Antiepileptic Drugs Flashcards
mechanistically what triggers seizures
decrease in inhibitory synaptic activity or an increase in excitatory synaptic activity
what are the two main classes of anti epileptic drugs
- drugs that block voltage gated channel: Na and T type Ca
- drugs that affect synaptic transmission: GABA agonist or glutamate antagonist
what are the drugs that block Na voltage gated channels
PCOLZ PVT (not so sure about PVT)
- Phenytoin
- Carbamazepine
- Oxcarbazepine
- Lamotrigine
- Zonisamide
- Phenobarbital
- Valproate
- Topiramate
drugs that block T type Ca channels
Ethosuximide
Valproate
drugs that enhance GABA transmission postsynapticallly and their mechanism
Direct action on the GABA receptors
Benzos
Barbiturates
Topiramate
drugs that enhance GABA transmission pre-synaptically and their mechanism
- inhibit reuptake of GABA: Tiagabine
- inhibit degradation of GABA by irreversibly inhibiting GABA aminotransferase: Vigabatrin
drugs that inhibit glutamate neurotransmission pre-synaptically and their mechanism
- decrease glutamate release by blocking pre-synpatic voltage gated Ca channels: Gabapentin and Pregabalin
- binds to synaptic vesicle glycoprotein 2A (SV2A) : Levetiracetam
drugs that inhibit glutamate neurotransmission post synaptically and their mechanism
Phenobarbital and Topiramate: blocks glutamate receptors
drugs used for tonic-clonic seizures (generalized seizure)
COLT PV (Coach J)
Carbamazepine
Oxcarbazepine
Lamotrigine
Topiramate
Phenytoin
Valproate
drug of choice for absence seizures (generalized seizures)
Ethosuximide
Valproate
drug of choice if tonic-clonic seizures occur or emerge during absence seizures or preferred for atypical absence seizures
Valproate
drug of choice for myoclonic seizures (short episode of muscle contractions that may happen for several minutes) and drug used for adjunct therapy
Valproate
-Levetiracetam as adjunct therapy
drug of choice for atonic seizure (sudden loss of postural tone)
usually all drugs are refractory
Valproate and Lamotrigine may be beneficial
treatment of febrile seizures
- if less than 15 minutes, give supportive therapy
- if greater than 15 minutes, use diazepam IV or as rectal solution
first line treatment for status epilepticus (seizures lasting longer than 30 minutes – life threatening)
IV Lorazepam
if seizures in status epilepticus continue after administration of IV lorazepam, what drug should be given
IV phenytoin or Fosphenytoin
in status epilepticus, if IV lorazepam and phenytoin fail, what should be given
Phenobarbital
Common complication of phenobarbital especially after giving lorazepam and phenytoin …how should the complication be handled
Respiratory depression –> intubation and ventilation should be instituted
In status epilepticus, if lorazepam, phenytoin, and phenobarbital are not working, what should be done
general anesthesia with
Barbiturates (thiopental or pentobarbital)
Propofol
Midazolam
seizures due to drug overdose or poisoning in a non epileptic person should be treated how
local anesthesia such as
Diazepam
Lorazepam
Phenobarbital
all IV
drug used for breakthrough seizures (seizures in those on anti epileptic regimen)
Diazepam rectal gel
AE of phenytoin
Gingival Hyperplasia
Fetal Hydantoin Syndrome
AE of valproate
Hepatotoxicity
Spina Bifida
AE of lamotrigine and what should be done
Steven Johnson’s rash - discontinue at first sign of rash
carries black box warning about rash
AE of carbamazepine
Aplastic anemia
Agranulocytosis
what occurs with overdose of anti epileptics
Respiratory Depression
AE of phenobarbital
Cardiac defects
Oral clefts
AE of Topiramate
Oral clefts
what are some supplements that are given to pregnant women on anti epileptics drugs
first off, they should be avoided if possible especially ones like Valproate and Phenytoin
- supplement folate to prevent spina bifida
- supplement vitamin K especially in final months of pregnancy and in newborn to prevent Newborn Hemorrhagic Disease
first line for essential tremor and also used as an anti epileptic
Primidone
used for trigeminal and post herpetic neuralgia
Trigeminal Neuralgia: Carbamazepine
Post Herpetic Neuralgia: Gabapentin and Pregabalin
non pharmacological treatment of seizures
Vagus Nerve Stimulation
Surgery
Ketogenic Diet
