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Dynamics II > Anti-seizure Medication > Flashcards

Anti-seizure Medication Flashcards

1
Q

What is epilepsy?

A

disturbances of mental functions or movements of the body that is due to excessive discharge of signals from brain cells

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2
Q

Epileptic seizures are an imbalance of what?

A

GABA and Glutamate neurotransmission

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3
Q

What are some causes of epilepsy?

A

idiopathic epilepsy
trauma
tumor
developmental abnormality
stroke

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4
Q

What is a partial seizure?

A

a seizure that occurs on one side of the brain

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5
Q

What is a generalized tonic-clonic seizure?

A

abnormal on both sides of the brain

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6
Q

What does a generalized absence seizure look like?

A
  • shown as a 3-Hertz spike wave on both sides of the brain
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7
Q

Absence seizures occur so quickly that ______?

A

another seizure occurs before the patient is even conscious which could lead to hypoxia which then leads to brain damage

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8
Q

What are the 4 options of treatment for Epilepsy?

A
  1. Benzodiazepine
  2. Phenytoin/fosphenytoin/valproic acid/levetiracetam
  3. Phenobarbital
  4. Propofol
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9
Q

What is the strongest treatment for epilepsy?

A

Propofol (general anesthetic)

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10
Q

What is the most common type of seizure?

A

convulsion seizures

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11
Q

What are the different types of seizures? (4)

A
  1. Convulsive Seizures
  2. Absence
  3. Myoclonic
  4. Atonic
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12
Q

Which two seizures do you lose consciousness?

A

Convulsive Seizures
Absence

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13
Q

Which two seizures do you POSSIBLY lose consciousness?

A

Myoclonic and Atonic

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14
Q

What are automatisms?

A

repetitive gestures

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15
Q

What occurs during simple partial seizures?

A

uncontrolled muscle movements
automatisms
no loss of consciousness

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16
Q

Where does simple partial seizures originate?

A

1 hemisphere

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17
Q

What are the three parts of a seizure?

A
  1. Aura
  2. Ictus
  3. Postictus
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18
Q

What is an aura?

A

sensation or mood that will help identify location of seizure

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19
Q

What is an ictus?

A

the seizure itself; “what it looks like”

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20
Q

What is a postictus?

A

the period after the seizure

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21
Q

Auras do not occur in what types of seizures?

A

absence and myoclonic seizures

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22
Q

Postictus do not occur in what types of seizures?

A

absence seizures

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23
Q

How do you dose seizure medications?

A

you begin with one drug then you increase the dose until seizures stop or toxicity occurs, if seizures do not stop add another drug therapy and slowly increase that does as well until the seizures stop or toxicity occurs

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24
Q

Why measure serum levels of anti-seizures medications? (3)

A
  1. Help prevent toxicity
  2. Insure adequate dosing
  3. Increase patient compliance
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25
Q

What are the major mechanisms of action of for anti-seizure drugs? (3)

A
  1. decreases sodium and calcium influx
  2. increase GABA neurotransmission
  3. decrease glutamate/asparatate neurotransmission
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26
Q

What are the general side effects of anti-seizures drugs?

A

CNS effects: fatigue, dizziness, ataxia, blurry vision, headaches
GI upset
alterations in blood counts
potential to cause Stevens Johnson Syndrome

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27
Q

What are the comorbidities for anti-seizure drugs?

A

anxiety, depression,

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28
Q

How does Stevens Johnson Syndrome start?

A

a rash after using a seizure medication

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29
Q

What is the mechanism of action for Phenytoin (Dilantin)?

A

Na channel blocker; has the same mechanism as anesthetics

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30
Q

What is the drug that neurologists would not recommend?

A

Phenytoin (Dilantin)

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31
Q

What type of seizure is Phenytoin not used to treat?

A

absence and atonic epilepsy because it can exacerbate these issues

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32
Q

Why does it take phenytoin take a long time to get the brain?

A

because it has high protein binding

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33
Q

What are the two ways that Phenytoin can be administered?

