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Pharm III Exam 1 > Anticonvulsants (Lauren 🌭) > Flashcards

Anticonvulsants (Lauren 🌭) Flashcards

1
Q

What is the difference between partial/focal and generalized seizures?

A

Partial/Focal- originates in one area of brain

generalized- involves whole brain

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2
Q

What are the 3 types of partial/focal seizures?

A

Simple- short, no loss of consciousness

Complex- long

Partial with secondary general- starts in one spot then spreads to whole brain

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3
Q

What are the 4 types of Generalized seizures?

A

Absence (petit mal)- brief loss of awareness but not consciousness

Tonic-clonic (Grand mal)- initial rigidity, then clonic jerking. Loss of consciousness

Myoclonic- brief spasm

Atonic (no drugs to treat this type)- sudden loss of postural tone, patient falls down

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4
Q

True or False:

Activation of glutamate receptors (NMDA) can lead to seizures

A

True

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5
Q

true or false:

Blockage of GABA receptors causes seizures

A

True

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6
Q

Will increasing GABA activity stop seizures?

A

Yes

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7
Q

What are the mechanisms for increasing GABA activity?

A

Block GABA re-uptake (GAT inhibitor)- tiagabine

Inhibit GABA metabolism- vigabatrin

Stimulate GABA “A” receptors- benzos and barbs

Bind synaptic vesicular protein- levetiracetem

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8
Q

What are the common targets used to decrease excitatory glutamate activity in seizures?

A

Voltage gated Na+ and Ca++ channels

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9
Q

If a drug affects calcium channels, what kind of seizure will it help with/

A

Absence

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10
Q

Do we try to treat seizures with a single drug?

A

Yes, monotherapy is the goal because all these drugs have so many weird interactions

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11
Q

What are the 2 serious side effects of anticonvulsant drugs?

A

Teratogenic 👼🏻

Stevens-Johnson Syndrome

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12
Q

Which drug has the highest potential for Stevens Johnson syndrome?

A

Carbamazepine

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13
Q

Any drugs that block voltage gated Na+ channels have the potential to cause:

A

Stevens Johnsons Syndrome

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14
Q

What drug is the PROTOTYPE INDUCER of CYP450’s

A

Phenobarbital

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15
Q

Which drug is the PROTOTYPE INHIBITOR of CYP450s?

A

Valproic acid

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16
Q

How are most anticonvulsants metabolized?

A

By CYP450s

The pharmoacokinetics are “messy.” Phenytoin, carbamazepine and phenobarbital induce CYP450s.

Many drug interactions.

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17
Q

Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) are used for what types of seizures?

A

Partial

Tonic-clonic

NOT ABSENCE

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18
Q

What is the MOA of Phenytoin

A

Prolongs inactivation of Na+ channels

Decreases glutamate activity

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19
Q

If an anticonvulsant drug acts on Na+ channels, you know it’s going to decrease what

A

Glutamate activity

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20
Q

How is Phenytoin (and Fosphenytoin) eliminated

A

At low doses: 1st order kinetics

At therapeutic doses and higher: ZERO order

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21
Q

Why does it matter if Phenytoin is eliminated by zero order kinetics at therapeutic doses?

A

Small changes in dose can cause BIG CHANGES in plasma levels

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22
Q

Which anticonvulsant can cause gingival hyperplasia?

A

Phenytoin (Dilantin)

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23
Q

If your patient is on phenytoin and she starts to get a skin rash, what should you do?

A

Discontinue it becasue there is a risk of SJS!!!

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24
Q

Your patient takes phenytoin for her seizures, and now she wants to get pregnant. What should you tell her?

A

She should probably stop taking it because its pregnancy category D

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25
Q

What is the drug of choice for partial seizures?

A

Carbamazepine (Tegretol)

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26
Q

What is a compelling alternative use for Carbamazepine (Tegretol)?

A

Trigeminal Neuralgia**

Trigeminal nerve is in your cheeks and you chew CARBs with your cheek

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27
Q

What is the MOA of carbamazepine (Tegretol)?

A

Blocks Na+ channels, decreases glutamate activity

Inhibits NE release and reuptake

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28
Q

What do you need to test your patient for before you put them on Carbamazepine?

