Epilepsy Drugs Flashcards Preview

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Flashcards in Epilepsy Drugs Deck (56):
1

Ethosuximide Use:

1st line Absence

2

Ethosuximide mech:

Blocks thalamic T-type Ca++ channels

3

Ethosuxmide SE:

GI, Fatigue, headache, urticaria, Steven-Johnson syndrome. EFGHIJ

4

Benzodiazepines (diazepam, lorazepam) clinical use?

1st line for acute Status epilepticus; Also for eclampsia seizures (MgSO4 is first line)

5

Benzodiazepine mech

Increase GABA(A) action

6

Benzodiazepine SE

Sedation, Tolerance, Dependence, Respiratory Depression

7

Phenytoin clinical Use:

First Line Tonic-Clinic. First Line-prophylaxis for Status Epilepticus. Also Treats Simple and Complex Seizures

8

Phenytoin mech

Increase Na+ channel inactivation; zero-order kinetics

9

Phenytoin SE:

Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome) SLE-Like syndrome, induction of CYP-450, lymphadenopathy, Stevens-Johnson Syndrome, Osteopenia

10

What do you use for parenteral Use?

Fosphenytoin

11

Carbamazepine Clinical use?

First line for Simple, Complex, and Tonic-clonic. Also first line for trigeminal neuralgia

12

Carbamazepine mech

increase Na channel inactivation

13

Carbamazepine SE

Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of CYP 450-, SIADH, Stevens-Johnson syndrome.

14

Valproic Acid clinical use?

First line Tonic-Clonic. Also used to treat Simplex, Complex, Tonic-Clonic, Absense. Also used for myoclonic seizures and bipolar disorder.

15

Valproic Acid Mech:

Increase Na+ channel inactivation, Increase GABA concentration by inhibiting GABA transaminase

16

Valproic Acid SE:

GI, distress, rare but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus (spina bifida), tremor, weight gain, contraindicated in pregnancy.

17

Gabapentin Clinical use?

Simple, Complex, Tonic-Clonic Seizures. Also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder.

18

Gabapentin Mech:

Primarily inhibits high voltage activated Ca++ channels; designed as GABA analog

19

Gabapentin SE:

Sedation, Ataxia

20

Phenobarbital clinical use:

Simple, Complex, Tonic-Clonic

21

Phenobarbital Mech:

Increase GABA (A) action

22

Phenobarbital SE:

Sedation, tolerance, dependence, induction of CYP450, cardiorespiratory depression.

23

What drug is 1t line for neonates?

Phenobarbital

24

Topiramate Clinical use:

Simple, Complex, Tonic-Clonic. Also used for migraine prevention.

25

Topiramate SE:

sedation, mental dulling, kidney stones, weight loss

26

Topiramate mech:

blocks Na+ channels, increase GABA action

27

Lamotrigine clinical use:

Simple, Complex, Tonic-Clonic, Absence

28

Lamotrigine mech:

Blocks voltage-gated Na+ channels

29

Lamotrigine SE:

Stevens-Johnson syndrome (must be titrated slowly)

30

Levetiracetam clinical use:

Simple, Complex, Tonic-Clonic

31

levetiracetam mech

Unknown; may modulate GABA and glutamate release

32

Tiagabine clinical use:

Simple and Complex

33

Tiagabine mech

increase GABA by inhibiting re-uptake

34

Vigabatrin clinical use:

Simple and Complex

35

Vigabatrin mech

Increase GABA by irreversibly inhibiting GABA transamination.

36

What is the presentation of Stevens-Johnson syndrome?

Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal and sloughing.

37

What is the first line prophylaxis for Status Elipticus?

Phenytoin

38

What is the first line for for Simple?

Carbamazepine

39

What is the first line for acute status epilepticus?

Benzos (diazepam, lorazepam)

40

First line for Tonic - Clonic?

Phenytoin, Carbamazepine, Valproic Acid

41

First line for complex?

Carbamazepine

42

What are the barbiturates?

Phenobarbital, Pentobarbital, Thiopental, Secobarbital

43

What is the mech of Barbiturates?

Facilitate GABA(A) action by increasing duration of Cl- channel opening, thus decrease neuron firing (barbiDURATES increase duration).

44

Barbiturates are contraindicated in what?

Porphyria

45

What is the clinical use of Barbiturates?

Sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)

46

Toxicity of barbiturates?

Respiratory and cardiovascular depression (can be fatal); CNS dperession (can be exacerbated by EtOH use); dependence; drug interactions (induces CYP450). Overdose treatment is supportive (Assist respiration and maintain BP).

47

Benzodiazepines

Diazepam, lorazepam, triazolam, temazepam, oxacepam, midazolam, chlordiazepoxide, alprazolam.

48

mech of benzos?

Faciliate GABA(A) action by increasing (FREQUENCY) of Cl- channel opening. Decrease REM sleep. Most have long half-lives and active metabolites

49

most have long half lifes, what are the exceptions? what does this indicate?

Triazolam, oxazepam, and midazolam: short acting and therefore have a higher addictive potential.

50

Clinical use of benzos

Anxiety, spaticity, status epilepticus (lorazepam and diazepam), detoxification (especially alcohol withdrawal -DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia)

51

Benzo Toxicity

Dependence, additive CNS depression effects with alcohol. less risk of respiratory depression and coma than with barbiturates.

52

What is the antidote for benzo toxicity?

Flumazenil (competitive antagonist at GABA benzodiazepine receptor)

53

What are the nonbenzodiazepine hypnotics?

Zolpidem, Zaleplon, esZopiclone. (All ZZZs put you to sleep)

54

Nonbenzodiazepine mech

Act via the BZ1 subtype of the GABA receptor. Effects reversed by flumazenil.

55

Nonbenzodiazepine clinical use:

Insomnia

56

Nonbenzodiazepine Toxicity

Ataxia, headaches, confusion. Short duration because of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnestic effects. Decrease dependence risk than benzos