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Pharm 3 > Test 2- Anti seizure > Flashcards

Test 2- Anti seizure Flashcards

(102 cards)

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1
Q

What is the etiology of epilepsy?

A

disturbed regulation of electrical activity in the brain resulting in synchronized and excessive neuronal discharge

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2
Q

How do we define status epilepticus?

A

Technically a seizure lasting more than five minutes

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3
Q

What is the postictal period?

A

Transition from the ictal state back to pre seizure baseline level of awareness and function

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4
Q

What is photosensitive epilepsy?

A

Visual stimuli that results in seizures

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5
Q

What is gravet syndrome?

A

Genetic mutation in sodium channels

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6
Q

What is neurocysticerosis?

A

Epilepsy as an infectious sequelae

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7
Q

What is the main difference in focal and generalized seizures?

A

Focal- involves usually one portion of the brain

Generalized- Both hemispheres of the brain involved

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8
Q

What can a focal progress to?

A

Secondarily generalized seizure

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9
Q

What are the different types of generalized seizures?

A

Absence, clonic, myoclonic, tonic, atonic seizure

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10
Q

Why is it important to know the type of seizure occuring?

A

Incorrect selection can worsen or elicite seizures

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11
Q

What are the three goals of therapy for seizure related pharmacology?

A

Termination of seizure, maintenance, and avoiding adverse drug effects

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12
Q

What is the MOA of sodium channel blockers?

A

Prevent AP’s from occurring by binding to the sodium channel when it’s inactivated

AP’s prevented, not allowing signal to travel down and cause release of NT’s via calcium

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13
Q

What is the use of carbamazepine (tegretol)?

A

Focal seizures

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14
Q

What is the adverse effects of carbamazepine?

A

Hyponatremia, dipolopia, dizziness, and ataxia, SJS

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15
Q

What is important to know about tegretols metabolism?

A

Autoinduces its own metabolism through upregulation of CYP3A4

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16
Q

What are the important ddi for carbamazepine?

A

Oral contraceptives, and many others

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17
Q

What is Oxcarbazepines MOA? (Trileptal)

A

Enhances fast inactivation of na channel, aka, sodium blocker

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18
Q

What is Trileptals ADE’s?

A

Similar to carbamazepine, hyponatremia more likely

dipolopia, dizziness, and ataxia, SJS

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19
Q

What is the anti seizure activity attributed to in Oxacarbazepine?

A

It’s metabolite, S-licarbazepine

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20
Q

How does Oxcarbazepine relate to carbamazepine?

A

Ox is a derivative of carb

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21
Q

Whats the benefit of Oxcarbazepine to Tegretol?

A

Ox DOES NOT autoinduce, less hepatic enzyme induction overall

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22
Q

What seizures are Lacosamide (vimpat) used for?

A

Focal

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23
Q

What are the adverse effects of Lacosamide (Vimpat)?

A

Dizziness, HA, Nausea, diplopia, can also cause QT prolongation

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24
Q

Why are DDI with Lacosamide (Vimpat) minimal?