A

HLA-B 1502 gene

High risk of SJS if they have this!!!

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29
Q

What is the MOA of Lamotrigine (Lamictal)?

A

Inactivation of Na+ channels, decreases glutamate activity

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30
Q

What are the side effects of Lamotrigine (Lamictal)?

A

Skin rash and Stevens Johnson syndrome

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31
Q

What is the MOA of Topiramate (Topamax)?

A

Blocks Na+ channels, decreases glutamate activity

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32
Q

What anticonvulsants can help with bipolar disorder for some reason

A

Carbamazepine ( Tegretol)

Lamotrigine (Lamictal)

Gabapentin

Valproic acid

This is probably not on the test

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33
Q

What are two other things that Topiramate (Topamax) can be sued for other that’s partial and generalized tonic-clonic seizures?

A

Migraine prevention

Alcohol craving

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34
Q

What is the side effet of Topiramate (Topamax) that you need to know?

A

Visual stuff: myopia/glaucoma

👁

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35
Q

What is the MOA of Levetiracetam (Keppra)?

A

Binds synaptic vesicular protein (SV2A)

Decreases glutamate AND increases GABA release (TWO EFFECTS)

36
Q

Although monotherapy is the goal, if you absolutely had to add another drug to your patients treatment for seizures, which anticonvulsants have no or minimal drug interactions that you can try?

A

Gabapentin (Neurontin) would be your FIRST CHOICE since it has NO drug interactions at all

Levetiracetam (Keppra) would be your second choice

37
Q

Which drug is the prototype INDUCER of CYP450’s

A

Phenobarbital (Luminal)

38
Q

Since phenobarbital (Luminal) INDUCES CYP450’s, what will oit do to the metabolism of phenytoin and carbamazepine?

A

Increases metabolism of phenytoin and carbamazepine

39
Q

What is the MOA of phenobarbital (Luminal)?

A

Prolongs opening of chloride channel at GABA receptor

40
Q

What is an alternative use for Gabapentin (Neurontin) and Pregabalin (Lyrica) other than as anticonvulsants?

A

Neuropathic pain

41
Q

What is the MOA of Gabapentin (Neurontin) and Pregabalin (Lyrica)>?

A

They are GABA analogs

42
Q

Why doesn’t Gabapentin (Neurontin) have any drug interactions?

A

It is excreted unchanged by the kidney. No metabolism=no drug interactions

43
Q

What is the MOA of Tiagabine (Gabitril)

A

GAT-1 inhibitor (inhibits reuptake of GABA)

44
Q

What is the MOA of Vigabatrin (Sabril)?

A

Irreversibly inhibits GABA-T (GABA transaminase), which decreases GABA metabolism

45
Q

What are the side effects of Vigabatrin (Sabril)?

A

Visual field problems/retinal damage

Vigabatrin- Visual 👁

46
Q

What is the DRUG OF CHOICE for absence seizures?

A

Ethosuximide (Zarontin)

being absent SUX

47
Q

What is the MOA of Ethosuxamide (Zarontin)?

A

Inhibits T-Type Calcium channels

48
Q

What is the very unusual side effect of ethosuxamide (Zarontin)?

A

Hiccup

49
Q

Which anticonvulsant almost NEVER causes Stevens Johnson Syndrome?

A

Ethosuximide (Zarontin)

This is because it hits CALCIUM channels and not Na+ channels!

50
Q

What anticonvulsant is your go-to for every kind of seizure?

A

Valproic acid (Depakene)

It is your “All Pro”

51
Q

If your patient has absence seizures and tonic-clonic seizures, and monotherapy is your goal, what drug should you try first?

A

Valproic acid (Depakene)

52
Q

What kind of seizures does Valproic acid treat

A

All of them. Including absence

53
Q

What is the MOA of Valproic acid (Depakene)

A

Blocks Ca++ channels and Na+ channels

Enhance GABA activity

54
Q

What is the PROTOTYPE inhibitor of CYP450

A

Valproic acid (Depakene)

55
Q

What is the side effect of Valproic acid (Depakene)

A

Hepatotoxicity

56
Q

What do you need to do from time to time when your patient is on Valproic acid (Depakene)?

