anti-epileptics Flashcards
simple partial sz
no LOC
abnl activity of a single limb or muscle group
complex partial sz
LOS
motor dysfunction
generalized sz
immediate LOC
no evidence of localized onset
absent sz EEG
spike and wave pattern (3 Hz)
drugs that block voltage gated Na+ channels
phenytoin
carbamazepine
lamotrigine
zonisamide
may contribute to effects of: phenobarbital, valproate, topiramate
prevent AP and stop release of glutamate
phenytoin
drugs that block voltage gated Na+ channels
carbamazepine
drugs that block voltage gated Na+ channels
lamotrigine
drugs that block voltage gated Na+ channels
zonisamide
drugs that block voltage gated Na+ channels
drugs that block t- type calcium channels
ethosuximide
valproate
used for absence seizures
ethosuximide
drugs that block t- type calcium channels
valproate
drugs that block t- type calcium channels
drugs that enhance GABA transmission postsynaptically
benzodiazepines
barbiturates
topiramate
drugs that enhance GABA transmission presynaptically
tiagabine = inhibit GABA reuptake
vigabatrin = inhibit degradation of GABA - via inhibition of GABA aminotransferase
drugs that reduce glutamatergic transmission post-synaptically
phenobarbital
topiramate
topiramate
drugs that reduce glutamatergic transmission post-synaptically
phenobarbital
drugs that reduce glutamatergic transmission post-synaptically
gabapentin
drugs that reduce glutamatergic transmission pre-synaptically
via blocking presynaptic VG Ca2+ channels
pregabalin
drugs that reduce glutamatergic transmission pre-synaptically
via blocking presynaptic VG Ca2+ channels
Levetiracem
drugs that reduce glutamatergic transmission pre-synaptically - via binding to synaptic vesicle glycoprotein 2A
main drugs used for partial and secondarily generalized tonic-clonic sz
- Carbamazepine
- Oxcarbazepine
- Levetiracetam
- Zonisamide
- Phenytoin
- Valproate
- Lamotrigine
- Topiramate
- Phenobarbital
tonic clonic general seizures main drugs used
- Carbamazepine
- Oxcarbazepine
- Valproate
- Lamotrigine
- Phenytoin
- Topiramate
DOC for absence seizures
ethosuximide
valproate = atypical absent seizures (if EEG doesn’t match normal absence sz) and if tonic-clonic sz present
myoclonic sz DOC
valproate
topiramate also used
levetiracetam used as adjunctive
atonic sz DOC
valproate and lamotrigine
often refractory to all drugs
febrile convulsions tx
<15 mins = supportive therapy
> 15 mins = diazepam IV/rectal
status epilepticus algorithim
IV lorazepam –> IV phenytoin/fosphenytoin –> IV phenobarbital –> general anesthesia with IV midazolam/propofol/barbituates
drug induced seizures in non-epileptic pt tx
diazepam
lorazepam
phenobarbital
break through seizure tx
diazepam rectal gel
anti-epileptics that induce p450
carbamazepine
phenobarbital
phenytoin
anti-epileptic that inhibits p450
valproate
valproate AE
hepatotoxic
p450 inhibitor
inhibits metabolism of several drugs
phenytoin AE
diplopia gingival hyperplasia coarsening of facial features in children hirsutism steven johnson's
0 order elimination
carbamazepine AE
aplastic anemia
agranulocytosis
stevens johnson
anti-epileptics that can cause steven johnsons
phenytoin
lamotrigine**
carbamazepine
phenobarbital
which anti-epileptic has a black box warning
lamotrigine = stop at first sight of rash
phenobarbital AE
sedation stevens johnson tolerance hyperactivity p450 inducer
primidone AE
same metabolite of phenobarbital - same AE
sedation stevens johnson tolerance hyperactivity p450 inducer
vigabatrin AE
visual field loss
feblamate AE
aplastic anemia
hepatotoxicity
used for refractory epilepsy
discontinuing anti-epileptic tx
if sz free for 3-5 years
SLOW - esp with benzo and barb - to avoid withdrawal seizures
anti-epileptic OD
rarely lethal
most dangerous = respiratory depression
highest rate of fetal malformations out of anti-epileptics
valproate
newborn hemorrhagic dz with anti-epilep
enzyme induced anti-epileptics can inc degradation of vit K
should supplement mom and newborn with vit K
first line for essential termor
primidone
propranolol
