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pharm III exam 1 > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

seizures typically originate in what part of the brain

A

cerebral cortex

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2
Q

differentiate between partial and generalized seizures

A
  • Partial: begin in focused area in the cortex that may spread throughout the brain. Partial seizures often develop years after head injury or stroke
  • Generalized: generally involve both hemispheres from the outset
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3
Q

List the three types of partial seizures

A
  • Simple partial: jerking, lasting about 60 sec, preservation of consciousness, minimal spread
  • Complex partial: impairment of consciousness <2 min, automatic movements such as lip smacking or hand wringing; originates from the temporal lobe, often involves the limbic system
  • Partial with secondary generalized tonic-clonic: originates as a partial seizure and develops into tonic-clonic; loss of consciousness, muscle contractions alternating with relaxation
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4
Q

Describe simple partial seizures

A
  • focal
  • brief (< 90 sec)
  • no loss of consciousness
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5
Q

Describe complex partial seizures

A
  • last < 2 min
  • altered or loss of consciousness; hallucination
  • begin in temporal lobe
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6
Q

Describe partial with secondary generalized tonic-clonic

A
  • originates as a partial seizure and develops into tonic-clonic;
  • loss of consciousness
  • muscle contractions alternating with relaxation
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7
Q

List the four types of generalized seizures

A
  1. Tonic-clonic (grand mal)
  2. Absence (petit mal)
  3. Myoclonic
  4. Atonic
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8
Q

describe a Tonic-clonic (grand mal) seizure

A
  • loss of consciousness
  • muscle contractions, urinary incontinence
  • Tonic rigidity followed by tremor followed by clonic violent jerking of body
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9
Q

describe a absence generalized seizure

A
  • 10-30 sec
  • loss of awareness but not consciousness
  • staring, cease activity; may be some mild clonic movements
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10
Q

describe a myoclonic generalized seizure

A
  • brief shock-like muscle contraction, may be part of one extremity or general
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11
Q

describe an atonic generalized seizure

A
  • sudden loss of postural tone
  • patient can fall down
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12
Q

Anticonvulsants act on GABA to

A
  • goal is to increase GABA inhibitory activity
    • ​protects against both generalized and partial seizures
    • experimental blockade of GABA receptors causes seizures
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13
Q

MOA (4) of drugs that affect GABA neurotransmission and act as anticonvulsants

A
  1. block GABA re-uptake
  2. Inhibit GABA metabolism
  3. Stimulate GABAA receptors
  4. binds synaptic vesicular protein; SV2A
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14
Q

Goal of drugs that affect Glutamate and act as anticonvulsants.

A
  • activation of glutamate receptors (NMDA) causes seizures
  • goal is to decrease excitatory glutamate activity
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15
Q

common targets of drugs that inhibit glutamate activity

A
  • ​voltage gated Na+ channels
    • targets rapidly firing neurons
  • thalamic Ca2+ channels
    • T-type Ca2+ channels are overactive in absence seizure
  • SV2A
    • ​increase GABA release
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16
Q

Which 3 anti seizure drugs induce CYP450s

A
  • Phenytoin
  • Carbamazepine
  • Phenobarbital
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17
Q

MOA of Phenytoin (Dilantin)

A
  • Prolongs inactivation of Na+ channels
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18
Q

Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) treats what type of seizures

A
  • partial and generalized tonic-clonic seizures
    • not effective for absence seizures
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19
Q

MOA of Fosphenytoin

A
  • prolongs inactivation of Na+ channels
    • Blocks high-frequency repetitive firing
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20
Q

route of administration of Fosphenytoin

A

injectable

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21
Q

Elimination of Phenytoin and Fosphenytoin is

A
  • Dose dependent
    • ​first order metabolism occurs at low doses
    • therapeutic range and higher doses, liver reaches maximum capacity, and metabolism becomes zero-order.
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22
Q

Side effects of Phenytoin (dilantin)

A
  • gingival hyperplasia
  • risk of stevens johnson syndrome
  • pregnancy-category D
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23
Q