A

It does no induce/inhibit CYP 450

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25
What is now known about Lacosamide (Vimpat) MOA at the sodium channel?
It is a Na inactivator with SLOW binding
26
What is Lacosamides (Vimpat) BBW?
Suicidality
27
What is Phenytoid and Oxcarbazepines exact actions as a sodium channel blocker? Also, Lamotrigene (Lamictal)
Enhances fast inactivation of voltage gated sodium channels
28
What is phenytoin used for?
Focal, generalized, status epilepticus
29
What is phenytoins (Dilantin) ADE's
Nystagmus, gingival hyperplasia, hirsutism, peripheral neuropathy, osteomalacia, diplopia, ataxia, SJS, IV use is also associated with purple glove syndrome
30
What is phenytoin metabolized by?
CYP 450 inducer Highly protein bound But it varies on formulation. Metabolized by 2C9, 2C19 to inactive metabolites
31
What is the unique aspect of phenytoins metabolic considerations?
Saturation of metabolic enzymes results in zero order (NONLINEAR) kinetics
32
What is Lamotrigine (Lamictal) used for?
Focal, generalized, and absence seizures
33
What is Lamotrigine (Lamictal) ADE?
SJS, paradoxical insomnia, dizziness, HA, Diplopia, nausea, somnolence
34
What is lamotrigine (Lamical) metabolization through?
Glucuronidation
35
Which medication is preferred for absence seizures?
Valproate/ethosuximide
36
What medication is preferred for absence seizures in women that are of childbearing age?
Lamotrigene (Lamictal)
37
What is the only calcium channel blocker listed in this ppt?
Ethosuximide
38
How does ethosuximide specifically work?
Blockage of calcium channel, specifically T-type in the thalamus
39
What drug is considered a first line treatment for absence seizures?
Ethosuximide, which is the only thing it can treat
40
What is ethosuximdes ADE's?
GI upset, fatigue, HA, dizziness, hiccup, euphoria HICCUP Also, some beneficial behavior changes possible?
41
How is ethosuximide metabolized?
3A4
42
What is the only potassium channel opener listed?
Ezogabine
43
What is ezogabine used for?
Third line drug or focal seizures, but it's no longer used in the US
44
Why was ezogabine D/C in the US?
Major vision side effects
45
What is the MOA of phenobarbital?
GABA a agonist, causes hyperpolarization through increased duration channel opening
46
What is the use of phenobarbital? What can it also be technically used for as well?
Focal and generalized seizures | Also myoclonic, but must be careful because it can worsen absence and infantile
47
What is important to know about phenobarbitals metabolism?
Metabolized by 2C19, Induces CYP enzymes
48
What drug is Primidone similar to?
Phenobarbital
49
What is primidone used for?
Focal and generalized | Also, essential tremor (Tremor during movement)
50
What is primidones ADE's?
Sedation, GI upset
51
What is primidone metabolized to?
Phenobarbital and PEMA
52
What is benzos MA?
GABA allosteruc agonist, increases the frequency of channel openings
53
What is benzos used for in the seizure world?
Status epilepticus, cluster seizures
54
Which benzo can be given rectally?
Diazepam
55
Which benzo is approved for Lennoz Gastaut?
Clobazam
56
What is Vigabatrin (Sabril, vigadrone) MOA?
Irreversible GABA transaminase (GABA-T )inhibitor
57
What is vigabatrin used for?
Focal seizures
58
What is vigabatrins ADE's?
Irreversible retinal dysfunction, somnolences, HA, dizziness, weight gain, psychiatric issues IRREVERSIBLE RETINAL DYSFUNCTION
59
What is one broad category of diseases that would be containdicated with vigabatrin?
Psychiatric issues
60
What is Tiagabine (Gabitril) MOA?
Inhibits GAT-1 GABA transporter, preventing the reuptake of GABA
61
What is Tiagabine used for?
Focal seizures
62
What is tiagabines ADE's?
Nervousness, dizziness, tremor, difficulty concentrating, depression, confusion, ataxia
63
What is tigabine contraindicated in?
Generalized seizures
64
What is Tiagabine (gabitril) formulated with? why?
Lipohpilic tag to cross the BBB
65
What is bromides for?
Epilepsy in dogs
66
What is bromism?
Mental slowing, almost like a severe CNS depression
67
``` What is levetitacetam (Keppra) MOA? Also Brivaracetam (Briviact) ```
Binds SV2A to modify release of NT's Note-SV2A is an integral membrance protein that promotes vesicles exocytosis
68
How is Keppra metabolized?
In the blood, NO CYP INVOLVEMENT
69
What is keppras ADEs?
Minimal, somnolence, asthenia, ataxia, and dizziness
70
What is brivaracetam (Briviact) used for?
Focal, but perhaps generalized as well
71
Should we use brivaracetam and keppra together?
Nah, no benefits to doing that
72
What is Gabapentin (Neurontin) MOA?
Binds to subunit of a2 delta voltage dependent calcium channel
73
What is gabapentin used for?
Add on therapy for focal seizures
74
What is gabapentins ADEs?
Sedation, ataxia, weight gain
75
What is gabapentin metabolized by?
No clue, but not the CYP system
76
What is the sister drug of gabapentin?
Pregabalin (lyrica)
77
What is the MOA of Perampanel (Fycompa)
Allosteric, noncopetitve AMPA receptor antagonist | PREVENTS CORTICAL SPREAS
78
What is Perampanel (Fycompa) used for?
Focal
79
What is Perampanel (Fycompa) ADEs?
Behavioral changes dizziness, somnolence, HA
80
How is Perampanel metabolized?
CYP 3A4
81
What is valproate (Depakote) used for?
VERY VERSATILE Focal, generalized, absence Also bipolar and migraines
82
What is valproates ADEs?
Tremor, weight gain, hair loss, hepatotoxic Fat, yellow, and bald lol
83
What is important to know about valporates metabolism?
Its highly protein bound, which effects the metabolism of many other drugs
84
What is Dicalproex a combination of?
Valproic acid an sodium valproate
85
What is valporates effects on newborns?
Teratogenic, category x
86
What is felbamates (felbatol) MOA?
Blocks NMDA receptors, barbituate like potentiation of GABA a receptors
87
What are the used for Felbamate (felbatol)?
Focal, Lennox-Gastaut
88
What is Felbamates ADE's?
Improved alertness, aplastic anemia, severe hepatitis
89
How is felbamate metabolised?
3A4 an 2E1
90
What is Topiramate (Topamax) used for?
Focal, generalized, Lennox-Gastuat, migraines
91
What is topiramate ADEs?
Cognitive effects, parathesias, weight loss
92
What is topitamate a weak inhibitor of?
Carbonic anhydrase, which can lead to metabolic acidosis
93
What is Zonisamide (Zonegran) MOA?
Blocks voltage gated na channels, but likely more actions
94
What is Zonisamide used for?
Focal, generalized
95
What are the ADE's for Zonisamide?
Drowsiness, cognitive impairment, renal stones, skin rashes, weight gain
96
How is zonidamide metabolized?
3A4
97
What does Zonidamide (Zonegran) contain?
Sulfur, which can elicit a sulfa allergy reaction
98
What is Ruinamide (Banzel) used for?
Lennox-Gastaut, focal
99
What is Rufinamides ADE's?
HA, dizziness, somnolence, fatigue, nausea
100
VOLT Cant Get Peanut Butter
``` Vigabatrin Oxcarmazepine Lacosamide Tiagabine Carbamazepine Gabapentin Perampanel Brivarecetam ``` Just Focal
101
P3 LKZ
``` Focal and Gernalized Phenobarbital Primidone Phenytoin Lamictal Keppra Zonisamide ```
102
Forget The Refs
Felbremate Topiramate Rutinamide

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