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Pharmacology > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

What is epilepsy

A

its a chronic brain disorder characterised by recurrent (>_ 2 unprovoked seizures)

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2
Q

Characteristics of epilepsy

A

Abnormal electrical discharges
loss of consciousness
abnormal movements
odd behavior
distorted perceptions

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3
Q

What determines the symptoms of epilepsy

A

the origin of the abnormal firing

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4
Q

Aetiology of epilepsy

A

often idiopathic but various brain disorders; malformations, strokes and tremors can cause symptomatic epilepsy

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5
Q

Where do epileptic seizures originate from

A

they originate in a group of neurons (the epileptogen focus) which is hyperexcitable and discharges periodically

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6
Q

What is a generalised seizure

A

aberrant/unusual electrical discharge diffusely involves the entire cortex of both hemispheres from the onset, consciousness is usually lost

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7
Q

Causes of generalised seizures

A

from metabolic disorders
sometimes genetic disorders

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8
Q

Generalised seizures include

A

AMAIT
infantile spasm
absence seizures
tonic-clonic seizures
atonic seizures
myoclonic seizures

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9
Q

What is a tonic-clonic seizure

A

seizure that causes loss of consciousness and violent muscle contractions

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10
Q

Another name for tonic-clonic seizures

A

Grand mal

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11
Q

What is an absence seizure

A

its a type of seizure that causes brief, sudden lapses in attention.
More common in children than in adults

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12
Q

What is a myoclonic seizure

A

type of seizure that causes quick, uncontrollable muscle movement with no change in the level of awareness or consciousness.

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13
Q

What is an atonic seizure

A

a type of seizure that causes sudden loss of muscle strength.
Person may not loose consciousness

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14
Q

Define febrile convulsions

A

a fit that can happen when a child has a fever

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15
Q

What are focal(partial) seizures

A

caused by excess neuronal discharge that occurs in one cerebral cortex

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16
Q

Focal seizures are results from

A

structural abnormalities

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17
Q

Effect of focal seizures on consciousness

A

may be simple (no impairement of consciousness) or complex (decr. but not complete loss of consciousness)

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18
Q

Can a generalised seizure occur after a focal seizure

A

Yes

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19
Q

How to know if one is about to have a focal seizure

A

its preceded by an aura- may consist of sensory, autonomic or psychic sensations

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20
Q

How long do focal seizures last

A

1-2 mins

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21
Q

What does status epilepticus involves

A

Either of the following:
1. tocic-clonic seizure lasting >5-10mins
2. >_ 2 seizures between which patients do not fully regain consciousness

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22
Q

What does abrupt withdrawal of anticonvulsants cause

A

Status Epilepticus

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23
Q

Prophylactic drugs for Grand mal

A

Carbamazepine
Phenytoin
Phenobarbitone
Valproic acid

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24
Q

Prophylactic drugs for Petit mal in children

A

Ethosuximide
Clonazepam
Valproic acid

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25
Q

Prophylactic drugs for myoclonic and atonic seizures in children

A

Valproic acid

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26
Q

Prophylactic drugs to avoid in myoclonic and mixed seizures

A

Carbamazepine as it may complicate seizures

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27
Q

Prophylactic drugs for Status epilepticus

A

LD PP MC
Diazepam
Clonazepam
Phenytoin
Phenobarbitone
Lorazepam
Midazolam

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28
Q

Prophylactic drugs for Febrile Convulsions

A

Paracetamol
Diazepam
Clonazepam
Phenytoin
Phenobarbitone

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29
Q

Na channel blockers are

A

PVT LC
Phenytoin
Valproic acid
Topiramite
Lamotrigine
Carbamazepine

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30
Q

HV dependents Ca channel blockers are

A

LT
Lamotrigine
Topiramate

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31
Q

T-type Ca Channel blockers are

A

Valproic acid
*Ethosuximide

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32
Q

GABA Transaminase blockers are

A

Vigabatrin
Valproic acid

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33
Q

MOA of Phenytoin

A

blocks voltage gated Na channels
*is a CYP450 inducer

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34
Q

I of Phenytoin

A

focal and generalized tonic-clonic seizures
(all forms except absence)
Status Epilepticus

35
Q

Dosage of Phenytoin

A

200-600mg daily
MAX: 400 mg nocte

36
Q

DI of Phenytoin

A

Is a CYP450 inducer= exhibits zero-order kinetics

37
Q

AE of Phenytoin

A

NV
Headaches
Disorientation
megoblastic anaemia
gingival hyperplasia
hirsutism
loss of bone density;
Idiosyncratic rash
Exfoliative dermatitis

38
Q

Incr. dose of Phenytoin cause

A

Nystagmus
Ataxia
lethargy

39
Q

MOA of Carbamazepine

A

Blocks NA channels–> inhibits generation of repetitive APs in epileptic focus and prevents their spread

40
Q

I of Carbamazepine

A

1st line monotherapy for generalised tonic-clonic and partial (focal) seizures
Trigeminal neuroglia
Bipolar disorder

41
Q

Dosage of Carbamazepine

A

200mg po bd for 2/52 then 300 mg
MAX: 900mg bd

42
Q

DI of Carbamazepine

A

is a CYP450 Inducer–> incr. toxicity of MAOIs (tranylcypromine) by unknown mechanism;
discontinuse MAOI use 14days prior to starting Carbamazepine

