Anti Seizure And Anti Epileptics Flashcards
Summary of factors contribute to seizure vs control
Epsps Ipsp
Na influx K efflux
Ca currents Cl influx
Paroxysmal depolarization Pumps
Low ph
May exacerbate bleeding disorders
Valproic acid
Newer aeds have ______ cns sedating effects than classical
Less
_____ receptor is responsible for absence sezuire
T
Nmds recptor blockers
Reduce seizure incidence
Carbamazepine
1st line for partial seizure
Moa- slows rate of recovery of na channels
AUTO INDUCTIVE STATE
AE: agranulocytosis and aplastic anemia in elderly
Induces cyp450 enzymes
Oxcarbazepine
Improved version of carbamazepine
Moa: blockade of na channels
Ae: cns sedation
Stimulate cyp3a inhibit cyp2c19
Phenytoin
1st line forpartial
Mediated by slow rate of recovery of na
Peak level - 4-12 hrs
Ae: cns sedation(nystagmus, diplopia) GUM HYPERPLASIA
Lamotrigine
Mono therapy for refractory partial seizure
Effective against generalized
Moa- dependent inhibition of na; inhibit ca channels
Ae: dermatitis
Zonisamide
Add on for partial and generalized
Moa: blocks na and t type ca
Ae: cns sedation
Lacosamide
Inactive against clonic but efficacious against hippocampal kindled seizures; improved zonisamide
Ae: headache, nausea, dizziness, diplopia
Phenobarbital
1st effective organic anti seizure Not used for coma patients Synaptic inhibition through gabaa receptor Ae: cns, ataxia, rash, tolerance, C/i for diagnosing brain dead patients
Clonazepam
Doc for myoclonic seizure and subcortical clonus
Anxiolytic, anti depressant, hypnotic
Ae: withdrawal may induce exacerbation of seizures: insomnia,a nxiety, psychosis, tremor
Diazepam
Status epilepticus
Allosteric modulator
Cns, tolerance, dependence, hyperexcitability
Valproic acid
1st line for generalized
Enhance gabatransmission, block na
Hepatotoxicity, birth defects
Potentiate cns depressants
Tiagabine
Add on therapy
Interferes with gaba reuptake
Cns sedation
Gabapentin
Add on for partial
Also for neuropathic pain and migraine
Eliminated by RENAL excretion
Somnolence, dizziness,ataxia, fatigue
Vigabatrin
Add on for partial
Mono for infantile spasms
Blocks gaba metab
Cns sedation, opthal abnormal
Felbamate
3rd line for refractory partial
Aplastic anemia, severe hepa
Topiramate
Block na, inc freq gaba openings
Ae: can precipitate renal canaliculi: due to carbonic anhydrase
Drug inter: lessen effectiveness of birth control pills
Levetiracetam
Add on for partial
Most commonly used drug at present
Ae: somnolence, asthenia, dizziness, cns depression, behavioral change
Ethosuzomide
For Absence
Blocks t type ca currents
Ae: gastric distress: pain, nausea, vomitting; less cns
Drug inter: inhibition of metab if with valproic
Retigabine
Novel aed
K channel opener
Aeds that do not appear inducers or inhibitors of cyp system
And also NOT METAB BY LIVER
Gabapentin Lamotrigine Tiagabine Levetiracetam Zonisamide
Doc for partial
Carbamazepine
Phenytoin
Valproic
Doc for primary generalizetc
Carbamazepine
Phenytoin
Vslproic(not approved)
Doc for generalized absence
Ethosuximide
Valproate
Doc for atypical absence, myoclonic, atonic
Valproate
Lamotrigine
Doc for infantile spasms
Corticotropin
Zonisamide
