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Pharmacology 1 > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

Seizure (convulsion)

A

Clinical manifestation of abnormal activity in the brain

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2
Q

Epilepsy

A

Multiple seizures over a long period of time

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3
Q

Status epilepticus

A

Seizure lasting at least 5 minutes or 2+ discrete seizures without full recovery of consciousness between seizures

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4
Q

Primary cause of seizures

A

Idiopathic epilepsy

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5
Q

Secondary cause of seizures

A

Distemper, head injury, encephalitis

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6
Q

Reactive cause of seizures

A

Fever/heatstroke, poisoning

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7
Q

At home treatment of seizures

A

Diazepam 1-2mg/kg via rectum up to 3x/24hrs

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8
Q

In hospital treatment of seizures

A

Diazepam 5-10mg IV to effect
Diazepam 1-2mg/kg rectal if no IV access
0.5mg/kg/hr CRI if seizures reoccur after Diazepam bolus
Lorazepam, Midazolam, Clonazepam, Chlorazepate
Phenobarbital (10-20mg/kg IV increments to effect)
If no response - general anesthesia

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9
Q

When do you start treatment when diagnosed with epilepsy?

A

More than 1 seizure per month, seizure within 1 week of head injury, or when brain lesion is ID’s

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10
Q

Drugs to avoid

A

Phenothiazines
Butyrophenones
Opioid agonists
Fluoroquinolones (+NSAIDs) - lower seizure threshold

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11
Q

Where do Benzodiazepines act?

A

GABA agonist

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12
Q

Where does Phenobarbital act?

A

GABA agonist

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13
Q

Where does Gabapentin act?

A

Block Ca2+ channels

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14
Q

Where does Felbamate act?

A

GABA agonist
NMDA antagonist
Block Na+ channels

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15
Q

Where does Valproate act?

A

GABA agonist

Block Ca2+ channels

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16
Q

Clinical uses for Benzodiazepines

A

Emergency anticonvulsant

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17
Q

Clinical uses for Phenobarbital

A

Initial therapy (drug of choice in cats and dogs)

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18
Q

Clinical uses for Bromide

A

Add-on to Phenobarbital or initial therapy

19
Q

Clinical uses for Levetiracetam

A

Mono therapy or as an add-on to Phenobarbital

20
Q

Clinical uses for Valproate

A

Add-on to Phenobarbital

21
Q

Clinical uses for Zonisamide

A

Add-on to Phenobarbital or mono therapy

22
Q

Clinical uses for Gabapentin

A

Add-on with Phenobarbital and/or Bromide

23
Q

Clinical uses for Felbamate

A

Add-on to Phenobarbital or mono therapy

24
Q

Side effects of Benzodiazepines

A

Enzyme induction (will effect PK of other drugs)

25
Q

Side effects of Phenobarbital

A

Sedation
Hyperexcitability
Prolonged use/high dose = hepatotoxic - cytochrome P450 induction

26
Q

Side effects of Bromide

A

Sedation
Emesis
Pancreatitis

27
Q

Side effects of Levetiracetam

A

Sedation

Polyphagia (uncommon)

28
Q

Side effects of Zonisamide

A

Sedation
Emesis
Cytochrome P450 induction

29
Q

Side effects of Gabapentin

A

Sedation

Mild ataxia

30
Q

Side effects of Felbamate

A

Nervousness

Hepatic disease?

31
Q

Side effects of Valproate

A

Alopecia
Hepatotoxicity
Emesis (give with food)

32
Q

Contraindications of Benzodiazepines

A

Diazepam PO in cats = FATAL LIVER NECROSIS

33
Q

Contraindications of Phenobarbital

A

Liver disease

34
Q

Contraindications of Bromide

A

Cats - pneumonitis
Hyperadrenocorticism (NaBr)
Congestive heart failure (KBr)

35
Q

Contraindications of Gabapentin

A

Oral solution has Xylitol - TOXIC to dogs = pancreatitis

36
Q

Special considerations for Benzodiazepines

A

Diazepam is most common
Not for long-term Tx
Short duration = frequent administration
Cross-tolerance

37
Q

Special considerations for Phenobarbital

A

LONG DURATION
IV loading dose
Metabolized in liver
Half-life decreases after 4 days (100->24hrs)

38
Q

Special considerations for Bromide

A

KBr with congestive heart failure
Loading dose, add NaBr if IV
T1/2 = 21-24 days

39
Q

Special considerations for Levetiracetam

A 
Not metabolized (excreted unchanged)
T1/2 = 3-4hrs (dogs), 3hrs (cats)
40
Q

Special considerations for Zonisamide

A

Liver induction

T1/2 = 15hrs (dogs), 35hrs (cats)

41
Q

Special considerations for Gabapentin

A

Partially metabolized in the liver

T1/2 = 2-4hrs (dogs)

42
Q

Special considerations for Felbamate

A

30% metabolized in the liver

T1/2 = 5-6hrs (dogs)

43
Q

Special considerations for Valproate

A

T1/2 = 1.5-3hrs (dogs), 8.5hrs (cats)

Pharmacology 1 (8 decks)

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