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U3 Pharm > Anticonvulsants and Headaches > Flashcards

Anticonvulsants and Headaches Flashcards

1
Q

Phenytoin

  • class
  • use
  • pharmacokinetics
  • side effects
  • teratogenicity
A

stabilize inactive conformation of Na channels

  • blocks axonal Na channels
  • seizure states, except for absence seizures
  • zero-order kinetics, p450 inducer, reduces efficacy of birth control pills
  • (CNS depression, megaloblastic and aplastic anemia) Gingival hyperplasia and hirsutism
  • cleft lip and palate
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2
Q

Carbamazepine

  • class
  • use
  • pharmacokinetics
  • side effects
  • Similar drug
A

stabilize inactive conformation of Na channels

  • blocks axonal Na channels
  • seizure states, especially complex partial seizures, bipolar, neuropathic pain
  • contraceptive failure, autoinduction (decreases its own half life)
  • Exfoliative dermatitis (Stevens-Johnson), Increase ADH secretion-> edema in CNS
  • Oxcarbazepine: prodrug, longer half life
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3
Q

Lamotrigine

  • class
  • use
  • side effects
A

stabilize inactive conformation of Na channels

  • blocks axonal Na channels, block glutamate receptors
  • seizure states, absence seizures (adjunct)- indicated in children, bipolar
  • Stevens-Johnson
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4
Q

Benzodiazepines

  • class
  • use
  • side effects
A

Bind GABA-A

  • GABAergic anti-epileptic
  • Status epilepticus, anesthesia
  • sedation
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5
Q

Valproic acid

  • class
  • use
  • side effects
  • teratogen
  • similar drugs
A

multiple mechanisms of action

  • stabilizes inactive conformation of Na channels, inhibits GABA-transaminase, blocks T-type Ca channels
  • seizure states (including absence), mania of bipolar, migraines
  • hepatotoxicity, thrombocytopenia, pancreatitis, alopecia
  • spina bifida
  • vigabatrin, tigabine
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6
Q

Gabapentin

  • class
  • use
  • side effects
  • similar drug
A

increase GABA effects (GABA analog)

  • blocks presynaptic Ca influx
  • seizure state adjunct, neuropathic pain
  • aplastic anemia, liver failure
  • pregabalin
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7
Q

Ethosuximide

  • class
  • use
  • side effects
A

blocks T-type Ca channels in thalamus

  • Ca channel blocker
  • absence seizures only
  • nausea, sedation
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8
Q

Topiramate

  • class
  • use
  • side effect
A

partial AMPA, Ca receptor blocker w/ secondary affect on Na channels and GABA system

  • glutamate receptor blocker
  • partial onset and secondary generalized, migraine prophylaxis
  • metabolic acidosis, kidney stones
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9
Q

Felbamate

  • class
  • use
  • side effect
A

Similar to lamotrigine- blocks Na channels and glutamate receptors

  • glutamate receptor blocker
  • seizure state adjunct
  • hepatotoxicity, aplastic anemia
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10
Q

First line of migraine treatment

A

behavioral: regular meals, exercise, rest, avoid triggers

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11
Q

Acute/abortive migraine treatment

A

used after an attack has already begun in attempt to reverse or stop the progression.

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12
Q

Specific acute treatment of migraines

A

ergots, triptans

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13
Q

Nonspecific acute treatment of migraines

A

analgesics, antiemetics, NSAIDS, steroids, anxiolytics, opioids

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14
Q

Analgesics in migraines

A

used in mild-moderate migraine, good for infrequent attacks, used w/ caffeine

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15
Q

Barbiturates in migraines

A

prescribed, lack of evidence, risk of overuse/withdrawal, drowsy and dizzy

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16
Q

Opioids in migraines

A

widely prescribed for migraines but there’s a high risk of overuse and development of chronic/daily headache; used when other meds are contraindicated (pregnancy)

17
Q

Steroids in migraines

A

used as a rescue treatment when the migraine will not subside

18
Q

Ergots in migraines (examples)

A

ergotamine, dihydroergotamine: adrenergic and serotonergic agonist. Dangerous with many side effects, use only with status migrainosus.

19
Q

Triptans

A

5HT1B-D agonists, reduce associated symptoms like naus/vom,

20
Q

Preventing migraines (examples)

A

taken everyday to reduce frequency and severity of migraine. Can be used preventively for patients who have had more than 3 severe headaches per month
(antidepressants, antihypertensive, antiepileptic, onabotulinumtoxin!)

21
Q

antidepressants in migraine

A

TCAs. SSRIs are used to treat coexisting depression

22
Q

Tricyclic acid side effects

A

dry mouth, constipation, weight gain; cardiotoxic q

23
Q

antihypertensives in migraine

  • beta blockers (2)
  • use
  • side effects
  • contraindication
A
  • timolol and propranolol
  • prevention
  • drowsiness, depression, decreased libido, hypotension
  • asthma, diabetes, congestive heart failure, Raynauds
24
Q

Divalproex sodium

-side effects

A

AED used to prevent migraines

-sedation, hair loss, weight gain, tremor

25
Q

antihypertensives in migraine

  • Ca channel blocker
  • use
  • side effect
A
  • verapamil
  • prolonged or disabling aura and complicated migraine syndrome
  • constipation and dizziness
26
Q

Topiramate

-side effect

A

AED used to prevent migraines

-change in cognition, paresthesias and weigh loss

27
Q

Acute therapy for cluster headache

A

oxygen, triptans, DHE, anesthetic

28
Q

Prophylactic therapies for cluster headache

A

short term- ergotamine and steroids

long term- verapamil, topiramate, divalproex, lithium

29
Q

Migraines

  • first line therapy
  • specific abortive drug
  • prophylactic drug
  • rescue treatment
A

-behavioral
-ergots, triptans
-TCAs (amitriptyline), SSRIs
(betablocks, Ca blocks, valproic acid, botox)
-steroids

30
Q

Tension headache

  • acute treatment
  • prophylactic
A
  • analgesics, anxiolytics, NSAIDS (naproxen, ketorolac, indomethacin)
  • antidepressants (TCAs, SSRIs)
  • amitriptyline*
31
Q

Cluster headache

  • acute
  • short term prophylactic
  • long term prophylactic
A
  • oxygen, triptans, DHE
  • steroids, ergotamine,
  • verapamil, topiramate, divalproex sodium, lithium

U3 Pharm (7 decks)

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