A

oral or IV

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34
Q

What is a side effect of phenytoin that occurs in children?

A

Gingival Hyperplasia

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35
Q

What is Gingival Hyperplasia?

A

abnormal amount of collagen

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36
Q

What is a side effect of phenytoin?

A

Hirsutism

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37
Q

What is Hirsutism?

A

abnormal amount of facial hair

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38
Q

What does Phenytoin induce?

A

CYP3A4, CYP2C, and UGT

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39
Q

When taking Phenytoin patients should be treated with _______ to prevent _____ ?

A
  1. vitamin K supplements
  2. bleeding
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40
Q

What type of drug is Fosphenytoin?

A

prodrug

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41
Q

How is Fosphenytoin administered?

A

IM

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42
Q

What is the difference between phenytoin and fosphenytoin (Cerebyx)?

A

less hypotension risk

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43
Q

What is the enzyme that converts fosphenytoin to phenytoin?

A

phosphatases

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44
Q

What is the mechanism of action for Carbamazepine (Tegretol)?

A

blockage of Na channels

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45
Q

What are the uses of Carbamazepine (Tegretol)? (3)

A

generalized and partial seizures
trigeminal neuralgia (facial pain)
bipolar disorder

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46
Q

What does Carbamazepine induce?

A

CYP1A2, CYP2C, CYP3A, UGT

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47
Q

True or False: Carbamazepine do not induce their own metabolism with the rate of metabolism increasing in the first 4-6 weeks of therapy

A

False: they do induce their own metabolism

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48
Q

What is carbamazepine (Tegretol) metabolized to?

A

10,11 - epoxide which is pharmacologically active

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49
Q

What are the side effects of Carbamazepine (Tegretol)?

A

weight gain
Steven-Johnson syndrom
Hyponatremia
Liver toxicity

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50
Q

With what types of seizures are carbamazepines contraindicated?

A

in absence seizures

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51
Q

What is the mechanism of action of Ethosuximide?

A

calcium channel blocker

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52
Q

What is the indication of Ethosuximide?

A

absence seizures ONLY

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53
Q

What are the side effects of Ethosuximide?

A

GI irritation
blood dyscrasias

54
Q

What is the mechanism of action for Phenobarbital (Luminal)?

A

binds to the GABA receptor and then enhances GABA mediated chloride flux and prolongs opening of GABA channel

55
Q

What are the indications associated with Phenobarbital (Luminal)?

A

status epilepticus

56
Q

Can phenobarbital be used for veterinary medications?

A

No

57
Q

In what type of seizures is Phenobarbital (Luminal) contraindicated?

A

in absence seizures because of the cognitive effect

58
Q

What are the 2nd line uses for phenobarbital (luminal)?

A

generalized tonic-clonic epilepsy
partial seizures

59
Q

What does phenobarbital (luminal) induce?

A

induction of CYP450 enzymes

60
Q

What are the side effects of phenobarbital (luminal)?

A

nystagmus
highly sedating
ataxia, cognitive impairment

61
Q

What is the mechanism of action of Primidone (Mysoline)?

A

facilitates GABA, Block Na channels

62
Q

What are the metabolites of Primidone (Mysoline)?

A

Phenobarbital and PEMA

63
Q

What are the indications of Primidone (Mysoline)?

A

partial seizure and tonic-clonic

64
Q

What are the side effects of Primidone (Mysoline)?

A

nystagmus
highly sedating
ataxia, cognitive impairment

65
Q

What is the mechanism of action for Divalproex (Depakote)?

A

elevates brain levels of GABA by inhibition of degradation
potentiates inhibitory effects of GABA
Blockage of Na and Ca channels

66
Q

What are the side effects of Divalproex (Depakote)?

A

alopecia and weight gain

67
Q

What are the different formulations of Divalproex (Depakote)?

A

Valproic acid
Divalproex sodium

68
Q

What are the indications of Divalproex (Depakote)?

