Anti-seizure Drugs Flashcards

1
Q

types of seizures

A
  1. simple partial seizures: preserved consciousness
  2. complex partial seizures: impaired consciousness; with psychological symptoms
  3. generalised tonic clonic seizures = grand mal seizures
  4. absence seizures = petit mal; impaired consciousness
  5. myoclonic seizures
  6. status epilepticus: series of seizures without recovery of consciousness between attacks
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2
Q
receptors affected by anti-seizure drugs:
phenytoin
carbamazepine
valproic acid
phenobarbital
topiramate
A

phenytoin: Na
carbamazepine: Na, glutamate
valproic acid: Na, Ca, GABA, NMDA
phenobarbital: Na, GABA, glutamate
topiramate: Na, Ca, GABA, glutamate, carbonic anhydrase

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3
Q

tradition anti-seizure drug
anti-convulsant (hydantoin)
blocks voltage-gated Na channels
SE: GINGIVAL HYPERPLASIA, hirsutism, anemias, teratogen (fetal hydantoin syndrome)
POTENT INDUCER OF CYP450 ENZYMES
FOLLOWS ZERO-ORDER KINETICS AT HIGH DOSES

A

phenytoin = diphenyl-hydantoin

fosyphenytoin, mephenytoin, ethotoin

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4
Q

what comprises fetal hydantoin syndrome?

A

upturned nose
mild mid-facial hypoplasia
long upper lip with thin vermillion border
lower distal digital hypoplasia

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5
Q
traditional anti-seizure drug
anti-convulsant (tricyclic)
blocks voltage gated Na channels and decreases glutamate release
for TRIGEMINAL NEURALGIA (TIC DOLOREAU)
POTENT INDUCER OF CYP450 ENZYMES
INHIBITED BY ERYTHROMYCIN
A

carbamazepine

oxcarbazepine, eslicarbazepine

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6
Q

traditional anti-seizure drug
anti-convulsant (branched chain fatty acid)
for GENERALISED TONIC CLONIC SEIZURES, ACUTE MANIA OF BIPOLAR DISORDER
SE: HEPATOTOXICITY (infants), teratogen (NEURAL TUBE DEFECTS), SPINA BIFIDA
INHIBITOR OF CYP450 ENZYMES

A

Valproic Acid
sodium valproate

acts on GABA transaminase, which degrades GABA

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7
Q

traditional anti-seizure drug
anti-convulsant (barbiturate)
increases DURATION of CL- channel opening
SE: dependence liability greater than benzodiazepines, ACUTE INTERMITTENT PORPHYRIA
POTENT INDUCER OF CYP450 ENZYMES
PREFERRED ANTI-SEIZURE DRUG IN CHILDREN AND PREGNANT WOMEN

A

Phenobarbital

Primidone

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8
Q
traditional anti-seizure drug
anti-convulsant (cyclic ureide)
decreases Ca currents (t-type) in thalamus
DOC FOR ABSENCE SEIZURES
SE: GI distress
A

ethosuximide

phensuximide, methsuximide

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9
Q

traditional anti-seizure drug
anti-convulsant (benzodiazepine)
increases FREQUENCY of Cl- channel opening
for STATUS EPILEPTICUS

A

diazepam

lorazepam, clorazepate

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10
Q

traditional anti-seizure drug
anti-convulsant (benzodiazepine)
increases FREQUENCY of Cl- channel opening
for INFANTILE SPASMS

A

clonazepam

clobazam

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11
Q

traditional anti-seizure drug
anti-convulsant (GABA derivative)
for NEUROPATHIC PAIN (POST-HERPETIC NEURALGIA), MIGRAINE

A

gabapentin (enhances GABA)

pregabalin

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12
Q
traditional anti-seizure drug
anti-convulsant (phenyltriazine)
blocks Na and Ca channels
decreases glutamate
SE: STEVEN JOHNSON SYNDROME
A

lamotrigine

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13
Q

traditional anti-seizure drug
anti-convulsant (piracetam)
selectively binds vesicular protein SV2A
SE: PSYCHOSIS (due to decreased dopamine levels, schizophrenia develops)

A

levetiracetam

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14
Q

traditional anti-seizure drug
anti-convulsant (monosaccharide derivative)
multiple actions on synaptic function (Na, Ca, GABA, AMPA-glutamate, carbonic anhydrase)
for: Lennox-Gestaut Syndrome, West Syndrome
SE: PSYCHOMOTOR SLOWING, MEMORY IMPAIRMENT, WEIGHT LOSS, ACUTE MYOPIA, GLAUCOMA, UROLITHASIS
ANTI-SEIZURE DRUG WITH MOST NUMBER OF MECHANISMS OF ACTION

A

topiramate

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15
Q

DOC for generalised tonic-clonic seizures

A

valproic acid
phenytoin
carbamazepine

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16
Q

DOC for partial seizures

A

carbamazepine
lamotrigine
phenytoin

17
Q

DOC for absence seizures

A

ethosuximide

valproic acid

18
Q

DOC for myoclonic and atypical absence syndromes

A

valproic acid

19
Q

status epilepticus

A

lorazepam
diazepam
phenytoin
phenobarbital

20
Q

other clinical uses for anti-seizure drugs

A
  1. bipolar affective disorders
  2. trigeminal neuralgia
  3. neuropathic pain (post-herpetic neuralgia)
  4. migraine