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Pharmacology 2 Connor > Anticonvulsants and Benzodiazepines > Flashcards

Anticonvulsants and Benzodiazepines Flashcards

1
Q

Major classifications of epilepsy/seizure (3)

A
  1. Partial
  2. Generalized
  3. Unclassified
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2
Q

Types of partial seizures (3)

A
  1. Simple
  2. Complex
  3. Partial leading to generalized
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3
Q

Types of generalized (convulsive/non-convulsive) seizures (7)

A
  1. Absence
  2. Atypical absence
  3. Myoclonic
  4. Clonic
  5. Tonic
  6. Tonic-Clonic
  7. Atonic
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4
Q

What is status epilepticus

A

Seizure of >15 minutes in duration or multiple within30 minutes with no recovery between them

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5
Q

Causes of electrical disturbances of epilepsy (4)

A
  1. Alteration in membrane
  2. Calcium, sodium conductances implicated
  3. Imbalance between excitatory and inhibitory neurons
  4. Potentiation
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6
Q

Where are most epileptic drugs metabolized

A

Liver

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7
Q

How many half lives before evaluating drug effectiveness

A

5

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8
Q

T/F All epileptic drugs are teratogenic

A

True

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9
Q

What seizures are phenobarbital effective against (3)

A
  1. Simple partial
  2. Complex partial
  3. Febrile
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10
Q

Which is more effective… Phenobarbital or carbamazepine

A

Carbamazepine

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11
Q

How does phenobarbital effect adults and kids

A

Adults - drowsiness
kids - hyperactivity

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12
Q

T/F Physical dependence is common with chronic use of phenobarbital

A

True

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13
Q

T/F It is easy to wean infant from phenobarbital

A

False

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14
Q

What seizures is primidone (mysoline) effective against

A

Most types except ABSENCE

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15
Q

What generation is phenytoin (Dilantin)

A

1st generation

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16
Q

What seizures is phenytoin (dilatin) effective against

A

Most types except ABSENCE

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17
Q

What is the prime area of use for phenytoin (dilatin)

A

Post-traumatic seizures

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18
Q

What does toxicity/chronic use of phenytoin (dilatin) cause

A

Cerebellar degeneration

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19
Q

Side effects of phenytoin (dilatin) (4)

A
  1. Gingival hyperplasia
  2. Vitamin K deficiency
  3. Cleft palate deformity
  4. Bone marrow hypoplasia
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20
Q

What is ethosuximide (zarontin) indicated for

A

ABSENCE seizure

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21
Q

What seizure types is carbamazepine (tegretol) effective against

A

Most seizure types except ABSENCE

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22
Q

What is carbamazepine (tegretol) metabolized into

A

Carbamazepine-10. 11-epoxide

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23
Q

Side effect of carbamazepine (tegretol)

A

Transient rash

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24
Q

T/F Regular blood work/monitoring is needed for carbamazepine (tegretol)

A

True

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25
Q

What medication has the broadest spectrum of antiepileptic activity

A

Valproic acid (Depakene, Stavzor)

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26
Q

Side effects of valproic acid (depakene, stavzor) (3)

A
  1. Behavioral changes (bipolar disorder)
  2. Hair loss
  3. Weight gain
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27
Q

T/F we need to monitor drug level and response/side effects regularly for valproic acid (depakene, stavzor)

A

True

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28
Q

What generation is oxcarbazepine (trileptal, oxtellar XR)

A

2nd Generation

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29
Q

Does oxcarbazepine (trileptal, oxtellar XR) produce epoxied metabolite

A

Nope

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30
Q

What does oxcarbazepine (trileptal, oxtellar XR) not producing epoxied metabolite mean

A

Very little toxicity

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31
Q

What are the indications for use of oxcarbazepine (trileptal, oxtellar XR)

A

Primary mono therapy for primary and secondary epilepsy syndrome

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32
Q

Do we need continuous blood monitoring for oxcarbazepine (trileptal, oxtellar XR)

A

Nope

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33
Q

What baseline blood monitoring do we need for oxcarbazepine (trileptal, oxtellar XR)

A

Sodium level

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34
Q

What generation is eslicarbazepine (aptiom)