A

absence seizures refractory to ethosuximide
generalized and partial seizures
bipolar disorder
prophylaxis of migrains

(broad spectrum)

69
Q

What does Divalproex (Depakote) inhibit?

A

CYP450, UGT, and Epoxide Hydrolase

70
Q

What are the drug interactions with Divalproex (Depakote)? (2)

A
  1. Displaces phenytoin from plasma proteins
  2. Inhibits hepatic oxidative metabolism of carbamazepine, phenobarbital, and phenytoin
71
Q

What is the mechanism of action of Lorazepam (Ativan)?

A

enhances GABA activity by binding allosterically to the GABA receptor

72
Q

What are the uses of Lorazepam (Ativan)?

A

IV agent in status epilepticus

73
Q

What are the side effects of Lorazepam (Ativan)?

A

sedation
anteroprade amnesia
ataxia
withdrawal seizures following abrupt cessation

74
Q

What are the benzodiazepines that are for chronic treatment of seizures?

A
  1. Clorazepate (Tranxene)
  2. Clonzepam (Klonopin)
75
Q

What is Clorazepate metabolized to?

A

Diazepam

76
Q

What is the type of seizure that Clonazepam treats?

A

absence seizure

77
Q

What does Clobazam treat?

A

adjunctive for Lennox-Gastaut in patients 2 years of age or older

78
Q

What are the BDZ Nasal Sprays?

A

Midazolam (Nayzilam) and diazepam (Valtoco)

79
Q

What is Diastat Acudial?

A

rectal administration

80
Q

When is Diastat Acudial used?

A

optional treatment for long lasting seizure

81
Q

What are the advantages of Second Generation Antiepileptics?

A
  1. fewer side effects
  2. little or no need for serum monitoring
  3. fewer drug interactions
82
Q

What is the mechanism of action for Gabapentin (Neurontin)?

A

Analong of GABA and inhibits Ca channels

*may increase the release of GABA from neurons

83
Q

What are the uses of Gabapentin (Neurontin)?

A
  1. partial seizure
  2. postherpetic neuralgia
  3. migraine, chronic pain, bipolar disorder
  4. alcohol and opiate withdrawal
84
Q

What patient population is Gabapentin (neurontin) best for?

A

the elderly

85
Q

What is a side effect of Gabapentin?

A

somnolence, weight gain

86
Q

When is the best time to take Gabapentin?

A

in the evening because it causes sedation

87
Q

What is the mechanism of action Pregabalin (Lyrica)?

A

binds calcium channels and decreases glutatmate activity

88
Q

What are the side effects of Pregabalin (Lyrica)?

A

Somnolence and weight gain

89
Q

Is Pregabalin (Lyrica) metabolized in the liver?

A

no

90
Q

What are the indications for Pregabalin (Lyrica)?

A
  1. adjunctive therapy for partial onset seizures
  2. diabetic neuropathic pain
  3. postherpetic neuralgia
  4. fibromyalgia
91
Q

What is the mechanism of action for lamotrigine (lamictal)?

A

inhibits voltage-sensitive Na and Ca channels and inhibits glutamate/aspartate release

92
Q

What are the uses of lamotrigine (Lamictal)?

A

broad spectrum: treatment of partial and generalized seizures and absence seizures and bipolar disorder

93
Q

What are the side effects of Lamotrigine (Lamictal)?

A

skin rash, higher risk of Stevens-Johnson and higher risk of children

94
Q

What age group should not use Lamotrigine (Lamictal)?

A

< 16 years old

95
Q

What is the metabolism of Lamotrigine (Lamictal) decreased by?

A

CYP inhibitors (valproic acid)

96
Q

What is the metabolism of Lamotrigine (Lamictal) increased by?

A

CYP inducer (phenytoin and CBZ)

97
Q

What is the mechanism of action of Topiramate (Topamax)?

A

inhibits voltage-dependent Na channels
potentiates GABA neurotransmission
blocks glutamate neurotransmission

98
Q

What are the indications of Topiramate (Topamax)?

