Chapter 14 Antiepileptic Drugs Flashcards Preview

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Flashcards in Chapter 14 Antiepileptic Drugs Deck (26):
1

Seizure

Brief episode of abnormal electrical activity in nerve cells of the brain

2

Convulsion

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

3

Epilepsy

Chronic, recurrent pattern of seizures

4

Primary (idiopathic) Epilepsy

Cause cannot be determined
Roughly 50% of epilepsy cases

5

Secondary (symptomatic) Epilepsy

-Distinct cause is identified
Trauma, infection, cerebrovascular disorder

6

Generalized onset seizures

-Formerly known as grand mal seizures
-Tonic-clonic seizures
-Absence seizures

7

Partial onset seizures

-Simple (formerly known as petit mal seizures)
-Complex
-Secondary generalized tonic-clonic

8

Status Epilepticus

-Multiple seizures occur with no recovery between them
-Result: hypotension, hypoxia, brain damage, and death
-True medical emergency

9

Goals of therapy for Antiepileptic Drugs (AEDs)

-To control or prevent seizures while maintaining a reasonable quality of life
-To minimize adverse effects and drug-induced toxicity

10

Antiepileptic drugs traditionally used to manage seizure disorders include:

-Barbiturates
-Hydantoins
-Iminostilbenes plus valproic acid
-Second- and third-generation antiepileptics

11

Pharmacologic effects of Antiepileptic drugs

-Reduce nerve’s ability to be stimulated
-Suppress transmission of impulses from one nerve to the next
-Decrease speed of nerve impulse conduction within a neuron

12

Antiepileptic Drugs: Indications

-Prevention or control of seizure activity
-Long-term maintenance therapy for chronic, recurring seizures
-Acute treatment of convulsions and status epilepticus

13

Antiepileptic Drugs: Adverse Effects

-Numerous adverse effects; vary per drug
-Adverse effects often necessitate a change in medication
-Black box warning as of 2008
Suicidal thoughts and behavior
-Long-term therapy with phenytoin (Dilantin) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies.

14

Primidone is metabolized in the liver to:

phenobarbital

15

Most common adverse effect of Phenobarbital and Primidone (Mysoline)

sedation

16

Barbiturates: Phenobarbital and Primidone (Mysoline): Contraindications

known drug allergy, porphyria, liver or kidney impairment, and respiratory illness

17

Barbiturates: Phenobarbital and Primidone (Mysoline):
Adverse effects

cardiovascular, CNS, gastrointestinal (GI), and dermatologic reactions

18

Hydantoins: Phenytoin
Adverse Effects

gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis

19

Carbamazepine (Tegretol)

-Second most commonly prescribed antiepileptic drug in the United States after phenytoin
-Autoinduction of hepatic enzymes

20

Oxcarbazepine (Trileptal)

-Chemical analogue of carbamazepine
-Precise mechanism of action has not been identified

21

Ethosuximide (Zarontin)

-Used in the treatment of uncomplicated absence seizures
-Not effective for secondary generalized tonic-clonic seizures
-Contraindication: known allergy
-Adverse effects: GI and CNS effects
-Drug interactions: hepatic enzyme–inducing drugs

22

Gabapentin (Neurontin)

-Chemical analogue of GABA, a neurotransmitter that inhibits brain activity
-Believed to work by increasing the synthesis and synaptic accumulation of GABA between neurons
-Contraindication: known drug allergy
-Adverse effects: CNS and GI symptoms

23

Lamotrigine (Lamictal)

-Also used for the treatment of bipolar disorder
-Contraindications: drug allergy
-Common adverse effects: relatively minor CNS and GI symptoms and possible Stevens-Johnson syndrome

24

Levetiracetam (Keppra)

-Adjunct therapy for partial seizures with and without secondary generalization
-Contraindication: known drug allergy
-Mechanism of action: unknown
-Adverse effects: generally well tolerated, CNS
-No drug interactions

25

Pregabalin (Lyrica)

-Schedule V controlled substance
-Indication: adjunct therapy for partial seizures
-Most common uses: neuropathic pain, postherpetic neuralgia, and fibromyalgia
-Contraindication: known drug allergy
-Adverse drug reactions: primarily CNS related

26

Monitor for adverse effects of Antipileptic Drugs:

-Mental status changes, mood changes, changes in level of consciousness or sensorium
-Eye problems, visual disorders
-Sore throat, fever (blood dyscrasias may occur with hydantoins)