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BCN Exam 3 > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

What are the general guidelines for epileptic drug use?

A

Monotherapy, don’t suddenly withdraw or start with a high dose, watch out for side effects, toxicity and individual variation

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2
Q

What anticonvulsant would be used for postherpetic neuralgia?

A

Gabapentin, lidocaine, pregabalin

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3
Q

What anticonvulsant would be used for diabetic neuropathy?

A

Carbamazepine, duloxetine, phenytoin, gabapentin, lamotrigine, pregabalin

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4
Q

What anticonvulsant would be used for HIV neuropathy and central post-stroke pain?

A

Lamotrigine

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5
Q

What anticonvulsant would be used for trigeminal neuralgia?

A

Carbamazepine, lamotrigine, oxcarbazepine

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6
Q

What is the best medication to use for focal onset seizures?

A

Carbamazepine, phenytoin

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7
Q

What is the best meds to use for general onset (tonic-clonic) seizures?

A

Valproate, topiramate

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8
Q

What is the mechanism of action for carbamazepinem, valproate, lamotrigine and phenytoin?

A

Inactivation of the sodium channel intracellularly

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9
Q

What are the general characteristics for phenytoin?

A

Oldest nonsedative, fosphenytoin (prodrug) better use for parenternal use, alters Na, Ca2+, K+, inhibits high frequency repetitive firing

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10
Q

What is the toxicity to phenytoin?

A

Ataxia, nystagmus, cognitive impairment, gingival hyperplasia, coarsing of facial features, exacerbates absence seizures, decerebrate rigidity

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11
Q

What are the therapeutic uses for carbamazepine?

A

All partial seizures, highly effective for tonic-clonic

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12
Q

What are some features of crabamzepine?

A

Binds to adenosine receptors, inhibits uptake of NE (not GABA) potentiate postsynaptic effects of GABA, metabolite active

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13
Q

What is the toxicity to carbamazepine?

A

Granulocyte suppression, aplastic anemia, exacerbates absence seizures

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14
Q

What are the features of oxcarbazepine?

A

Active metabolite, first choice for partial and generalized as adjunct

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15
Q

What is the toxicity to oxcarbazepine?

A

Hyponatremia, less hypersensitive of induction of hepatic enzymes

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16
Q

What are the features of lamotrigine?

A

Add for for valproic acid, T1/2=24 hrs, blocks Na channel firing

17
Q

What is lamotrigine used for?

A

Myoclonic, atonic and generalized seizures in childhood + absence attacks

18
Q

What is the toxicity for lamotrigine?

A

Life threatening rash “Steven Johnson”

19
Q

What are the features of levetiractam?

A

Broad spectrum, binds to synpatic vesicular protein SV2A, modifies release of GABA and glutamate

20
Q

What is levetiractam used for?

A

Myoclonic, atonic, generalized seizures in childhood and atypical absence

21
Q

What are the side effects of levetiracetam?

A

Somnolence, ataxia, anxiety, agitation, dec RBC

22
Q

What is phenobarbital used for?

A

50% favorable response to simple partials

Recurrent tonic-clonic

23
Q

What is the toxicity for phenobarbital?

A

Sedation, cognition impairment

CAN WORSEN absence and atonic seizures

24
Q

What are the features of phenobarbital?

A

Blocks GLU (AMPA), prolongs opening of Cl channels

25
Q

What are the features of ezogabine?

A

Adjunct therapy for partial seizures and refractory partial epilepsy in pts
First AED to target open voltage-gated K channels
Enhances GABA

26
Q

What are the side effects of ezogabine?

A

Urinary retention, somnolence, dizziness, confusion

27
Q

What are the features of gabapentin?

A

Adjunct in partial and generalized tonic-clonic

Analog of GABA, dec neuronal Ca currents by binding of a-2-delta subunits

28
Q

What are the features of topiramate?

A

Rapidly absorbed, T1/2=20-30 hrs
Blocks firing of neurons and Na channels
Potentiates GABA, depress action of kainate on AMPA

29
Q

What is the toxicity of topiramate?

A

Weakness carbonic anhydrase inhibitor, paresthesias, teratogenic

30
Q

What are the features of tiagabine?

A

Nipecotic acid, t1/2 = 5-8 hrs. adjunctive therapy, GABA uptake inhibitor to glial cells
Partial seizures

31
Q

What is the toxicity of tiagabine?

A

Ab pain w/ nausea, tremor, psychosis, skin rash

32
Q

What are the features of zonisamide?

A

Sulfanmide, T1/2 = 1-3 days
Tonic-clonic seizures
Inactivation of Na channels, bind GABA

33
Q

What is the toxicity of zonisamide?

A

Anorexia, renal stones, metabolized by CYP3A4

BCN Exam 3 (8 decks)

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