Pharmacology - Anticonvulsants (Exam 2)

Question 1

Brief, temporary disturbance in electrical activity of the brain; a single episode of jerky movements

Answer 1

Seizure (convulsion)

Question 2

Recurring seizures; group of disorders characterized by abnormal electrical discharge from CNS neurons in the form of imbalance between excitatory and inhibitory impulses

Answer 2

Epilepsy

Question 3

Excitatory receptors

Answer 3

NMDA
AMPA

Question 4

Excitatory neurotransmitters

Answer 4

Glutamate
Aspartate

Question 5

Inhibitory receptor

Answer 5

GABA-R

Question 6

Inhibitory neurotransmitter

Answer 6

GABA

Question 7

Benzodiazepines cause increased _______, leading to ______ __________ and ________

Answer 7

inhibition; CNS depression and sedation

Question 8

If you have too much __________ signals or too little ________ signals, you can have __________

Answer 8

excitatory; inhibitory; epilepsy

Question 9

Petit mal

Answer 9

Absence seizures

Question 10

Seizures that cause you to lose focus, blink rapidly, or stare out into space for a few seconds

Answer 10

Absence seizures

Question 11

Grand mal

Answer 11

Tonic-clonic seizures

Question 12

Seizures that cause you to cry out, fall to the ground, or experience strong muscle jerking or contractions

Answer 12

Tonic-clonic seizures

Question 13

What are the 2 generalized seizures?

Answer 13

1. Absence seizures
2. Tonic-clonic seizures

Question 14

What are the 3 focal (partial) seizures?

Answer 14

1. Simple
2. Complex
3. Secondary generalized

Question 15

Seizures that affect a small part of the brain and can have minimal symptoms like a small twitch or strange taste in your mouth

Answer 15

Simple focal seizure

Question 16

Seizures that involve multiple areas of the brain and cause confusion; disoriented or unable to respond for a few seconds to minutes

Answer 16

Complex focal seizure

Question 17

Seizures that begin as focal seizure in one part of the brain and progress to a generalized seizure

Answer 17

Secondary generalized seizure

Question 18

Seizures that are very prolonged and cause brain damage or death; EMS must be called

Answer 18

Status epilepticus

Question 19

How do anti-seizure drugs work?

Answer 19

Reduce excitatory signals
Enhance inhibitory signals

Question 20

How do you reduce excitatory signals?

Answer 20

Inhibit glutamate/aspartate release

Inhibit NMDA/AMPA signaling

Question 21

How do you enhance inhibitory signals?

Answer 21

Block GABA reuptake

Enhance GABA-R signaling

Question 22

How to block action potential

Answer 22

1. Enhance Cl- channels
2. Block Na+ channel
3. Enhance K+ channel

Question 23

What drug is a barbiturate? What is it used to treat?

Answer 23

Phenobarbital; treats seizures

Question 24

How does phenobarbital work?

Answer 24

Enhance binding of GABA

Increase the time that GABA-A activated Cl- channels are open

Question 25

What is an adverse effect of barbiturates?

Answer 25

Osteomalacia

Question 26

What drugs are hydantoins?

Answer 26

Phenytoin Dilantin

Question 27

How do phenytoin, dilantin, and carbamazepine work?

Answer 27

Reversible binding to inactivated Na+ channels Stabilize Na+ channels in inactivated state

Question 28

What factors can alter phenytoin protein binding? What do all of these factors cause?

Answer 28

Hypoalbuminemia Renal disease Presence of displacing drugs (ex: aspirin) Causes increased unbound ("free") drug

Question 29

What are the adverse effects of hydantoins?

Answer 29

Fetal hydantoin syndrome (cleft lip, cleft palate, congenital heart disease, neural tube defect) Osteomalacia (interferes with Ca2+ absorption)

Question 30

Which drug causes gingival overgrowth?

Answer 30

Phenytoin

Question 31

What drug is the 1st choice for absence seizures?

Answer 31

Ethosuximide

Question 32

What is the mechanism for ethosuximide?

Answer 32

Reduce Ca2+ influx through T type Ca2+ channels

Question 33

What is the mechanism for valproic acid?

Answer 33

Binds to inactivated Na+ channels Reduces Ca2+ influx through T type Ca2+ channels Enhances GABA activity

Question 34

What can valproic acid cause?

Answer 34

Spina bifida and neural tube defects

Question 35

What are the 3 things GABA drugs do?

Answer 35

1. Increase GABA-R activation 2. Inhibit GABA transaminase 3. Inhibit GABA transporter-1

Question 36

What drugs are benzodiazepines?

Answer 36

Diazepam Midazolam

Question 37

What is the mechanism for diazepam and midazolam? What do they treat in emergencies?

Answer 37

Increase GABA-R activation Treat status epilepticus

Question 38

What drug is a neurosteroid?

Answer 38

Ganaxolone

Question 39

What is the mechanism for ganaxolone?

Answer 39

Steroid binding site (allosteric site) on GABA-R

Question 40

What is the mechanism of vigabatrin?

Answer 40

Inhibits GABA transaminase (vigabaTRin - TRansaminase)

Question 41

What is the mechanism for tiagabine?

Answer 41

Inhibits GABA transporter-1 (Tiagabine - Transporter)

Question 42

What is the mechanism for gabapentin?

Answer 42

Inhibits L-type Ca2+ channels

Question 43

What is the mechanism for lamotrigine?

Answer 43

Binds to inactivated Na+ channels

Question 44

What is the mechanism for levetiracetam?

Answer 44

Synaptic vesicle glycoprotein inhibition - modulates glutamate release

Question 45

Which drugs are the GABA acting drugs (gabanoids)?

Answer 45

Vigabatrine Tigabine Ganaxolone Gabapentin

Question 46

What is the main aim for anti-epileptic drugs?

Answer 46

Control seizures with least # of drugs

Question 47

T/F you should never stop treatment with anti-epileptic drugs suddenly

Answer 47

True, stopping suddenly could cause status epilepticus

Question 48

What should you do if a patient has a seizure in your office?

Answer 48

Inject midazolam intra buccal, IV, IM

Question 49

Repeated or continuous seizures for > 5 minutes or no return to baseline

Answer 49

Status epilepticus (emergency!)

Question 50

Which drugs can treat status epilepticus?

Answer 50

Benzodiazepines: Diazepam Midazolam