Anticonvulsant Flashcards
Seizure
spontaneous firings of neurons
convulsion
convulsion
activation of motor neurons leading to involuntary contraction of skeletal muscle
simple partial seizure
least complicated, minimal spread. affects only on muscle group. no loss of consciousness, person still alert and remembers what happens
complex partial seizure
spreading to other areas of brain: altered consciousness, automatism
Absence seizure (petit mal)
less severe; sudden onset and abrupt cessation, brief loss of consciousness (could have little motor jerking of eyelid), impaired consciousness
When is absence seizure most commonly found
children under 15
Phases of Tonic- clonic
- aura
- tonic phase:muscle tensing, rigidity of all extremities
- clonic phase: convulsion–>uncontrolled shaking body
- Stuporous state and sleep: confusion, amnesia, nausea
what type of seizures is common in children?
atonic, absence (petit mal)
clonic and myoclonic
loss of consciousness w/rhythmic clonic contractions phase, sudden flexion/extension of body and limbs
infantile spasm
epileptic syndrome. NOT a seizure type. recurrent myoclonic jerks
Status Epilepticus
continuous or very rapid recurring seizures that require immediate therapy
what are the main targets of anticonvulsant drugs?
Na and Ca channels to inhibit firing of certain hyper-excitable cerebral neurons, or increasing effects of GABA
what agents block T type channels of the Ca channels
ethosuximide, valprate
inhibiting Ca channels is effective against what seizure?
Absence seizure
which agents block L type Ca channels
lamotrigine, topiramate, gabapentin
What agents block AMPA receptors
phenobarbital, topiramate, lamotrigine
which agent blocks NMDA receptors
Felbamate
what agents tx absence seizure
ethosuximide, valproate, lamotrigine, topiramate
what drugs are used for status epilepticus
diazepam, lorazepam, phenytoin, fosphenytoin
which drugs block the inactivated state of Na channels
phenytoin, carbamazepine, Lamotrigine
Phenytoin function
blocks inactivated state of Na channels, increase release of GABA
phenytoin clinical use
main drug for tonic clonic, partial seizure, status epilepticus
what is the main drug for tonic-clonic (grand mal)
phenytoin
what agent can cause gingival hyperplasia
phenytoin
what agent can cause fetal hydantoin syndrome
phenytoin
How is Fosphenytoin diff from phenytoin
Newer drug, more soluble able to use IV or IM route
what is carbamazepine used for
clonic tonic seizure, partial seizures, trigeminal neuralgia,, bipolar, acute alcohol withdrawal
what anticonvulsants also treat manic phase in bipolar disorder
Valproic acid and carbamazepine
what is the number one drug to treat trigeminal neuralgia
carbamazepine
whats the difference between oxacarbazepine?
oxacarbazepine has a LONGER active metabolite and fewer drug interaction
what are carbamazepine side effects
SIADH: fluid retention, hyponatremia
Tetraogenic
what metabolizes into phenobarbital
primidone
whatis most commonly used for neonatal seizures
phenobarbital
clinical use for phenobarbital
neonatal seizure, status epilepticus
Main drug for Status epilepticus
benzodiazepine: DIazepam!
ethosuximide MOA
blocks ttype Ca channels; inactive metabolite
what agents can cause tetraogenic side effect?
carbamazepine, valproic acid
whats the common drug used for neuropathic pain
gabapentin
gabapentin MOA
blocks presynaptic Ca channels
Gabapentin clinical use
generalized tonic seizure, partial seizure, neuropathic pain
what causes steven johnson syndrome
mixing of valporoic acid and Lamotrigine–>toxicity–>bad rash–>SJ syndrome
lamotrigine MOA
blocks Na and Ca channels
Felbamate mOA
blocks Na channels and glutamate receptors
Which agent specficially inhibits GABA reuptake
Tiagabine
what drugs do you want to avoid with pregnancy, why?
phenytoin (fetal hydatoin syndrome) , tetraogenic:Carbamazepine, valproic acid
what type of elimination is phenytoin
zero-order elimination
what decreases phenytoin metabolism
barbiturates: high concentration of phenobarbital, warfarin
increased pheny
what is the difference between spasticity and spasm
Spasticity: exaggerated muscle stretch reflex due to injury in CNS
spasm: injury is local and NOT in CNS
which drug has Steven johnson syndrome side effect
Lamotrigine
which drug is used for muscle spasm? spasticity?
baclofen: spasticity
diazepam: spasm
