Anti-convulsants Flashcards
____ are short term alteration in behavior due to
disordered, synchronous, rhythmic firing of brain
neurons.
Seizures
What distinguished partial (focal) seizures from generalized seizures?
Partial seizures start at a single site in the cortex while generalized involve both hemispheres
How can you distinguish simple versus complex partial seizures?
In simple partial seizures, you do not lose consciousness. In complex partial seizures you have a gradual LOC and strong emotions, lip-smacking, or hand wringing are features
3 spikes/sec on an EEG suggests someone is having a ___ seizure
Absence Seizure
Which type of generalized seizure is associated with 3Hz spikes, sudden, impaired consciousness, staring, blinking. Cause?
Absence Seizures
Cause: thalmic T-type Ca
channels
Which type of generalized seizures is characterized as sudden impaired
consciousness, 20 sec muscle rigidity then 1-2 min
violent rhythmic body and limb movements
Tonic-clonic
Which type of generalized seizures is characterized as shock-like single (< 1 sec) contraction of
muscle in whole body or an extremity
Myoclonic
What types are seizures begin as partial seizure and then transform into generalized?
Secondarily Generalized Seizure (focal to bilateral
tonic clonic)
What four anti-convulsant drugs inhibit voltage-gated sodium channels and prolong inactive state of channel?
Cabamazepine
Oxycarbazepine
Phenytoin
Valproic Acid
Which two drugs act on T-type Ca2+ channels to treat absence seizures?
1) Valproic Acid
2) Ethosuximide
Barbituates like (___, ____) and benzodiazepines like (_____) enhance effect of GABA on GABAa receptors
phenobarbital, primidone
diazepam
What anti-convulsant inhibits the reuptake of GABA?
Tiagabine
Vigabatrin prolongs the effect of ____
GABA
Which anti-convulsant drug can treat absence, myoclonic, partial, and tonic/clonic seizures?
Valproic Acid
Carbamazepine can induce its own metabolism (autoinduce) while ____ cannot
Oxcarbazepine
What three anti-convulsants are good monotherapy treatments for myoclonic seizures?
-Valproic Acid
-Phenytoin
-Carbamazepine
What two drugs are good for treating partial seizures (secondarily generalized)?
-Phenytoin
-Carbamazepine
Phenobarbital is a monotherapy for generalize ____ and partial seizures
tonic-clonic
How does phenobarbital act?
GABAa-receptor (potentiation of synaptic inhibition)
Minor drug allergies occur in 1-2% of patients taking ____
phenobarbital
Common side effect of anti-epileptic drugs?
Ataxia
Phenytoin could have drug-drug interactions with which drug?
Warfarin
Gingival hyperplasia is common with taking which anti-convulsant?
Phenytoin
SJS is a side-effect with use of ____ or ____
Ethosuximide or Phenytoin
Which drug can be used as a monotherapy/adjunct treatment for partial seizure?
Oxcarbazepine
Which drug inhibits T type calcium channels, prolongs inactivation of sodium channels, and increases GABA synthesis (in vitro)
Valproic Acid
Which drug has side effects of increase in hepatic blood enzymes and hepatic toxicity in kids 2 and under on multiple AED?
Valproic acid
Which drug inhibits CYP2C0, result in increased concentrations of phenytoin, phenobarbital, also displaces phenytoin from plasma binding proteins?
Valproic Acid
Benzodiazepines are adjunctive treatment for ___ and juvenile _____ seizures
absence; juvenile myoclonic seizures
True or False: In general newer anti-epileptic drugs lack serious side effects, do not induce liver enzymes (less drug-drug interactions) and are approved for mostly adjunctive treatment
True
____ is a newer anti-epileptic drug used as an adjunctive treatment for partial secondary seizures and for neuropathy/fibromyalgia. It is NOT metabolized, excreted unchanged in the urine.
Gabapentin
Which drug is used to treat Lennox-Gustaut Syndrome?
Felbamate
Which anti-epileptic drug has no drug-drug interactions and is used as an adjunctive treatment for partial and tonic/clonic seizures in adults and myoclonic seizures in kids
Keppra (Levetiracetam)
What drug is a monotherapy and an adjunctive treatment for partial and generalized tonic clonic seizures?
Topiramate/Lamotrigine
How does Topiramate work?
Inhibits sodium channels/AMPA kaonate receptors that enhance GABA receptors
Which newer anti-epileptic drug is most apt to have drug-drug interactions?
Lamotrigine
Clonazepam is a good alternative/adjunctive for treating _____
generalized absence seizures
What two drugs are good adjunctive treatment to partial, secondarily generalized seizures?
Lamotrigine/Valproic acid
______ _____ is a series of seizures where full recovery
Status epilepticus
How is status epilepticus treated?
1) Sedate with benzodiazepine (lorazepam IV)
2) Once seizures are controlled, give fosphenytoin/keppra/ph
Drug concentration increases
disproportionately as dosage is increased for what drug?
Phenytoin
AED’s can alter vitamin D metabolism in liver, which can lead to ___-
osteoporosis
Failure rate of ___ ____ is 3X more
in women taking AEDs
oral contraceptives
Facial and cranial deformities
associated with ___, but all AEDs can
cause fetal hydantoin syndrome
phenytoin
How do manage anti-convulsants in pregnant mother
-If on combo therapy, change to mono
-Give folate to reduce risk of neural tube birth defects
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