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Pharma > Anti-Epileptics > Flashcards

Anti-Epileptics Flashcards

1
Q

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what is epilepsy

A

chronic condition of the brain characterized by recurrent seizures

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2
Q

what is a seizure

A

a single occurence caused by abnormal neuronal disharge in one part of or the entire brain

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3
Q

causes of epilepsy

A
  1. increased activity of voltage-gated ion channels such as Na, K and Ca
  2. increased excitatory glutmate transmission
  3. decreased inhibitory GABA transmission
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4
Q

target of anti-convulsants

A
  1. inhibit Na channels by prolonged inactivation
  2. inhibit of Ca currents in T-type Ca channels
  3. increased gaba transmission
  4. decreased glutamate transmission
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5
Q

inhibtion of ca currents in t-type ca channels is used to treat

A

absence seizures

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6
Q

inhibition of na channels is used to treat

A

focal and generalized seizures except absence seizures

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7
Q

classification of anti-epileptics

A

aliphatic carboxylic acid
1. valproic acid

newer drugs
1. lamatrogine
2. topiramte

benzodizapenes
1. diazepam
2. clonazepam

iminostilbenes
1. carbamazepene

succinimides
1. ethosoxumide

barbiturates
1. phenobarbitone

hydantoins
1. phenytoin
2. fosphenytoin

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8
Q

Na channel inhibitors

A
  1. phenytoin
  2. valproic acid
  3. carbamazepine
  4. lamotrigine
  5. topiramate
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9
Q

drug of first choice for treatment of focal and generalized seizures

A

phenytoin

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10
Q

phenytoin not useful in the treatment of

A
  1. absence seizures
  2. infant spasms
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11
Q

drug interactions of phenytoin

A

phenylbutazone and sulfonamides displace phenyotin

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12
Q

drug of choice in the treatment of status epilepticus

A

IV fosphenytoin

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13
Q

drug of choice for IV or IM adminitration

A

fosphenytoin

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14
Q

is fosphenytoin or phenytoin more water soluble

A
  • fosphenytoin more water soluble so given IV
  • phenytoin less water soluble so given orally
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15
Q

adverse effects of phenytoin

A

PHENYTOIN

  1. purple glove syndrome (when IV)
  2. hirsutism, more and coarser facial hair
  3. enlarged gums (gingival hyperplasia)
  4. nystahmus
  5. yellowing of skin
  6. teraogeniciy ie fetal hydantoin syndrome
  7. osteoporosis and osteomalacia
  8. interference of vit b12 absorption, causing macrocytic anemina
  9. neuropathies
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16
Q

fetal hyantoin syndrome

A
  1. growth retardation
  2. microcephaly
  3. facial abnormalities such as cleft palate
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17
Q

fetal hydantoin syndrome caused by

A

epioxide metabolite of phenytoin

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18
Q

phenytoin causes osteoporosis due to

A

inhibtion of iron absorption

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19
Q

phenytoin causes macrocytic anemia due to

A

impaired vit b12 absorption

20
Q

at high concentrations phenyotin exhibits what order of kinetics

A

zero order

21
Q

carbamazepine is the drug of choice for

A

complex partial and generalized seizures

22
Q

clinical uses of carbamazepine

A
  1. complex seizures
  2. trigemial neuralgia
  3. bipolar disorder
23
Q

MOA of carbamazepine

A

Na channel blocker

24
Q

contraindications of carbamazepine

A
  • absence or myoclonic seizures
  • apalastic anermia/agranulocytosis
  • rash
25
Q

MOA of Lamotrigine

A

Na channel blocker

25
Q

adverse effects of carbamazepine

A

PATCH

  1. Potentiates ADH action - water retention and hyponatremia
  2. Aplastic anemia/agranulocytosis
  3. Teratogenic
  4. CNS effects (diplopia, ataxia)
  5. Hepatic enzyme elevation
26
Q

clinical uses of lamotrigine

A
  1. simple and complex seizures
  2. ABSENCE SEIZURES
  3. Lennox-Gastaut Syndrome
27
Q

MOA of valproic acid

A

broad spectrum

  1. Na channel blocker
  2. GABA agonist
  3. blocker of t type Ca channels
28
Q

contraindication of valproic acid

A

liver disease

29
Q

adverse effects of VA

A
  1. NTDs
  2. PCOS
  3. weight gain
  4. bone loss
30
Q

first line of treatment for absence seziures

A

valproic acid

31
Q

uses of VA

A
  1. absence seizures
  2. myoclonic
  3. atonic
  4. simple and complex seizures
  5. mixed seizures
  6. when type of seizure cannot be detected
  7. photosensitive epilepsy
  8. juvenile myoclonic epilepsy
32
Q

GABA agonists

A
  1. Barbiturates
  2. Benzodiazapenes
33
Q

second choice for treatment of simple focal or generalized seizures

A

phenobarbital

34
Q

contraindications of phenobarbital

A

absence seizures

35
Q

MOA of phenobarbital

A

increases duration of opening of GABA channels

36
Q

MOA of benzodiazepines

A

increase frequency of GABA channels opening

37
Q

examples of benzodiazepines

A
  1. diazepam
  2. lorazepam
  3. clonazepam
38
Q

which benzodiazepine is used in the treatment of most seizures

A

clonazepam

39
Q

contraindications of benzodiazepines

A
  1. (diazepam) children under 9 years
  2. narrow angle glaucome
40
Q

adverse effects of bzd

A
  • hypotonia
  • dysarthria
41
Q

dysarthria is a common side effect of which anti-epileptic

A

benzodiazepines

42
Q

which antiepileptic is contraindicated in narrow angle glaucoma

A

benzodiazepines

43
Q

ca channel blockers

A
  1. ethosoxumide
  2. valproic acid
44
Q

first line therapy for absence seizures

A

ethosuxumide

45
Q

first line treatment for febrile seizures

A

diazepam

46
Q

treatment of status epilepticus

A
  1. IV diazepam
  2. IV lorazepam
  3. IV fosphenytoin
  4. IV phenobarbitone

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