinical applications

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

17

Lamotrigine (Lamictal) SE's

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

18

Valporic acid (Depakote) MOA

Alters synthesis and degradation of GABA

19

Valporic acid (Depakote) clinical application

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

20

Valporic acid (Depakote) SEs

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

21

Clonazepam MOA

Enhance GABAA receptor responses

22

Clonazepam clinical application

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

23

Clonazepam SEs

Sedation

24

Topiramate (Topamax) clinical application

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

25

Topiramate (Topamax) SE's

1. Cognitive slowing
2. Confusion

26

Drugs to avoid in absence seizures

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

27

Ineffective drugs in absence seizures

1. Phenytoin
2. Phenobarbital

28

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

1. Lamotrigine
2. Levatriacetam
3. Perampanel

29

tonic-clonic seizure US guideline treatment

Topiramate (Topimax)

30

Levatriacetam (Keppra) MOA

Binds synaptic protein

31

Levatriacetam (Keppra) SE's

1. Behavioral problems
2. HA

32

Carbamazepime (Tegretol) MOA

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

33

Carbamazepime (Tegretol) Box warning

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

34

Carbamazepime (Tegretol) ADEs

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

35

Lacosamide ADE's

EKG changes- small increase in PR interval

36

Phenytoin (Dilantin) MOA

Blocks voltage-gated Na+ channels

37

Phenytoin (Dilantin) Box warning

CV risk associated with rapid infusion

38

Phenytoin (Dilantin) ADEs

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

39

Phenobarbitol ADEs

1. Intellectual blunting
2. MBD
3. Behavior changes

40

What is unique about the Phenobarbitol drug reaction?

Idiosyncratic- reactionspecific to pt

41

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

Patient will die

42

Gabapentin (Neurontin) ADEs

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

43

Pregablin (Lyrica) ADE's

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

44

Vigabatrin (sabril) box warning

Permanent vision loss

45

Perampanel (Fycompa) Box warning

Serious psychiatric and behavioral rxn

46

Tiagabine (Gabitril) ADEs

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

47

Zonisamide MOA

blocks Na+ channel

48

Zonisamide ADEs

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

49

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

Interacts with oral contraceptives
-Consider IUD or patch

50

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

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

51

What drug has rare or minimal drug interactions?

Lamotrigine