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NS II > Anti-convulsants > Flashcards

Anti-convulsants Flashcards

1
Q

Define seizure

A

Abnormal neuronal control resulting in dysfunction of motor control, sensory perception, autonomic dysfunction, and behavior changes.

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2
Q

Define epilepsy

A

Spontaneous, unprovoked seizures separated by 24 hours

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3
Q

Describe the pathophysiology of a seizure

A

Multiple different mechanisms (ions, neurotransmitter, 2nd messenger) lead to the excess of excitability or the disorder of inhibition. The result is spreading excitability.

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4
Q

Describe the classification of seizures.

A

Seizures can be classified into broad categories based on region of activity. Partial (focal) or generalized.

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5
Q

Name and describe the 3 types of partial (focal) seizures.

A
  1. Simple partial seizures - patient maintains awareness, but there are motor, autonomic, sensory, and behavioral manifestations
  2. Complex partial seizures - began focally, but progress to widespread; involve the limbic system –> memory loss and abnormal behavior
  3. Secondarily Generalized - focal onset progresses to generalized tonic-clonic seizure
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6
Q

Describe the generalized tonic-clonic seizure.

A

Generalized tonic-clonic (grand mal) seizure - begins with tonic contractions, followed by clonic contractions; patient may moan, become incontinent, become cyanotic, or bite tongue; followed by posttictal state (confusion and temporary amnesia)

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7
Q

Describe the absence seizure.

A

Absence (petit mal) seizure - sudden onset and abrupt cessation of blank state; occurs in young children to adolescence

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8
Q

Describe the myoclonic jerk.

A

Shock-like muscle contractions of many seizure types

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9
Q

Describe the general treatment approach to seizures.

A

The goal of therapy is to suppress seizures, not prevent or cure. Compliance is of utmost importance.

Begin with monotherapy at low doses and titrate gradually. If the dosing can’t be increased, switch to another monotherapy before double therapy. The second drug should be titrated before the 1st drug is tapered.

Treatment must be monitored regularly due to narrow therapeutic windows.

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10
Q

What are the common ADRs of anti-epileptic drugs (AEDs)

A

Sedation, dizziness, ataxia, visual disturbances, and difficulty concentrating

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11
Q

Describe the MOA, uses, unique ADRs, and DDIs (3) of phenytoin

A

MOA - prolongs Na channel inactivation, inhibits glutamate release, and enhances GABA release

Uses - partial and generalized tonic-clonic

Unique ADRs - Gingival hyperplasia, hirsutism, bradycardia, hypotension, and dysrrhythmias

DDIs - Highly protein bound (displaced by sulfonamides), CYP2C9 inducer (warfarin decreased) and CYP3A4 inducer (decreased oral contraceptives

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12
Q

Describe the MOA, uses, unique ADRs, and DDIs of carbemazepine.

A

MOA - prolong Na channel inactivation, inhibits glutamate release

Uses - partial, generalized tonic-clonic, and mania of bipolar disorder

Unique ADRs - hyponatremia, blood dyscrasias (aplastic anemia and agranulocytosis, leukopenia, and SJS

DDIs - Potent CYP3A4 inducer –> autoinduction, decreased levels with phenytoinn and phenobarbital; may decrease oral contraceptive; synergistic with valproic acid

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13
Q

Describe the MOA, uses, unique ADRs, and DDIs of phenobarbital.

A

MOA - enhances GABA-A current and decreases glutamate release

Uses - partial seizures and tonic-clonic seizures

Unique ADRs - none

DDI - potent CYP450 inducer

Note: belongs to the barbituate drug class

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14
Q

Describe the MOA, uses, and unique ADRs of gabapentin.

A

MOA - binds alpha2delta portion of Ca channels –> decreased calcium conductance and release of glutamate

Uses - partial seizures and generalized tonic-clonic

Unique ADRs - headache and tremors

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15
Q

Describe the MOA, uses, unique ADRs, and DDIs of lamotrigine.

A

MOA - inactivation of Na and Ca channels

Uses - partial seizures, generalized tonic-clonic seizures, and bipolar disorder

Unique ADRs - skin rash

DDIs - concentration may be reduced by estrogen containing OCPs; may cause failure of progestin-only OCPs

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16
Q

Descirbe the MOA, uses, and unique ADRs of levetiracetam.

A

MOA - binds to SV2A on vesicle preventing fusion and modulating release of glutamate and GABA

Uses - partial seizures, generalized tonic-clonic, and myoclonic

Unique ADRs - mood and behavioral changes (less common)

17
Q

Describe the MOA, uses, unique ADRs, and DDIs of topiramate.

A

MOA - blocks Na and Ca channels, binds GABA-A, and may act on NMDA receptors

Uses - partial seizures, generalized tonic-clonic, and migraines

Unique ADRs - parasthesias, nervousness, and weight loss

DDIs - may decrease effectiveness of OCPs

18
Q

Describe the MOA, uses, unique ADRs, and DDIs of ethosuximide.

A

MOA - Inhibits T-type Ca channels; responsible for pacemaker current in thalamic neurons which cause the rhythmic cortical discharge of absence seizures

Uses - absence seizures

Unique ADRs - gastric distress

DDIs - metabolism inhibited by valproic acid

19
Q

Describe the MOA, uses, unique ADRs, and DDIs of valproic acid.

A

MOA - blocks Na channels; blocks NMDA receptors, and increases GABA

Uses - absence, partial, generalized tonic-clonic, myoclonic, status epilepticus, bipolar disorder, and migraine prophylaxis

Unique ADRs - gastric distress, fine tremor, weight gain, hepatotoxicity (requires monitoring), and thrombocytopenia

DDIs - Inhibits enzymes –> increased [carbamazepine]

20
Q

Describe the MOA, uses, and unique ADRs of diazepam.

A

MOA - binds GABA-A; Highly lipophilic –> short duration of action

Uses - status epilepticus, partial, generalized tonic-clonic, and myoclonic

Unique ADRs - none

21
Q

What are the DOCs for Tx of partial seizures, including secondarily generalized?

A

Carbamazepine and lamotrigine and levetiracetam

22
Q

What are the DOCs for Tx primary generalized tonic-clonic seizures?

A

Valproate and lamotrigine and levetiracetam

23
Q

What are the DOCs for Tx of absence seizures?

A

Ethosuximide and valproate

24
Q

What are the DOCs for Tx of atypical, myoclonic, and atonic seizures?

A

Valproate and lamotrigine and levetiracetam

25
Q

Which AEDs are thought to be teratogenic? What is the result?

A

Phenytoin, valproate, and topiramate are thought to cause congenital malformations

NS II (7 decks)

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