A

3rd Generation

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35
Q

Warning for eslicarbazepine (aptiom) (2)

A
  1. Suicidal ideation
  2. Aggressive behavior
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36
Q

What regular blood monitoring should be done for eslicarbazepine (aptiom) (2)

A
  1. Sodium
  2. Chloride
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37
Q

When should LFTs be evaluated for eslicarbazepine (aptiom)

A

Baseline only

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38
Q

T/F eslicarbazepine (aptiom) are not the first drug of choice

A

True

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39
Q

When is lamotrigine (lamictal) indicated

A

Adjunctive treatment in patients over age of 18 years old

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40
Q

What adjunctive treatments is lamotrigine (lamictal) used for (3)

A
  1. Partial onset generalized tonic-clinic seizures
  2. Secondarily generalized tonic-clinic seizures
  3. Lennox-Gastaut syndrome
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41
Q

Risk of using lamotrigine (lamictal)

A

Severe life threatening rash (Steven Johnston Syndrome)

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42
Q

T/F lamotrigine (lamictal) is available in a PO form

A

True

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43
Q

T/F lamotrigine (lamictal) interferes with folate metabolism

A

True

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44
Q

T/F zonisamide (zonegran) is a carbonic anhydride inhibitor

A

True

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45
Q

What does zonisamide (zonegran) being a carbonic anhydrase inhibitor put the pt at risk of developing

A

Kidney stones

46
Q

T/F zonisamide (zonegran) is a sulfonamide

A

True

47
Q

T/f zonisamide (zonegran) suppresses appetite

A

True

48
Q

What type of patient should we not use lacosamide (vimpat)

A

Hepatic insufficiency

49
Q

What warnings does lacosamide (vimpat) carry (3)

A
  1. Cardiac
  2. Hepatic
  3. Psychiatric
50
Q

Major side effects/risks of cenobamate (xcopri) (3)

A
  1. DRESS and multi organ sensitivity
  2. Shortens QT interval
  3. Suicidal ideations
51
Q

What do we need to monitor for with tiagabine (gabitril)

A

Suicidal tendencies

52
Q

Side effect of ezogabine (potiga)

A

Significant risk of retinal pigment dystrophies

53
Q

What does retinal pigment dystrophies lead to with ezogabine (potiga) (2)

A
  1. Vision loss (reversible)
  2. Destruction of photoreceptors
54
Q

What is the risk of vigabatrin (sabril)

A

Risk of irreversible vision loss

55
Q

What is the only way you can acquire vigabatrin (sabril)

A

The SHARE program because its distribution is limited

56
Q

T/F gabapentin (neurontin, horizant) is only used for adjunctive treatment

A

True

57
Q

Major side effects of gabapentin (neurontin, horizant) (2)

A
  1. Edema
  2. Somnolence
58
Q

What schedule is pregabalin (lyrica)

A

IV

59
Q

Side effects of topiramate (topamax, trokendi XR) (3)

A
  1. Weight loss
  2. Kidney stones (higher doses)
  3. Acute angle glaucoma (higher doses)
60
Q

What patient age can we use perampanel (fycompa) for

A

12 years and older

61
Q

T/F perampanel (fycompa) has multiple reactions with medications metabolized by CYP 450 and CYP 3A

A

True

62
Q

What is the black box warning on perampanel (fycompa)

A

Aggressive behavior and suicidal ideation

63
Q

What schedule is perampanel (fycompa)

A

III

64
Q

What are the 2 barbiturates used in the treatment of seizures

A
  1. Phenobarbital
  2. Primidone (metabolized into phenobarbital)
65
Q

What do barbiturates do/action

A

CNS depression

66
Q

How long after discontinuing perampanel (fycompa) do we need to monitor patients for black box warning

A

1 month

67
Q

T/F leviteracetam (keppra) is a first line agent for seizures

A

True

68
Q

Does leviteracetam (keppra) have any significant drug interactions

A

NO, which is why we use it (EXTREMELY SAFE)

69
Q

Do we have to dose adjust for hepatic or renal patients when using leviteracetam (keppra)

A

Nope… Remember it is safe.

