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Flashcards in Pharm anticonvulsants Deck (69)
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1

definition of epilepsy

at least 2 unprovoked seizures separated by 24 hours

2

what single events can precipitate seizusres

withdrawal of CNS depressants
acute neuro illness or toxic systemic
fever

3

what is a simple partial seizure

minimal spread of abnormal discharge, normal consciousness, preserved awareness

4

what is a complex partial seizure

localized onset but discharge becomes widespread, almost always involves limbic system

5

characterstics of complex partial seizure

lip smacking, swallowing fubmling, scratching, memory loss or aberrant behavior

6

secondarily generalized seizure

partial that immediately precedes a generalized tonic clonic seizure

7

what is a generalized seixure

without evidence of localized onset, both brain hemispheres involved

8

what is a grand mal seizure

generalized tonic clonic
sudden, sharp tonic contraction followed by rigidity and clonic movements
patient may cry, moan, lose sphincter control, bite tongue or develop cyanosis

9

after grand mal seizure, patient may have

altered consciousness, drowsiness or confusion

10

postictal Sx of seizure

grand mal
generalized tonic clonic

11

what is an absence seizure

sudden onset and abrupt cessation, altered consciousness,
a blank stare
usually young children through adolescence

12

myoclonic jerking

brief shock like muscle contractions
occur in wide variety of seizures

13

atonic seizures

sudden loss of postural tone, head drop, fall to floor, slumping
many patients wear helmets to prevent head injury

14

AED treatments

suppress seizures but do not cure of prevent epilepsy

15

how do you switch AED Tx monotherapy

taper off initial AED after second AED is titrated to therapeutic level

16

MOA AED

affect ion channel kinetics
augmenting inhibitory neurotransmission
modulating excitatory neurotransmission

17

which AEDs are highly protein bound

phenytoin
tigabine
valproic acid

18

how are AEDs cleared

hepatic metabolism

19

Adverse effects AEDs

sedation, dizziness, blurred or double vision, difficulty concentrating and ataxia

20

MOA phenytoin

blocks sustained high frequency firing action potentials due to preferential binding to and prolongation of inactivated state of Na channel
also dec glutamate and enhances GABA release

21

PK phenytoin

not IM
erratic absorption
highly protein bound
low dose first order kinetics
high dose disproprotionate elimination

22

use of phenytoin

partial seizures, generalized tonic-clonic seizures

23

adverse effects phenytoin

diplopia, ataxia, nystagmus, sedation, gingival hyperplasia, hirsutism

24

long term adverse effects phenytoin

worsening facial features, mild peripheral neuropathy
abnormalities in vit D metabolism causing osteomalacia

25

cardiac effects of phenytoin

hypotension, bradycardia, cardaic arrhythmia, CV collapse, venous irritation and pain, thrombophlebitis

26

DDI phenytoin

related to protein binding
sulfonamides by dispalce phenytoin from site increasing the amount of free drug!
CYP2C9, increased warfarin!!!
CYP3A4, increased risk pregnancy on oral contraceptives

27

MOA carbamazepine

acts on Na Ch resulting in inhibition of high frequency repetitive firing
also acts presynaptically to decrease synaptic release of glutamate

28

PK carbamezepine

autounduction, increased expression of CYPs and UGT

29

use of carbamezapine

partial seizures, generalized tonic-clonic seizures, trigeminal neuralgia, mania in bipolar disorder

30

adverse effects carbamazepine

diplopia, ataxia, mild GI upset, unsteadiness, drowsiness
hyponatremia and water intoxication
idiosyncratic blood dyscrasias
rash, sometimes stevens johnson