A

partial and generalized seizures
migraine prophylaxis
alcoholsim

99
Q

What are the side effects of Topiramate (Topamax)?

A

Nephrolithiasis (kidney stones)
Metabolic acidosis
Weight loss
Oligohydrosis (reduced perspriation)

100
Q

What is the mechanism of action of Levetiracetam (Keppra)?

A

unknown

101
Q

What is the use of Keppra?

A

partial and generalized seizures

102
Q

is Keppra metabolized by CYP450?

A

no; therefore, it is good for patients with hepatic disease

103
Q

What is a side effect of Keppra?

A

mood changes

104
Q

What are the uses of Keppra?

A

antiseizures, bipolar disorder, and migraine prophylaxis

105
Q

Oxcabazepine does not induce its own metabolism

A

true

106
Q

What is the MOA of Oxcabazepine (Trileptal)?

A

blocks voltage dependent Na channels

107
Q

What patient population has an increased risk oof SJA?

A

asian populations

108
Q

What is the indication of Oxcabazepine?

A

partial seizure

109
Q

What type of drug is Oxcabazepine?

A

prodrug

110
Q

What is the active metabolite of Oxcabazepine?

A

eslicarbazepine

111
Q

What is the drug that is used with patients that haven’t responded well to other medications?

A

Vigabatrin (Sabril)

112
Q

What is the mechanism of action of Vigabatrin (Sabril)?

A

inhibition of GABA transaminase induces CYP2C9

113
Q

What is the use of Vigabatrin (Sabril)?

A

reduction of partial seizure (refractory patients)

114
Q

What is the side effects of Vigabatrin (Sabril)?

A

drowsiness, dizziness, weight gain, suicide, and permanent vision loss

115
Q

What is the mechanism of action of Peramapanel (Fycompa)?

A

AMPA receptor antagonist

116
Q

What are the adverse effects of Peramapanel (Fycompa)?

A

psychiatric
aggressive behavior
psychosis
suicidal ideation

117
Q

How is Permapanel (Fycompa) contraindicated?

A

patients with preexisting psychiatric illness/psychosis

118
Q

What is Lennox-Gaustaut Syndrome?

A

is a multitude of seizures

119
Q

How do you treat Lennox-Gaustaut Syndrome?

A

poly-drug approach

120
Q

What is the mechanism of action of Felbamate (Felbatol)?

A

blocks activation NMDA receptors
blocks Na and Ca channels
Enhances GABA

121
Q

What is Felbamate (Felbatol) recommended for?

A

patients who respond inadequately to alternative treatments and whose epilepsy is very severe

122
Q

What is the drug that requires consent from a parent?

A

Felbamate (Felbatol)

123
Q

What are the side effects of Felbamate (Felbatol)?

A
  1. acute liver failure
  2. aplastic anemia
124
Q

When do you use Epidiolex?

A

for treatment resistant seizures

125
Q

What is the mechanism of action of Epidiolex?

A

seritonin and glycine receptors

126
Q

What are non-pharmacological therapy that treats seizures?

A
  1. Ketogenic Diet
  2. Vagus Nerve Stimulation
127
Q

how do you treat Epilepsy in pregnancy?

A
  1. monotherapy
  2. folic acid supplementation before/during pregnancy
128
Q

What are the ways that folic acid supplementation helps with baby growth?

A
  1. DNA synthesis
  2. RBC production
  3. Developmental of brain, spinal cord
  4. Helps prevent birth defects and low birth weight
129
Q

What are the 3 drugs to avoid to treat epilepsy in pregnant women?

A
  1. Phenytoin
  2. Carbamazepine
  3. Phenobarbital
130
Q

What does phenytoin cause in children?

A

cleft palate and poor cognition

131
Q

What does carbamazepine cause in children?

A

cleft palate

132
Q

What does phenobarbital cause in children?

A

cardiac malformations and poor cognition

Dynamics II (6 decks)

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