A

Monitor liver function

57
Q

If your patient has status epilepticus or has been seizing for like 3-4 minutes, what do you need to give them NOW

A

Diazepam (Valium)

Or

Lorazepam (Ativan)

58
Q

Are anticonvulsants a good idea to take during preganncy?

A

No. Increased risk of congenital malformations, and Valproic acid can even cause spina bifida

59
Q

What happens if you stop taking anticonvulsants suddenly

A

Rebound seizures

60
Q

Is it common to overdose and die from anticonvulsants?

A

No

61
Q

What is the relationship between anticonvulsants and suicide

A

Increase occurrence of suicidal behaviors and thoughts

62
Q

Which 4 drugs blocks Na+ channels and can cause Stevens Johnson Syndrome?

A

Phenytoin

Lamotrigine

Carbamazepine**

Valproate

63
Q

Why do so many ladies who take anticonvulsants get WHOOPSY pregnancies?

A

Because anticonvulsants make contraceptives FAIL. A LOT

64
Q

What are your treatment opetions for tonic-clonic seizurs?

A

Phenytoin

Carbamazepine

Topiramate

Valproic acid

(Idk these 4 were on his little summary case study slide but these other drugs also said they could be used for tonic-clonic: Levetiracetam (Keppra), Phenobarbital (Luminal), Gabapentin)

65
Q

What are your options for treating absence seizure?

A

Ethosuxamide

Valproic acid

66
Q

What is the drug of choice for partial seizures?

A

Carbamazepine

67
Q

A patient is on a cocktail of 768 drugs and is in need of an anticonvulsant, which drug would most likely be recommended in this patient?

A

Gabapentin

68
Q

What is the drug of choice for absence seizures ?

A

Ethosuxamide

69
Q

Which drug requires HLA B 1502 testing before you start a patient on it?

A

Carbamazepine

70
Q

Which anticonvulsant requires you to monitor liver function?

A

Valproic acid

71
Q

Which anti convulsant works by binding the synaptic vesicular protein, SV2A?

A

Levetiracetam (Keppra)

72
Q

Which anticonvulsant works by inhibiting GAT-1 to prevent GABA reuptake?

A

Tiagabine (Gabatril)

73
Q

Which anticonvulsant works by inhibiting GAT-1 to prevent GABA reuptake?

A

Tiagabine (Gabatril)

74
Q

Which anticonvulsant works by inhibiting GABA-T, to prevent GABA metabolism?

A

Vigabatrin (Sabril)

75
Q

Which anticonvulsant makes you hiccup?

A

Ethosuxamide

76
Q

Which two anticonvulsants have visual side effects? 👁

A

Topiramate (Topamax)- myopia/glaucoma

Vigabatrin (Sabril)- visual field problems/retinal damage

77
Q

Which three anticonvulsants are less teratogenic than the rest of them (aka they are category C whereas the others are category D)

A

Lamotrigine (Lamictal)

Levetiracetam (Keppra)

Gabapentin (Neurontin)

78
Q

Which benzodiazepine can be used in the treatment of absence seizures

A

Conazepam (Klonipin)

79
Q

When i say “spina bifida” you say:

A

Valproic acid

80
Q

When I say “refractory complex partial seizures” you say:

A

Vigabatrin (Sabril)

81
Q

When I say “West’s syndrome” you say:

A

Vigabatrin (Sabril)

82
Q

When I say “Xerostomia” as a side effect, you say:

A

Pregabalin (Lyrica)

83
Q

Gabapentin and Pregabalin (Lyrica) are both gaba analogs. One of them increases GABA and one of them decreases glutamate. Which one does which?

A

Gabapentin - increased GABA

Pregabalin (Lyrica) - decreased glutamate

84
Q

If there is a test question about drug interactions with anticonvulsants, which two are the ABSOLUTE WORST to put together

A

Phenytoin and phenobarbital

**PANCE questions love this!!

85
Q

When i say “trigeminal neuralgia” you say:

A

Carbamezepine (Tegretol)

86
Q

What medication can you use to treat atonic seizures

A

NONE

Tell them to get a fuckin helmet 🏂🚴🏼‍♂️

Pharm III Exam 1 (4 decks)

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