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D&T2 Exam 2 > Anticonvulsants - egleton > Flashcards

Anticonvulsants - egleton Flashcards

1
Q

abnormal EEG is indicates what

A

Seizure

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2
Q

Generalized tonic-clinic seizures so frequent that another seizure occurs before the patient returns to normal consciousness from the postictal state
- how severe is this? how?

A

Status Epilepticus
medical emergency and high mortality rate
hypoxia leads to brain damage

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3
Q

What is the treatment for Status Epilepticus

A

IV Benzodiazapams

followed with IV Phenytoin/Fosphenytion ( prevent reoccurance)

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4
Q

what treatment is used for status Epilepticus if refractory? and if this doesn work? Any extra support

A

more phenytoin and more BCZ

  • Barbituates ( phenobarbital/phentobarbtial/Midazolam/propofol)
  • may need respiratory support
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5
Q

what are 3 parts of a history of seizure

A

aura
ictus: seizure itself
Postictus

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6
Q

how is epilepsy diagnosis made

A

history with electrical studies

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7
Q

what are 3 MOA for antiepileptic drugs

A
  1. inhibition of sodium and calcium influx
  2. augmentation of inhibitory GABA neurotransmission
  3. inhibition of excitatory glutamate neurotransmission
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8
Q

MOA for Phenytion

A
  • inhibition of seizure spread: blockade of Ca influx, enhances Cl- IPSPs
  • suppression of epileptic focus: affinity for inactivated Na channels at depolarized membrane potentials, stimulates Cl- mediated IPSP
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9
Q

Use of Phenytion

A

Initial treatment for: Absence Epilepsy Atonic Seizures

effective treatment for: generalized tonic-clonic seizures, partial and status epiepticus

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10
Q

if Phenytoin is give IM what happens

A

crystallization and possible muscle necrosis

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11
Q

when the hepatic hyroxylation system becomes saturated small increases in dose of Phenytoin causes what

A

large increase in the plasma concentration of drug

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12
Q

Side effects of Phenytoin

A 
Hirsutism 
gingival hyperplasia
nystagmus 
Steven-Johnson syndrome
Hematological reactions
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13
Q

what allergic reactions to Phenytoin require cessation of therapy

A

Hematological reactions

Steven-Johnsons

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14
Q

how is Phenytoin administered for cardivascular collapse

A

IV

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15
Q

what are fetal abnormalities of Phenytion

A

pregnancy category D

heart malformations

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16
Q

what is the prodrug of Phenytion

A

Fosphenytion

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17
Q

MOA for Carbamazepine

A

unknown

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18
Q

Carbamazepine 2nd line of drug for what

A

2nd: generalized tonic-clonic seizures
complex partial seizures
other: may make myoclonic seizures worse
trigeminal neuralgia

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19
Q

Carbamazepine has an autoinduction of metabolism of what

A

CYP 1A2 / 2C/ 3A

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20
Q

when does the rate of metabolism increase for Carbamazepine? 1/2 lives?

A

first 4-6 weeks
30hr = naive patient
10-20 hours - after few weeks

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21
Q

what are side effects of Carbamazepine

A

G.I. upset
vertigo
Hematological disorders
hepatoxicity

22
Q

MOA for PHenobarbital

A

enhances the GABA mediated Cl-flux that causes membrane hyperpolarization
- older drug

23
Q

Side effects of Phenobarbital

A

sedation
addiction
rashes

24
Q

Drug interaction of Phenobarbital

A

induces various CYPs
addictive with other CNS depressants
Valproic acid increases Phenobarbital blood levels

25
Q

Primidone

A

antiepileptic drug

26
Q

MOA for Valproic acid/Divalproex

A

Interacts with GABAergic:

blocks both Na and K channels and T-type calcium channels

27
Q

uses for Valproic acid/Divalproex

A

absence seizures refractory to ethosuximide

bipolar

28
Q

what is so great about Valproic acid/Divalproex

A

well absorbed in gut
low molecular weight fatty acid
“sprinkles”

29
Q

Side effects of Valproic acid/Divalproex

A

Alopecia
hepatic failure
decrease in platelet and clotting function

30
Q

for Valprioc acd/Divalproex who does hepatic failure have the greatest risk for

A

under 2 years

31
Q

what is drug interaction of Valproic acid/Divalproex

A

inhibits P450s
displaces phenytoin from plasma protein
decreases elimination of Phenytoin

32
Q

Should you take Valproic acid/Divalproex while pregnant or child bearing age

A

no

33
Q

what is the use for Ethosuximide

A

absence seizures - only indication

34
Q

MOA of Ethosuximide

A

blocks T-type Ca channels

35
Q

what are side effects of Ethosuximide

A

GI
CNS depression
Rashes
Blood dyscrasia

36
Q

which Lorazepam if given as an IV agent for status Epilepticus

A

Clonazepam

Diazepam

37
Q

MOA for Lorazepams

A

action on Benzodiazepine binding site of GABAa receptor complex: promoting GABA action

38
Q

what is Gabapentin used for

A

diabetic neuropathy

39
Q

what are side effects of Gabapentin

A

CNS: dizziness

weight gain

40
Q

MOA for Lamotrigine

A

inhibits voltage-sensitive Na channels

may inhibit Ca channel

41
Q

what is the side effect of Lamotrigine? how can this be reduced

A

severe steven-johnson and potentially life threatening

-titrating dose

42
Q

What are side effects for Topiramate

A

renal stone formation

paresthesias ( carbonic anhydrase inhibitor) can be used in treatment of IICH

43
Q

MOA for OXacarbazepine

A

blocks voltage dependent Na channels

44
Q

what are other uses for Levetriacetam

A

migraine

45
Q

Side effects of Oxcarbazepine

A

Hyonatremia common in first 3 months

46
Q

What is Pregabalin used for

A

Neuropathic pain

Diabetic peripheral neuropathy

47
Q

what drugs are used for broad spectrum (all seizure types: generalized from onset and partial onset seizures)

A

Lamotrigine
Levetiracetam
topiramate
Valproate

48
Q

what drugs are used for narrow spectrum ( simple partial, complex partial, and secondarily generalized seizures)

A

Carbamazepine
oxycarbazepine
phenobarbital
phenytoin

49
Q

what drugs are used for absence seizure

A

Ethosuximide

50
Q

how do anticonvulsants impact contraceptive

A

hepatic metabolism
plasma protein binding
- unplanned pregnancy, birth defects

51
Q

what is the drug interaction of Lamotrigine

A

metabolism induced by phenytoin, carbamazepine,

inhibited by valproic acid

52
Q

if an epileptic gets pregnant what happens to the frequency of epilipsy

A

increases

D&T2 Exam 2 (14 decks)

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