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Neuro II > Anti-epileptic drugs > Flashcards

Anti-epileptic drugs Flashcards

1
Q

Brief recurrent myoclonic jerks of body with sudden flexion or extension of the body and limbs that presents before 1 yo

A

Infantile spasms/West syndrome

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2
Q

Severe myoclonic epilepsy in infancy

A

Dravet syndrome

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3
Q

More than 5 minutes of generalized convulsive seizure, or 2+ seizure episodes without recovery of consciousness in between

A

Status epilepticus

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4
Q

Drugs for epilepsy that act on Na channels

A

Phenytoin
Carbamazepine
Lamotrigine
Topiramate
Valproic acid

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5
Q

Drugs for epilepsy that act on Ca channels

A

Ethosuximide
Valproic acid

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6
Q

Strategies of epilepsy treatment

A

-stabilize membrane by blocking voltage-gated channels to prevent depolarization
-Increase GABA-ergic transmission
-Decrease excitatory glutamate transmission

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7
Q

Mechanism of phenobarbitone

A

Potentiation of synaptic inhibition through action on GABA-A receptors by prolonging opening of Cl channels

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8
Q

Toxicity of phenobarbitone

A

Sedation
Nystagmus and ataxia
Rashes
Megaloblastic anemia
Osteomalacia

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9
Q

Drugs for generalized tonic clonic seizures

A

Phenobarbitone
Phenytoin
Carbamazepine **
Valproic acid
Zonisamide
Topiramate
Parampanel (adjuvant)

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10
Q

Drugs for simple partial/focal aware seizures

A

Phenobarbitone
Phenytoin
Lacosamide
Carbamazepine **
Valproic acid
Tiagabine (adjuvant)
Vigabatrin (adjuvant)
Zonisamide
Levetiracetam
Topiramate
Parempanel (adjuvant)

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11
Q

Drugs for complex partial/focal impaired awareness

A

Phenobarbitone
Phenytoin
Lacosamide
Carbamazepine
Valproic acid
Lamotrigine (adjuvant)
Levetiracetam

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12
Q

Drugs for status epilepticus

A

Phenobarbitone (IM or IV)
Phenytoin

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13
Q

Prodrug of phenobarbital

A

Primidone

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14
Q

Mechanism of phenytoin/dilantin

A

Limits the sustained high frequency repetitive firing of APs

Slows the rate of recovery of voltage activated NA channels

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15
Q

Pharmacokinetics of phenytoin

A

Highly protein bound
Microsomal enzyme inducer
Metabolism shifts from first order to zero order kinetics (saturation kinetics)

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16
Q

Adverse effects of phenytoin

A

Gum hypertrophy
Hirsutism
Coarse facial features
Acne
Drug induced lupus
Megaloblastic anemia
Osteomalacia

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17
Q

Epilepsy drug that can cause fetal hydantoin syndrome if taken in pregnancy

A

Phenytoin

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18
Q

Therapeutic range of phenytoin

A

10-20 mcg/mL

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19
Q

Additional use of phenytoin, other than epilepsy

A

Trigeminal neuralgia

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20
Q

IV form of phenytoin

A

Fosphenytoin

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21
Q

Mechanism of lacosamide

A

Na channel blocking antiseizure drug

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22
Q

Mechanism of carbamazepine

A

Inhibits high frequency repetitive firing by prolonging the inactivated state of Na channels

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23
Q

Adverse effects of carbamazepine

A

Drowsiness
Vertigo
Ataxia
Diplopia
Blurred vision
Hyponatremia and water intoxication
Idiosyncratic reactions –> agranulocytosis and aplastic anemia

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24
Q

Most effect drug for complex partial/focal impaired awareness

A

Carbamazepine

25
Q

First choice drug for general tonic-clonic and simple partial/focal aware seizures

A

Carbamazepine

26
Q

Other, non epileptic, uses for carbamazepine

A

Neuralgias
Bipolar disorder
Acute mania

27
Q

Drug interactions of carbamazepine

A

Induces microsomal enzymes
Metabolism inhibited by macrolide antibiotics

28
Q

Less potent analog of carbamazepine

A

Oxcarbazepine

29
Q

Mechanism of ethosuximide

A

Primarily on thalamocortical system that selectively inhibits low threshold, high amplitude, T type Ca current

30
Q

Toxicity of ethosuximide

A

Gastric distress
Lethargy and fatigue
Hypersensitivity
Drug induced lupus

31
Q

Drugs used for absence seizures

A

Ethosuximide
Valproic acid
Clonazepam

32
Q

Mechanism of valproic acid

A

Inhibits sustained repetitive firing, reduces low threshold T type Ca current, and increases levels of GABA

33
Q

Toxicity of valproic acid

A

Transient GI symptoms
Alopecia
Curling of hair
Rashes
Stimulation of appetite
Fulminant hepatitis
Hyperammonemia

34
Q

Effect of using valproic acid in pregnancy

A

NTDs

35
Q

Drugs used in myoclonic and atonic seizures

A

Valproic acid

36
Q

Other, non-epileptic, uses of valproic acid

A

Bipolar disorder
Mania

37
Q

Mechanism of felbamate

A

Block NMDA receptor

38
Q

Side effects of felbamate

A

Aplastic anemia
Severe hepatitis at unexpectedly high rates

39
Q

Third-line drug for refractory partial seizures

A

Felbamate

40
Q

Drugs for Lennox-Gestaut syndrome

A

Valproic acid
Felbamate
Clobazam

41
Q

Medications used for emergency control of convulsions in status epilepticus, tetanus, or eclampsia

A

Diazepam
Lorazepam

42
Q

Add on drugs for partial and general tonic-clonic seizures

A

Gabapentin
Pregabalin

43
Q

Mechanism of gabapentinoids

A

Bind to alpha-2-delta, decreasing glutamate

44
Q

Mechanism for tiagabine

A

Inhibitor of GABA uptake

45
Q

Drug of choice for infantile spasms

A

Vigabatrin

46
Q

Mechanism of lamotrigine

A

Blocks Na channels
Prevents release of excitatory NTs

47
Q

Toxicity of lamotrigine

A

Rash
Stevens-Johnson syndrome

48
Q

Mechanism of levetiracetam

A

Binds selective to SV2A, reducing the release of the excitatory NT glutamate

49
Q

Pharmacokinetics of levetiracetam

A

Not metabolized by cytochrome P450
No interactions with other antiepileptics

50
Q

Mechanism of topiramate

A

Block Na channels
Potentiates actions of GABA
May also block glutamate receptors

51
Q

Side effects of topiramate

A

Kidney stones

52
Q

Mechanism of parempanel

A

Selective non-competitive antagonist of AMPA receptors

53
Q

Only approved uses of cannabidiol

A

Dravet syndrome
Lennox-Gestaut syndrome

54
Q

Drug interactions of carbamazepine

A

Phenytoin
Valproate
Macrolide antibiotics
Phenobarbital

55
Q

Side effect of lacosamide

A

Small increase in PR interval

56
Q

Drug interactions of phenytoin

A

Phenobarbital
Carbamazepine
OCPs
Valproate

57
Q

Interactions of phenobarbital

A

Valproate
Carbamazepine
Phenytoin
Steroids

58
Q
A

Neuro II (21 decks)

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