Flashcards in Exam #01i - Anticonvulsants Deck (56):
This condition is defined as an abnormal, synchronized, excessive discharge of a population of cortical neurons?
What condition is characterized by chronic, recurring seizures?
What criteria can you use to diagnose a patient with epilepsy (HINT: # of seizures in time period)?
occurrence of 2 unprovoked seizures separated by 24 hours
List (8) causes of seizures?
1. illness (tumor, stroke, meningitis)
5. high fever
6. children with cerebral palsy or mental retardation
8. withdrawal from alcohol or drugs
What is a mutation in an ion channel called?
True or False - anti-epileptic drugs (AEDs) are only meant to control epilepsy, not cure the disorder?
True or False AED CANNOT prevent the development of epilepsy in individuals who have acquired a risk for seizures?
Which seizure type may start as a small part of the brain thens spread to several areas of the brain?
Secondary generalized seizure
Which seizure type is characterized by motor, sensory, and speech disturbances, but NO loss of consciousness (in other words, the patient is fully aware of what is happening and can describe it)
partial (focal) seizure
What type of general seizure is characterized by a sudden jerk or so called "lightening bolt response?"
What phase of a grand mal seizure is characterized by quick loss of consciousness followed by sudden tensing of skeletal muscles, with the entire phase only lasting a few seconds?
What phase of a grand mal seizure is characterized by convulsions
What seizure type is characterized by loss of muscle tone?
True or False - tonic-clonic (grand mal) seizure affects the entire brain?
Which type of seizure is the most common type associated with epilepsy?
What disorder does this describe: prolonged depolarization and dysfunction of Na+ channels (channelopathy)?
In the normal brain, what is excitatory neurotransmission modulated by? In the normal brain, what is inhibitory neurotransmission modulated by?
excitatory modulated by voltage-gated ion channels
inhibitory modulated by GABA
Name the (3) ways hyperexcitability can be normalized?
1. inhibit activation of Na+ and Ca2+ channels
2. prolong inactivation of Na+ channels
3. increase inhibition by increasing [GABA]
What types of seizures are sodium channel blockers indicated for?
partial and generalized tonic-clonic seziures
List (7) Na+ channel blocker anti-seizure drugs?
Which (2) Na+ channel blocker anti-seizure drugs should not be given together b/c of risk of Stevens-Johnson syndrome?
Valproate + Lamotrigine
Valproate inhibits the metabolism of Lamotrigine
What type of anti-seizure drugs are important in treating absence seizures that originate in the thalamus?
Ca2+ channel blockers
Name the (2) T-type calcium channel blocker anti-seizure drugs for treatment of absence seizures (generalized petit mal)?
Name the (1) L-type calcium channel blocker anti-seizure drug for treatment of focal seizures?
1. Gabapentin (neurontin)
Name (5) GABA agonists?
4. Diazepam (Valium)
5. Clonazepam (Klonopin)
Which GABA agonist is used for infantile spasms (generic and brand)?
Name (1) GABA uptake inhibitor?
1. Tiagabine (Gabitril) - increases [GABA] in synaptic cleft
List (4) drugs that affect GABA metabolism
1. Vigabatrin - inhibits GABA metabolism
2. Valproate - inhibits GABA metabolism
3. Gabapentin - increases synaptic [GABA]
4. Pregabalin - decreases release of excitatory NT
Describe Keppra's unique MOA? What type of seizure is Keppra used for?
Keppra inhibits the fusion of vesicles to the synaptic terminal via protein modulation, limiting the release of NT into synaptic cleft
Name (1) K+ channel activator anti-seizure drug that was approved in 2010, approved for adjunctive therapy for partial onset seizures, and can cause blue skin discoloration and eye abnormalities?
Promotes opening of K+ channels to depolarize cells and dissipate the hyperexcitability of seizing. This stabilizes resting membrane potential and reduces brain excitability
What are the (5) most common AEs of Retigabine (K+ channel activator)?
5. slurred speech
Name (1) Glutamate receptor blocker?
Remember, glutamate is excitatory so blocking this binding will block excitation
What (2) major AE's are associated with Felbamate?
1. aplastic anemia
2. liver failure
Which anti-seizure drug's use is limited to refractory patients who don't respond to any other therapy?
Felbamate (glutamate receptor blocker)
In what (3) ways does Valproate control seizures?
1. Na+ channel blocker
2. Ca2+ channel blocker
3. increases GABA levels
Which anti-seizure drug blocks Na+ and Ca2+ channels, enhances GABA, and blocks glutamate receptors?
In what (2) ways does Levetiracetam (Keppra) control seizures?
1. modulates release of GABA
2. modulates release of glutamate
This term is defined as repeated convulsive seizures, is life threatening, and requires emergency treatment?
What benzodiazepine (given IV) would have the fastest onset of action to treat status epilepticus?
Diazepam (valium)....then quickest Lorazepam (Ativan)
Which benzodiazepine (given IV) with a long duration of action would you transition to after initially treating a patient in status epilepticus with a fast onset action benzo?
Phenobarbital....next longest acting Phenytoin
List the (11) major AE of anti-convulsant drugs?
5. somnolence (drowsiness)
7. blurred vision
8. visual field loss
11. mood disturbance
Which anti-convulsant drug is the only one with the AE of nystagmus?
Which anti-convulsant drug is the only one with the AE of visual field loss?
Retigabine (Ezogabine) - K+ channel activator
Which anti-convulsant drugs (2) have an AE of developing a rash?
Which (2) anti-seizure drugs should not be used to treat absence seizures?
Carbamazapine - exacerbates absence seizures
Phenobarbital - enhances T-type Ca channels
Which anti-seizure drug has autoinduction (induces hepatic enzymes responsible for metabolizing itself)?
Which anti-seizure drug has a non-linear relationship of drug dose and steady state plasma concentration and requires close monitoring to get drug levels correct?
What are the (4) DOC to treat Absence Seizures?
What are the (2) DOC to treat Myoclonic Seizures?
What is the DOC to treat Status Epilepticus?
What are the (5) DOC to treat Primary GTC seizures?
List the 5 comorbidities of seizures?
3. psychotic disorders
4. learning disabilities
5. cognitive impairment
True or False - many anti-seizure drugs are teratogenic?
Which anti-seizure drug is implicated as higher risk for pregnancy?
True or False - polytherapy with anti-seizure drugs increases teratogenic risk?