70
Q

T/F Brivaracetam (briviact) requires CBC monitoring

A

True

71
Q

What is rufinamide (banzel) used to treat

A

Adjunctive treatment for Lennox Gastaut syndrome ONLY

72
Q

Who is rufinamide (banzel) contraindicated for

A

Patiens with short QT syndrome so check baseline EKG

73
Q

What is cannabidiol (epidiolex) used to treat (2)

A
  1. Lennox Gastaut syndrome
  2. Dravet syndrome (intractable seizures)
74
Q

When is stiripentol (diacomit) used

A

Only as an add-on to clobazam for dravet syndrome over the age of 2 years

75
Q

What is fenfluramine (fintepla) used to treat

A

Dravet syndrome in patients over 2 years old

76
Q

What are the 3 objectives of anticonvulsants

A
  1. Reduce seizures to maximum extent possible
  2. Avoid chronic drug related adverse effects
  3. Maintain normal psychosocial and vocational adjustment
77
Q

T/F Less than 50% of patients become seizure free for more than 12 months

A

True

78
Q

What should be start with someone who is taking an anticonvulsant and wants to get pregnant

A

Folic acid supplementation 6 months before pregnancy

79
Q

T/F We want to employ monotherapy as much as possible

A

True

80
Q

When do we start anticonvulsants (2)

A
  1. After second defined episode
  2. If lesion identified in epilptogenic regions of the brain, with or without seizure
81
Q

What are the epileptogenic regions of the brain (2)

A
  1. Temporal lobe (hippocampus)
  2. Frontal lobe
82
Q

How long do you have to be seizure free in NY to drive

A

12 months

83
Q

When can driving trial begin

A

3 months minimum

84
Q

How often is medical justification required for someone to drive who has seizures

A

Yearly

85
Q

What is lorazepam (ativan, loreev XR) used to treat

A

Status epilepticus

86
Q

What is diazepam (valium) used to treat

A

Skeletal muscle relaxation

87
Q

T/F Diazepam (vallium) is the only muscle relaxant that doesn’t effect the liver enzymes

A

True

88
Q

T/F Alprazolam (xanax) is the only benzo without anti-depressant action

A

True

89
Q

What is alprazolam (xanax) metabolized into

A

a-hydroxyalprazolam

90
Q

T/F a-hydroxyalprazolam has a long half-life so it accumulates in the body

A

True

91
Q

T/F chlordiazepoxide (librium) requires CBC and LFT monitoring

A

True

92
Q

What is a risk of using chlordiazepoxide (librium) for greater than 4 months

A

Porphyria (edema forms)

93
Q

What is chlordiazepoxide (librium) associated with long term

A

Extrapyramidal effects (parkinsonism)

94
Q

What is temazepam (restoril) used to treat

A

Disabling insomnia

95
Q

How long can temazepam (restoril) be used for insomnia

A

<10 days due to dependence

96
Q

What category is temazepam (restoril)

A

IV

97
Q

T/F midazolam (versed) is very long acting

A

False

98
Q

Whatdoes midazolam (versed) do

A

Induces insomnia during procedures

99
Q

What can the nasal formulation of midazolam (versed) be used for

A

Seizure rescue in patients over 12 years old

100
Q

What category are the new benzos

A

I

101
Q

What is the designer (new) benzo we need to know

A

Remimazolam (byfavo)

102
Q

What is the defined antagonist of remimazolam (byfavo)

A

Flumazenil

103
Q

What does having a defined antagonist mean for remimazolam (byfavo)

A

There is increased safety in cases of overdose

104
Q

How long should procedures be if using remimazolam (byfavo)

A

30 minutes or less

105
Q

What is the non-benzo benzo

A

Buspirone (buspar)

106
Q

What is buspirone (buspar) a partial agonist of

A

5-HT 1 A receptors

107
Q

T/F buspirone (buspar) has less sedation

A

True

108
Q

T/F buspirone (buspar) has a high abuse potential

A

False

109
Q

T/F there is no withdrawal or dependence with buspirone (buspar)

A

True

110
Q

What is buspirone (buspar) the drug of choice for

A

Severe anxiety in those recovering from alcohol or sedative drug dependence

Pharmacology 2 Connor (13 decks)

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