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From Flashcardlet > Neuro 59: Antiepiletic drugs > Flashcards

Neuro 59: Antiepiletic drugs Flashcards

1
Q

Tx single unprovoked seizure?

A
  • need to assess the risk of another seizure with the risk of the tx
  • factors that increase risk of another seizure: brain lesion, post-ictal Todd’s paralysis, prior CNS infection, traumatic brain injury, hx of childhood febrile seizure, hx of siblings with epilepsy, etc.
  • after a second unprovoked seizure the risk of having another is 70%, so usually medicate!
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2
Q

How do antiepiletic drugs work?

A

-have a variety of mechanisms that aim to correct the channelopathies, balance cexcitation/inhibition, or correct K conductance

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3
Q

Type of seizures ethosuxidie is good for?

A

-absence seizures ONLY

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4
Q

Type of seizures that valproate is good for?

A

-broad spectrum drug, good for virtually ANY seizure type

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5
Q

Type of seizures Carbamazepine is good for?

A
  • complex partial seizures

- can EXACERBATE absence and myoclonic seizures

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6
Q

6 most common anti-epilectic drugs

A
  1. phenytoin
  2. carbamazepine
  3. valproate
  4. Phenobarb
  5. Diazepime
  6. ethosuximide
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7
Q

Which 1 of the 6 common anti-epileptic drugs arent used for tonic-clonic seizures?

A
  1. ethosuximide = only for absence
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8
Q

Which 2 of the 6 common anti-epiletic drugs arent used for absence seizures

A
  1. CARBAMAZEPINE = make them worse!

2. phenytoin

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9
Q

Which 2 of the 6 common anti-epiletic drugs are not used for myoclongic seizures?

A
  1. CARBAMAZEPINE = make them worse!

2. phenytoin

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10
Q

What is the first choice drug for myoclonic seizures?

A

-valproate

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11
Q

What are some side effects that all anti-convulsants seem to cause?

A
  • lethargy, cognitive slowing
  • dizziness
  • GI upset
  • decreased coordination
  • weight gain
  • tremor
  • *these tend to diminished during the first 12 weeks
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12
Q

What are the 3 scary side effects of carbamazepine?

A
  1. aplastic anemia
  2. hepatotoxcity
  3. lupus-like syndrome
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13
Q

What are the 4 scary side effects of phenytoin?

A
  1. aplastic anemia
  2. hepatotoxicity
  3. stevens-johnson syndrome
  4. lupus-like syndrome
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14
Q

What are the is scary side effect of Valproate?

A
  1. hepatotoxicity
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14
Q

What are the scary side effects of ethosuximide?

A
  1. stevens-johnson syndrome
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15
Q

What are 3 more common side effects of phenytoin?

A
  1. gum hypertrophy –> can lead to increased risk of stroke
  2. periopheral neuropahty
  3. pseudolymphoma
16
Q

What are 3 more common side effects of carbamazepine

A
  1. hyponatremia -dose dependent
  2. leukopenia
  3. thrombocytopenia
17
Q

What are 5 more common side effects of valproate?

A
  1. weight gain
  2. tremor
  3. hair thining
  4. amenorrhea
  5. thrombocytopenia
18
Q

Anti-convulsants and bone disease

A
  • anti-convulsants can cause bone disease, possibly b/c they cause an increase in the catabolism of vit D, which leads to decreased Ca absorption
  • MOA unclear
  • seen with valproate especially
  • the more anti-c meds a pt is one, the more likely bone disease is!
19
Q

Anti-convulsants and birth defects

A
  • increased risk of birth defects in women with epilepsy, this risk increases with use of meds and increases even more with higher doses and multiple drugs used
  • most common defects are cardiovascular malformations and orofacial clefts
  • valproate has the highest defect rate –> epecially linked to neural tube defects!
  • *these drugs can alse decrease the effectiveness of oral contraceptives!
  • give phenobarbital to preg mom if they need meds!
20
Q

Checking blood levels of the anti-convulsant drugs

A
  • test should be done in the morning, prior to the first dose
  • should only be done when the epileptic staus of the pt changes, does not need to be done routinely
  • treat the pt, not the drug levels!
21
Q

Tx of status epilepticus

A
  • tx should be initiated whenenver seizure duration is longer than normal for that pt
  • IV meds are given
  • this is a medical emergency so pick a drug and give it! –> usually benzodiapime!
  • usually give something short term and then something for long term
22
Q

What are 3 non-drug tx for epilepsy?

A
  1. surgical intervention
  2. ketogenic diet
  3. vagal nerve stimulator

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