Antiepileptic Drugs Context Info Flashcards
Seizure def
transient occurrence of signs/sx due to abnormal excessive or synchronous neuronal activity in the brain “lightening storm”
Epilepsy def
enduring predisposition to generate epileptic seizures
Epilepsy def requirements
at least one epileptic seizure not caued by another treatable medical condition
what are some medical conditions that can cause a seizure?
fever, infection, hypoglycemia, medication (PNC, carbepenems, Bupropion)
Diagnostic epilepsy criteria
at least 2 unproved seizures less than 24 hours apart OR one unprovoked seizure and probability of future seizures
when is epilepsy considered resolved?
no seizures in 10 years and off meds for 5 years
what Is AED treatment decision based off of?
type of seizure
side effect profile
patient preference
cost and dosing
when do most seizures occur?
within first 2 years of life, treatment can lower risk of recurrence
definition of generalized seizure
both hemispheres from outset
6 examples of generalized seizure types
absence, tonic clonic, tonic, clonic, myoclonic, atonic
absence seizure
staring out into space seems like they zoned out
absence seizure diagnosis
made via sx, EEG sometimes but hard to catch during small testing time frame
tonic clonic seizure presentation
classic aka grand mal
loss of consciousness, jerky motion, get them to a safe area
get onto floor and turn on side
tonic seizure
all muscles stiffen may drop to floor - high risk injury
clonic seizure
sustained jerky contraction of muscles that stop with restraint or repositioning of limbs
seizure prodrome
changes in behavior, mood, or feelings that occurs hours or days before seizure
aura
a simple partial seizure the sx correlate with what area of the brain is experiencing the abnormal electrical activity
itcus
what is seen/felt during abnormal electrical activity, includes all the manifestations and sx occurring during the seizure while abnormal electrographic activity occurs
postictal
what is seen/felt until brain recovers to baseline normal function.
Confusion, sleepiness, impaired awareness, paralysis until brain function returns
todd’s paralysis
occurs during postictal stage, temporary paralysis after seizure until brain returns to baseline activity
Indications to stop AED
seizure free 2-4 yrs, depends on seizure type
complete control within one year of onset
normal neuro exam
normal EEG
withdraw slowly over last 6 mo
onset 2-35 more likely can remove meds eventually
GABA causes a large concentration of ____
chloride ions (-) to enter receiving neuron telling the neuron to STOP passing on msg
what happens without GABA?
not enough stop signal so electrical activity gets out of controi
are sodium channels open or closed in resting state?
closed prior to activation
what is the brain’s major excitatory NT?
glutamate
what are 2 groups of glutamate receptors?
ionotropic and metabotropic
ionotropic receptors do what?
fast synaptic transmission and they are glutamate gated cation channels
what are 3 subtypes of ionotropic receptors?
AMPA, kainite, and NMDA
what do metabotropic receptors do?
slow synaptic transmission, modulation of synaptic activity via G protein coupled regulation of second messengers (cAMP and phospholipase C)
what is major inhibitory NT ?
GABA
what are 2 GABA receptor types
GABA a and GABA b
what gaba receptor is postsynaptic with specific recognition sites linked to Cl- channel?
GABA a
what are GABA b receptors like?
presynaptic autoreceptors that reduce NT by lowering calcium influx and coupled to a postsynaptic G protein to increase K+
exciatation ions
inward sodium and calcium currents
excitation NT
glutamate and aspartate
inhibition ions
inward CL and outward K+ currents
inhibition NT
GABA
8 main AED MOA
block repetitive Na channel action GABA enhancers Glutamate modulators T calcium channel blockers N and L CCB H current modulators Blockers of unique binding sites carbonic anhydrase inhibitors
Sodium channel blocker examples 10
phenytoin carbamazepine oxcarbazepine valproate felbamate lamotrigine topiramate zonisamide rufinamide lacosamide
GABA enhancers 8
barbiturates benzodiasepines carbamazepine valproate felbamate topiramate tiagabine vigabatrin
glutamate modulators 6
phenytoin gabapentin lamotrigine topiramate levetiracetam felbamate
T calcium channel blockers 3
ethosuximide
valproate
zonisamide
N and L CCB 4
lamotrigine
topiramate
zonisamide
valproate
H current modulators 2
gabapentin
lamotrigine
Blockers of unique binding sites 4
gabapentin
levetiracetam
pregabalin
lacosamide
carbonic anhydrase inhibitors
topiramate
zonisamide