DOC for parital seizures

A

Carbamazepine

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24
Q

MOA of Carbamazepine

A
  • inhibits Na+ channels and decreases transmitter release
25
Q

side effects of Carbamazepine

A
  • diplopia
  • ataxia
  • stevens johnson syndrome
  • pregnancy category D
26
Q

MOA of Phenobarbital

A
  • Prolongs opening of chloride channel at GABA receptor
27
Q

Phenobarbital is used in treatment of what type of seizures

A
  • parital seizures
  • generalized tonic-clonic seizures
28
Q

MOA of Gabapentin

A
  • GABA analog
    • but does not act on GABA receptor
    • may increase GABA release
29
Q

Uses of Gabapentin

A
  • adjunct for partial and generalized tonic-clonic seizures
  • neuropathic pain
30
Q

drug interactions with Gabapentin

A

Negligible

31
Q

Levetiracetam (Keppra) is used to treat what type of seizures

A
  • Partial
  • myoclonic
  • tonic-clonic
32
Q

MOA of Levetiracetam (Keppra)

A
  • binds to synaptic vesicular protein (SV2A)
    • decreases glutamate and increases GABA release
33
Q

MOA of Lamotrigine (Lamictal)

A
  • voltage dependent inactivation of Na+ channels
34
Q

Lamotrigine (Lamictal) is used to treat what type of seizures

A
  • Partial seizures
35
Q

side effects of Lamotrigine (Lamictal)

A
  • skin rash and stevens-johnson syndrome
36
Q

Topiramate (Topamax) is commonly used to treat what type of seizure disorder

A
  • partial and generalized tonic-clonic seizures
37
Q

MOA of Topiramate (Topamax)

A
  • Blocks Na+ channels
38
Q

side effects of Topiramate (Topamax)

A
  • acute myopia/glaucoma
39
Q

Tiagabine is used to treat what type of seizures

A
  • adjunct treatment for partial seizures
40
Q

MOA of Tiagabine

A
  • inhibits reuptake of GABA (GAT-1)
  • enhances GABA activity
41
Q

Vigabatrin is used to treat what type of seizures

A
  • refractory complex partial seizures
    • infantile spasm (west’s syndrome)
42
Q

MOA of Vigabatrin

A
  • irreversibly inhibits GABA transaminase
  • decreases GABA metabolism and enhances activity
43
Q

side effects of Vigabatrin

A
  • visual field problems/ retinal damage
44
Q

DOC for absence seizures

A

Ethosuximide

45
Q

MOA of Ethosuximide

A
  • inhibits T-type Ca2+ channels
46
Q

side effects of Ethosuximide

A
  • hiccup
  • stevens johnsons syndrome
47
Q

second choice for absence seizures

A

Valproic acid

48
Q

Valproic acid is used to treat what type of seizures

A
  • absence seizures
  • myoclonic seizures
  • mixed sz
49
Q

MOA of Valproic acid

A
  • blocks Ca2+ channels and Na+ channels
50
Q

side effects of Valproic acid

A
  • hepatotoxicity
  • pregnancy category D
  • alopecia
51
Q

Clonazepam is a BZ that is used to treat what types of seizures

A
  • absence seizures
52
Q

adverse effects of Clonazepam

A
  • sedation
  • tolerance for anti-sz effect may occur
53
Q

DOC status epilepticus

A

Diazepam

54
Q

MOA of Diazepam and Lorazepam

A
  • Benzodiazepines
  • stimulate GABA channel
55
Q

adverse effects of Diazepam and Lorazepam

A

pregnancy category D

56
Q

What anti-seizure medications have the highest risk to produce stevens johnson syndrome

A
  • phenytoin
  • Lamotrigine
  • Carbamezapine
  • Valproate
57
Q

what is stevens johnson syndrome

A
  • toxic epidermal necrolysis
58
Q

which Drugs are used in absence seizures

A
  • Ethosuximide (Zarontin®)
  • Valproic acid (Depakene®)
  • Clonazepam (Klonopin®)

pharm III exam 1 (11 decks)

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