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Psych Pharmacology > Anti-Seizure Drugs > Flashcards

Anti-Seizure Drugs Flashcards

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1
Q

What drug is used as 1st line treatment for silent (absence) seizures?

A

Ethosuximide

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2
Q

What is the mechanism of ethosuximide?

A

Blocks thalamic T-type Ca2+ channels –> irregular rhythmic cortical discharge of absence attack

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3
Q

What are the major side effects of Ethosuximide?

A

(EFGHIJ) Ethosuximide causes fatigue, GI distress, headache, itching, Stevens-Johnson syndrome

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4
Q

What do benzodiazepines do & which ones are used for status epilepticus? P.S. what are benzos also used for?

A

Benzos increase GABAa action - Diazepam and lorazepam - they are also used for eclampsia seizures (first line is MgSO4)

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5
Q

What are the side effects of Benzodiazepines? (4)

A

Sedation, tolerance, dependence, respiratory depression

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6
Q

What is the mechanism of Phenytoin?

A

Increase Na+ channel inactivation & decrease release of glutamate; zero-order kinetics (give more –> more effect)

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7
Q

What is the 1st line use of Phenytoin? What is the prophylactic use of Phenytoin?

A

1st line: tonic-clonic seizure; prophylaxis: status epilepticus

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8
Q

What is the parenteral form of Phenytoin?

A

Fosphenytoin

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9
Q

What is the acute use of Phenytoin? (2)

A

Simple & complex partial (focal) seizures

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10
Q

What are the side effects of Phenytoin?

A

Nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, peripheral neuropathy, teratogenesis (fetal hydrantoin syndrome), megaloblastic anemia, SLE-like syndrome, induction of P-450, lymphadenopathy, Steven’s Johnson syndrome, osteopenia

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11
Q

When does sedation occur in Phenytoin use?

A

only @ HIGH levels of Phenytoin use!

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12
Q

What is Carbamazepine used for?

A

1st line treatment for simple and complex partial (focal) seizures & tonic-clonic seizures <– first line along with Phenytoin and Valproic acid

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13
Q

What is the mechanism of Carbamazepine?

A

Increases Na+ channel inactivation & decreases release of Glutamate

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14
Q

What else other than anti-seizure is Carbamazepine used for?

A

1st line for trigeminal neuralgia - brief episodes of sudden & severe unilateral “electric shock like” and “stabbing” pain (V2, V3)

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15
Q

Valproic Acid mechanism?

A

Increase Na+ channel inactivation; also increases GABA concentration by inhibiting GABA transaminase

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16
Q

What are the uses of Valproic acid? (5)

A

1st line for tonic-clonic seizures (1st line along with Phenytoin and Carbamazepine)

  • Acutely for simple partial (focal) seizures
  • Acutely for complex partial (focal) seizures
  • Acutely for myoclonic seizures (along with Phenobarbital and Levetiracetam)
  • Acutely for absence seizures
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17
Q

Side effects of Valproic acid?

A

GI distress, rare but fatal hepatotoxicity (must measure LFTs), neural tube deficits in fetus (spina bifida) so contraindicated in pregnancy, tremor, weight gain, hair loss

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18
Q

Other than anti-seizure, what is Valproic acid also used for?

A

Bipolar disorder as a mood stabilizer

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19
Q

Which anti-seizure drugs are highly bound to plasma protein?

A

Phenytoin & Valproic acid

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20
Q

What are the side effects of Carbamazepine?

A
  • Diplopia
  • Ataxia
  • Blood dyscrasias (agranulocytosis, aplastic anemia so CBC should be monitored)
  • Liver toxicity
  • Teratogenesis
  • Induction of cyt P-450 so may metabolize other drugs
  • SIADH
  • Stevens-Johnson syndrome
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21
Q

What is Stevens-Johnson syndrome?

A

Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules in oral region, ocular region, and genitals)

Skin lesions progress to epidermal necrosis & sloughing

22
Q

What is the mechanism of Gabapentin?

