Mod 3 Antiepileptic Drugs

Question 1

Epilepsy

Answer 1

Seizure
 Brief episode of abnormal electrical activity in the nerve cells of the brain
Convulsion
Involuntary spasmodic contractions of any or all voluntary
muscles throughout the body, including skeletal and facial
muscles
 Epilepsy
Chronic, recurrent pattern of seizures
Primary (idiopathic)
 Cause cannot be determined
 More than 50% of epilepsy cases
 Secondary
 Distinct cause identified
• Trauma, infection, cerebrovascular disorder

Question 2

Classification of Epilepsy

Answer 2

Partial-onset seizures
 Simple (formerly known as petit mal seizures)
 Complex
 Secondary generalized tonic-clonic
 Generalized-onset seizures
 Formerly known as grand mal seizures
 Unclassified seizures
 Status epilepticus

Question 3

Antiepileptic Drugs

Answer 3

Also known as anticonvulsants
 Goals of therapy
 To control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug-induced toxicity
 AED therapy is usually lifelong
 Combination of drugs may be used
Single-drug therapy started before
multiple-drug therapy is tried
 Serum drug concentrations must be
measured
 Therapeutic drug monitoring
 Patients who are seizure free for 1 to 2 yearsmay be able to discontinue antiepileptic
therapy

Question 4

Mechanism of Action

Answer 4

AED therapy must:
 Prevent generation and spread of excessive
electrical discharge from abnormally functioning nerve cells
 Protect surrounding normal cells
AEDs thought to alter movement of sodium,
potassium, calcium or magnesium ions across nerve cells in the brain
 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

Question 5

Mechanism of Action (cont’d)

Answer 5

Overall effect
 Neurons are stabilized
 Neuron hyperexcitability is decreased
 Spread of excessive nerve impulses is decreased

Question 6

Antiepileptic Drugs:

Indications

Answer 6

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

Question 7

Antiepileptic Drugs

Answer 7

Adverse effects often necessitate a change in
medication Black box warning as of  Suicidal thoughts and behavior
Long-term therapy with phenytoin may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies

Question 8

Antiepileptic Drugs (cont’d)

Answer 8

phenobarbital (Solfoton)
 primidone
 carbamazepine (Tegretol)
 valproic acid (Depakote)
 phenytoin (Dilantin)
 fosphenytoin
succinimides, such as ethosuximide (Zarontin)
benzodiazepines (clonazepam and clorazepate)
gabapentin (Neurontin)
lamotrigine (Lamictal)
 pregabalin (Lyrica)
 levetiracetam (Keppra)
 topiramate (Topamax)
 tiagabine (Gabitril)