A/33. Antiepileptics used in absence seizures. “Broad spectrum” antiepileptic drugs. Drugs used for treatment of status epilepticus Flashcards

1
Q

Drugs need to know in this topic

A

ethosuximide

valproate

lamotrigine

clonazepam

levetiracetam

diazepam

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2
Q

Ethosuximide

A

Inhibits T-type Ca2+ channels

Oral

∙no dependence

∙no enzyme induction

∙1st choice for absence seizures w/ minimal sedation

  • GI distress (nausea, vomiting, abdominal pain)
  • Headache, dizziness, lethargy
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3
Q

Valproic acid

A

increase GABA turnover,

Na channel inhibition,

decrease NMDA receptor

Oral

Inhibitor of cytochrome P450 enzymes

  • Seizures (broad-spectrum; including absence seizures)
  • Bipolar disorders
  • Migraine

Side effects:

  1. GI distress (nausea, vomiting, abdominal pain)
  2. Hepatotoxicity
  3. Thrombocytopenia – requires monitoring of PLT count
  4. Pancreatitis
  5. Alopecia
  6. Weight gain
  7. Teratogenicity → neural tube defects (spina bifida)
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4
Q

Lamotrigine

A
  1. Glutamate antagonist
    (AMPA receptor)
  2. Inhibition of axonal Na+ channels

Oral

  1. Broad-spectrum
  2. Partial seizures
  3. Adjunct therapy for generalized tonic-clonic seizures
    * *Side effects:**
  4. Stevens-Johnson syndrome (exfoliative dermatitis)
  5. Hepatotoxicity
  6. Dizziness, headache, diplopia
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5
Q

Clonazepam

A
  1. Anxiety, panic, and phobic disorders
  2. Bipolar disorders
  3. Seizures
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6
Q

Diazepam

A

Oral, IV

acute absence seizures

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7
Q

Levetiracetam

A

Interferes with synaptic release of glutamate

Oral

  1. Broad-spectrum
  2. Partial seizures
  3. Generalized tonic-clonic seizures
    * *Side effects:**
  4. Nervousness, dizziness
  5. Depression
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8
Q

Management of status epilepticus

A
  • Assess ‘ABC’ (airway, breathing, circulation)
  • Assess metabolic state (glucose, electrolytes)
  1. Lorazepam/Midazolam (preferentially IV, give IM if venous access is not secured) – bolus administration
  2. Phenytoin/Levetiracetam (IV) – continuous infusion over 5-20 min’
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