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Pharmacology > Anti-Convulsants > Flashcards

Anti-Convulsants Flashcards

1
Q

What is a partial seizure

A

Seizure in one hemisphere

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2
Q

Simple partial seizure:
Consciousness
Progress to what

A

No loss of consciousness

Auras (loss of consiousness)

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3
Q

Complex partial seizure

A

Impairment of consciousness

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4
Q

If a partial seizure becomes generalized, it is called what?
The process that leads to this

A

Secondarily generalized seizure.

Kindling

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5
Q

Generalized seizures originate where

A

Both cerebral hemispheres

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6
Q

Two types of generalized seizure

A

Convulsive

Non-convulsive

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7
Q

The one convulsive seizure type

A

Tonic-clonic

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8
Q

Tonic clonic:
Onset
Which phase first? Describe. Length?
Which phase second? Describe

A

Abrupt
Tonic first: Contractions with arm and legs becoming extended. Lasts 10-20 secs

Clonic second: Muscle relaxation due to exhaustion

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9
Q

Three non-consulsive types

A

Absence
Myoclonic
Atonic

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10
Q 
Absence seizure:
Describe
Consciousness
EEG pattern 
Atypical version difference
A

Sudden onset with brief seizures (zoning out)
Lose consciousness
3 Hz Spike and wave pattern
Less defined onsets/offsets

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11
Q

Myoclonic
Describe
Consciousness

A

Shock-like muscle contractions

No loss of consciousness

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12
Q

Atonic
Describe
Consciousness
2 other names

A

Loss of muscle tone
Loss in postural muscle tone (seem frozen)
Consciousness impaired
Drop attacks or astatic seizures

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13
Q

Status epilepticus?

A

Seizures with 30 mins or less frequency

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14
Q

Therapeutic goal of treating these

A

Control the seizures

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15
Q

When to use polypharmacy to treat?

A

After trying 3 other drugs first

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16
Q

When can you start to end anti-seizure meds?

A

After 3 years or more of being seizure free

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17
Q

How to taper off anti-seizure meds?

A

Slowly one at a time.

18
Q

3 goals of treating seizures

A
  1. Treat the focal seizure
  2. Prevent seizure from spreading
  3. Treat underlying cause
19
Q

3 ways to inhibit seizures

A
  1. Enhance inhibitory like through GABA
  2. Diminish excitatory like calcium channels
  3. Sodium channel blockade
20
Q

When to figure out therapeutic blood levels

A

blood level of drug when patient has favorable response

21
Q

3 early signs of toxicity of anti-seizure med

A

Sedation
Ataxia
Nystagmus

22
Q

8 other toxic changes from anti-seizure meds

A 
Teratogenic
Hepatic toxicity
Renal toxicity
Behavioral changes
Coag disorder
Weight change
Osteoporosis
Hyponatremia
23
Q

5 Sodium Channel blockers

A
  1. Phenytoin
  2. Fosphenytoin
  3. Carbamazepine
  4. Lamotrigine
  5. Felbamate
24
Q

Phenytoin/Fosphenytoin (Phone tow-truck)
Should you use generics?
Kinetics at therpeutic plasma levels

A

No

Zero order

25
Q 
Phenytoin
5 side effects
3 seizure indications
1 non-seizure indication
2 Contra-I's
Interactions (2)
A

SE: Nystagmus, Ataxia, gingival hyperplasia, hirsutism, p neuropathy

Seizure: Tonic-clonic, All partials, Status epilepticus

Non-seizure: Cardiac

Contra-I’s: Absence and Myoclonic

Interactions: Protein binding and biotransformation

26
Q

Fosphenytoin
Difference from phenytoin:
Different admin (2):
One problem

A

DIff: Water soluble with fast onset
Admin: IM or parenteral
Name gets confused, drug dispensing error

27
Q 
Carbamazepine (Car bomb)
Non-seizure use (2)
Three organs affected
Primary indication
Other 
One requirement when using this drug
A

Mood stabilizer for mania and bipolar + Anti-psychosis

Liver, kidney, bone marrow

Primary: Partial Seizure

Other indication: Tonic-clonic

Requirement: Have to check renal, hepatic, BM function

28
Q

Less toxic form of carbazepine

A

Derivative of carbamazepine

29
Q

Lamotrigine (Lamborghini)
Similar to what
Two different SE’s

A

Phenytoin

Stevens-Johnson rash + epidermal necrolysis

30
Q

Felbamate (Vegimite Fell)
Use
2 Main SE:

A

Use when patient doesn’t respond to anything else

SE: Aplastic anemia and stevens-johnson syndrome

31
Q 
Phenobarbital/Primidone
Primary mech
Biotransformation unique feature
Use similar to
Contra-I?
A

Na channel blockade dominates

Auto-induction

Use similar to phenytoin

Do NOT use in absence or myoclonic epilepsy

32
Q 
Primidone
Mech (2)
Biotransformed to (2)
High primidone: PB ratio indicates what
A

Block inactive Na channels + Enhance GABA inhib

PHenobarbital + PEMA

indication of poor compliance with normally low phenobarbital accumulation

33
Q 
Valproic Acid 
Special title
Mech (3)
Protein binding fact
Seizure use
Toxicity
3 interactions
A

Best seizure drug probably
Mech: GABA enhance, Block Na+, Block Ca+,
Protein binding: Near saturation
Use: All seizures
Toxicity: Very toxic below the diaphragm (liver, alopecia, pancreas, teratogenic)
Interactions: Bio-T, PB, Clonazepam

34
Q 
Topiramate
Similar to 
Extra mechanism
Indicated for
Non-seizure use
Drug Interaction special feature
A 
Similar to valproic
Also is carbonic anhydrase 
All seizures
Migraines
Low incidence of drug interactions
35
Q

Benzodiazepines
3 drugs
Mech (2)
Special feature in terms of anti-epileptic activity

A

3 drugs: Diazepam, Lorazepam, Clonazepam
Mech: GABA inhib and sodium blocking
Feature: Can all of the sudden stop being anti-convulsant

36
Q 
Ethosuximide
Special feature
Mechanism
Best for what seizure
Safety
A

The drug for absence epilepsy
Blocks T calcium currents
Absence epilepsy
Very safe at normal dose (toxic high)

37
Q 
Zonisamide
Type of drug
Indicated for
Mechanism
Minor mechanism
Half life
Adverse reaction (1)
A 
Sulfonamide
Partial seizures
Block sodium channels
Inhibit carbonic anhydrase
Long half life
Sulfonamide allergy
38
Q

Lacosamide
Mech
Indicated for

A

Slows Inactivates volgate-gated sodium channels

Partial seizures

39
Q

Tiagabine
Mech
Indicated for
Half life feature

A

Mech: Inhibit GABA uptake
Indicated: Partial seizures
Half life: Short so tough dosing

40
Q

Levetiracetam
Indicated for
Mechanism

A

Adjunct in all seizures

Inhibitory to kindling

41
Q

Ezogabine

Mechanism

A

a

Pharmacology (6 decks)

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