A

Gabapentin primarily inhibits high-voltage-activated Ca2+ channels; designed as GABA analog

23
Q

What are the uses for Gabapentin? (3) *NOTE: HIGH doses needed

A

Used acutely for the following:

  • Simple partial (focal) seizure
  • Complex partial (focal) seizure
  • Tonic-clonic seizure
24
Q

What are the side effects of Gabapentin?

A

Sedation, ataxia

25
Q

Other than anti-seizure, what else is Gabapentin used for?

A

Gabapentin is also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, and bipolar disorder

26
Q

What is the action of Phenobarbital?

A

Increased GABAa action (like Benzos and alcohol)

27
Q

What is phenobarbital used for?

A

Phenobarbital is acutely used for the following:

  • Simple partial (focal) seizure
  • Complex partial (focal) seizure
  • Tonic-clonic seizure
  • Status epilepticus
28
Q

What are the side effects of Phenobarbital?

A

Sedation, tolerance, dependence, induction of cyt p450, cardiorespiratory depression

29
Q

Is phenobarbital used in neonates?

A

Yes as first line in neonates to treat seizures

30
Q

What is topiramate used for?

A

Topiramate is used acutely for:

  • Simple partial (focal) seizures
  • Complex partial (focal) seizures
  • Tonic-clonic seizures
31
Q

What are the side effects of Topiramate?

A

Sedation, mental dulling, kidney stones, weight loss, myopia, glaucoma

32
Q

What is the mechanism of Topiramate?

A

Topiramate blocks Na+ channels; also increases GABA action

33
Q

What is the other use for Topiramate other than anti-seizure?

A

Topiramate is also used for migraine prevention

34
Q

What is the mechanism of Lamotrigine?

A

Lamotrigine blocks voltage-gated Na+ channels

35
Q

What is the major side effect of Lamotrigene?

A

Stevens-Johnson syndrome, so Lamotrigene must be titrated slowly

*NOTE: pediatric patients are @ high risk of Stevens-Johnson syndrome

36
Q

What is the mechanism of Levetiracetam?

A

Unknown; may modulate GABA and Glu release; it is a synaptic vesicle protein

37
Q

What is the mechanism of Tiagabine?

A

It increases GABA by inhibiting re-uptake of GABA (blocks GABA transporter called GAT-1)

38
Q

What is the mechanism of Vigabatrin?

A

Vigabatrin increases GABA by irreversible inhibiting GABA transaminase in presynaptic neuron

39
Q

What is the mechanism of Felbamate?

A

Felbamate blocks the NMDA receptor

40
Q

What are the symptoms of Felbamate toxicity?

A

Aplastic anemia, severe hepatitis

41
Q

A patient wants prophylaxis for status epilepticus. What do you prescribe?

A

Phenytoin!

42
Q

What do you prescribe for an acute attack of status epilepticus?

A

Benzodiazepines (diazepam, lorazepam)

43
Q

Someone has an absence seizure. What do you prescribe as first line drug?

A

Ethosuximide

44
Q

Someone has a tonic-clonic seizure. What are your options for first-line treatment?

A

Phenytoin, carbamazepine, valproic acid

45
Q

Someone has a simple partial (focal) seizure. What do you prescribe as first-line treatment?

A

Carbamazepine

46
Q

Someone has a complex partial (focal) seizure. What do you prescribe as 1st line treatment?

A

Carbamazepine

47
Q

What is status epilepticus?

A

One continuous seizure or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (can be convulsive or non-convulsive)

48
Q

Which anti-epileptic drugs are contraindicated in pregnancy? (5)

A

Valproic acid, phenobarbital, phenytoin, carbamazepine, benzodiazepines

49
Q

What do you prescribe to treat infantile spasms?

A

ACTH/vigabatrin

50
Q

What do you prescribe to treat benign occipital seizures?

A

Carbamazepine, oxcarbazepine

51
Q

What do you prescribe to treat juvenile myoclonic seizures?

A

Valproic acid

Psych Pharmacology (2 decks)

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