43
Q

AE of Carbamazepine

A

Sedation
Ataxia
dizziness
NV
rashes including SJS
Jaundice
Dry mouth
aplastic anaemia
Leukopenia
Hyponatraemia (esp. in elderly)

44
Q

MOA of Lamotrigine

A

Blocks Na channels and HV dependent Ca channels

45
Q

I of Lamotrigine

A

focal seizures
generalized seizures
absence seizures
Bipolar disorder
Lennox-Gastaut syndrome

46
Q

Dosage of Lamotrigine

A

slow-up titration of dose essential to minimse risk of serious and life-threatening skin rxns (SJS)

47
Q

AE of Lamotrigine

A

Blurred vision
Ataxia
Dizzines
Rash

48
Q

MOA of Topiramate

A

Block voltage gated Na channels (AMPA)
Reduce HV Ca currents
Target Glutamate (NMDA) sites: block

49
Q

Indications for Topiramate

A

Partial (focal) seizures
Primary generalised seizures
Migraine headache
Obesity

50
Q

AE of Topiramate

A

Drowsiness
Fatigue
weight loss
nervousness
renal stones
glaucoma
hyperthermia
parasthesia (pins and needles)

51
Q

MOA of Gabapentin

A

is a GABA analogue:has no effect on GABA Rs

52
Q

Indications for Gabapentin

A

focal seizures
other: post-herpetic neuralgia

53
Q

Dosage of Gabapentin

A

dose-dependent in renal disease is required

54
Q

Gabapentin dose in elderly

A

well-tolerated by elderly population with partial seizures with fewer DIs

55
Q

AE of Gabapentin

A

Fatigue
Ataxia
Dizziness
Drowsiness

56
Q

MOA of Vigabatrin

A

irreversibly inhibits GABA-T enzyme (enzyme responsible for GABA metabolism)

57
Q

Indications of Vigabatrin

A

Infantile spasms (west syndrome)

58
Q

AE of Vigabatrin

A

Dizziness
drowsiness
weight gain
mental confusion
psychosis

59
Q

MOA of Pregabalin

A

binds to auxiliary subunit of voltage-gated Ca channels

60
Q

Indications of Pregabalin

A

Focal-onset seizures
Other: diabetic peripheral neuropathy
post-herpetic neuralgia
fibromyalgia

61
Q

Dosage of Pregabalin

A

dosage adjustments needed in renal disease

62
Q

AE of Pregabalin

A

Weight gain
peripheral oedema
Impaired memory

63
Q

MOA of Levetiracetam

A

Has high affinity for SV2A protein (synaptic vesicle protein) and increases/enhances its activity

64
Q

Indications of Levetiracetam

A

Focal seizures
myoclonic
generalised tonic-clonic seizures
other: perioperative neurosurgery

65
Q

AE of Levetiracetam

A

Mood alterations
Ataxia
dizziness
agitation
somnolence

66
Q

Indications of Phenobarbitone

A

all forms of epilepsy except absence seizures

67
Q

Dosage of Phenobarbitone

A

60-180 mg/day po in 1-2 divided doses

68
Q

DI of Phenobarbitone

A

Is a hepatic enzyme inducer–> incr. metabolism of anti-epileptic drugs, estrogens and progesterone, ARV agents, alcohol or other CNS depressants- concomitant use leads to additive CNS depressants

69
Q

AE of Phenobarbitone

A

Sedation
Ataxia
Nystagmus
Paradoxical stimulation
Behavioral and learning problems in children
megoblastic anaemia
idiosyncratic rash

70
Q

MOA of Ethosuximide

A

inhibits T-type Ca channels–> reuced propagation of abnormal electrical activity in brain

71
Q

Indications of Ethosuximide

A

1st line monotherapy in typical absence seizures

72
Q

AE of Ethosuximide

A

NV
headache
sedation
ataxia
dizziness
euphoria
GIT disturbances (epigastric pain)
skin rashes- SJS
bone marrow suppression

73
Q

BDZs used in seizures

A

CCD
Clonazepam
Clobazam
Diazepam

74
Q

MOA of BDZs

A

bind to GABA inhibitory receptors to reduce firing rate

75
Q

Indications for BDZs

A

reserved for emergencies of seizure attacks

76
Q

Which BDZs are used for Adjunctive therapy for particular types of seizures

A

Clonazepam and Clobazam

77
Q

Administration of Diazepam in kids

A

Rectal admin.

78
Q

When is Diazepam also used

A

to avoid/interrupt prolonged generalised tonic-clonic seizures

79
Q

MOA of Valproic acid

A

Blocks voltage gated Na channels
Blocks T-type Ca channels
Blocks GABA-T

80
Q

Indications of Valproic acid

A

Focal
Primary generalised seizures
all forms of epilepsy
1st choice drug for patients on ART

81
Q

Dosage of Valproic acid

A

500mg po bd
MAX: 2500mg daily

82
Q

DI of Valproic acid

A

induces Hepatic enzymes

83
Q

AE of Valproic acid

A

Nausea
anaroxia/incr. appetite
ataxia
sedation
hepatotoxicity
alopecia
thrombocytopenia
tetragenicity

Pharmacology (50 decks)

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