Anticonvulsants

Question 1

Drug tx options for Partial Seizures:

Answer 1

Carbamazepine, Dilantin, Valium, Mysoline, Depakote, Lamactil

Question 2

Drug tx options for Absence seizures (Petit mal):

Answer 2

Zarontin, Depakote, Klonapin

Question 3

Drug tx options for Grand Mal seizures:

Answer 3

everything and kitchen sink

Depakote (#1), Valium, Dilantin, Carbamazepine….

Question 4

Drug tx options for Status Epilepticus:

Answer 4

Valium, Ativan (Lorazepam), Versed, Phenobarbital

Question 5

Other (alternative) tx options for seizure pathology:

Answer 5

Ketogenic diet, vagus nerve stimulation, brain neurostimulation, surgery, service pets

Question 6

Phenobarbital

Answer 6

Class: Barbiturate
Indic: generalized seizures, especially pediatrics
MOA: enhances GABA,
Char: IV, PO, slow onset, low 1/2 life
Notes: stimulates P450 enzymes
SE: CNS depression, drowsiness, low IQ in children

Question 7

Primidone/ Mysoline

Answer 7

Class: barbiturate
MOA: GABA mediation (phenobarbital is a metabolite)
Char: PO, long 1/2 life
Indic: all seizures EXCEPT absence
SE: nausea, anorexia, HA, vertigo, ataxia
CATEGORY D

Question 8

Diazepam/ Valium

Answer 8

Class: Benzodiazepine
MOA: increases GABA sensitivity with Increased Cl influx
Indic: Grand Mal, Status Epilepticus, anxiety, panic d/o
Rarely used for chronic Tx

Question 9

Clonazepam/ Klonopin

Answer 9

Class: benzodiazepine
MOA: Inc Cl influx –> inc GABA sensitivity
Char: PO, long acting
Indic: status epilepticus, Zarontin/Depakote alternative in absence seizures
SE: drowsiness, altered mentation, tolerance develops,
POTENTIAL FOR ABUSE

Question 10

Phenytoin/ Dilantin

Answer 10

Class: anticonvulsant
MOA: reduces Na/Ca currents
Indic: prophylaxis of all seizures except absence
Char: PO/IV/IM, slow onset
SE: tolerance develops, nystagmus, ataxia, GINGIVAL HYPERPLASIA, hepatotoxicity, bone marrow suppression, hypotension, arrhythmias
altered metabolism common with other drug use–> monitor patients closely!

Question 11

Carbamazepine/ Tegretol

Answer 11

anticonvulsant
MOA: reduces Na/Ca currents, GABA mediation
Indics: all seizures except absence, chronic pain, Trigeminal neuralgia, post-herpetic neuralgia, schizophrenia, bipolar
SE: vertigo, N/V, aplastic anemia, bone marrow suppression
MONITOR PTS
CI WITH CONCURRENT MAOI USE–> Hypertensive crisis

Question 12

Valproic acid/ Depakote

Answer 12

MOA: GABA enhancement
Indications: Grand Mal (#1), absence, all seizures, bipolar, chronic pain
Char: PO/IV
additive effect with other anticonvulsants
SE: nausea, insomnia, anxiety, hepatotoxic, folic acid antagonism
** MAY CAUSE BIRTH DEFECTS**

Question 13

Ethasuxamide/ Zarontin

Answer 13

anticonvulsant
MOA: may affect T-type CA channels, unknown; Increases Phenytoin levels
Char: PO
Indic: Absence seizures (#1)
SE: HA, N/V, fatigue, ataxia, blurred vision, confusion, skin rash, insomnia, gingival hyperplasia*, hepatotoxicity, SLE-like syndrome

Question 14

Gabapentin/ Neurontin

Answer 14

anticonvulsant, atypical analgesic
MOA: potentiates GABA, affect N-type Ca channels
Indic: adjunct Tx in partial seizures, chronic pain, post-herpetic neuralgia, migraine HA, cocaine withdrawal
Char: absorption is decreased by antacids, reduce dose with pt with renal dysfunction
1200mg in hs #40-60 (for cocaine withdrawal)
SE: somnolence, dizziness, ataxia, HA, CNS effects
(successor drug: pregabalin/ lyrica)

Question 15

Lamotrigine/ Lamactil

Answer 15

anticonvulsant, mood stabilizer
MOA: may dec glutamate/aspartate effects
Indic: Grand Mal, complex partial seizures resistant to other Tx, TYPE 1 BIPOLAR
SE: dizziness, HA, rashes, diplopia, somnolence, ataxia

Question 16

Levetiracetam/ Keppra

Answer 16

anticonvulsant
MOA: may inhibit Ca movement
Indic: grand mal, complex partial seizures resistant to other tx
SE: generally well tolerated, drowsiness, weakness, coordination/gait disturbances, HA, mood changes…