Antiepileptics Flashcards
How do you distinguish between a partial and a generalized seizure?
Partial: starts focally and can evolve into tonic-clonic with loss of consciousness
Generalized: immediate loss of consciousness, doesn’t evolve
How do you distinguish between a simple partial and a complex partial seizure?
Simple: no loss of consciousness - abnormal movement of single limb
Complex: loss of consciousness - can urinate
Describe the difference between grand mal and petite mal seizures
Both generalized
Grand mal: tonic-clonic
Petit mal: absence seizure - pt stares with rapid eye blinking (loss of consciousness)
Two mechanisms that can cause seizures (general ideas)
Loss of inhibition
Over excitement
Think in terms of GABA and glutamate
GABA antagonists and glutamate agonists can cause seizures
Name the four drugs used in epilepsy who’s main method of action is blocking voltage-gated sodium channels
Phenytoin
Carbamazepine
Lamotrigine
Zonisamide
name the two drugs effective in treating absence seizures. what channels do they act on?
Ethosuximide and Valproate
Block T-type Calcium channels
Name the drug that treats epilepsy by inhibiting the reuptake of GABA
Tiagabine
Name the drug that treats epilepsy by inhibiting the degradation of GABA
Vigabatrin
Name the two drugs that treat epilepsy by increasing GABA release AND blocking glutamate release
Gabapentin and Pregabalin
Name two drugs that treat epilepsy by blocking glutamate receptors
Phenobarbital and topiramate
DOC simple and complex generalized tonic-clonic seizures
Carbamazepine
Oxcarbazepine
Lamotrigine
Phenytoin
Which drug is used to treat generalized tonic-clonic as well as myclonic seizures, but is now second line due to adverse effects?
Phenobarbital
DOC generalized tonic-clonic seizures
Valproate
Carbamazepine
Phenytoin
DOC atypical absence seizures
Valproate
DOC myoclonic seizures
Valproate
What is important to remember about atonic seizures? what two drugs can help?
they are often refractory of all drugs
Valproate and Lamotrigine
Name three drugs used to treat infantile spasms
Corticotropin
Glucocorticoids
Vigabatrin
What is the time frame for treatment of febrile convulsions? How do you treat?
If seizures less than 15 minutes, just supportive care
If they are longer than 15 minutes, treat with Diazepam given IV or rectally
For Status Epilepticus give the first (1), second (2), third (1), and final drugs of choice (3) to treat if seizures continue
IV Lorazepam
IV Penytoin or Fosphenytoin
IV Phenobarbital
General anesthesia with IV Midazolam, Propofol, or barbiturates
Name the three drugs used to treat drug-induced seizures in nonepileptic patients
Diazepam
Lorazepam
Phenobarbital
What is the drug of choice for breakthrough seizures and how is it administered?
Diazepam via rectal gel
which three antiepileptics are CYP inducers?
Phenytoin
Carbamazepine
Phenobarbital
Which anti-epileptic causes hepatotoxicity and actually inhibits its own metabolism through CYP inhibition?
Valproate
Which anti-epileptic drug causes nystagmus, hirsutism and gingival hyperplasia?
Phenytoin
Adverse effects of Carbamazepine?
aplastic anemia, agranulocytosis, rash
Adverse effects of Vigabatrin?
irreversible visual field defects in 1/3 of patients
How long does a patient have to be seizure free to consider withdrawing treatment? How do you withdraw treatment?
3-5 years
gradual tapering (very gradual for benzos and barbituates to avoid withdrawal) and if on several, remove one at a time
An epileptic patient is tired of shitting himself and takes the rest of the pills in his almost full bottle of antiepileptic meds. What is the most important concern for overdose? How likely is he to be successful at suicide?
respiratory depression
not very, anti-seizure drugs are rarely lethal in overdose
Which anti-epilepsy drug has the highest rate of fetal malformations?
Valproate
What is an important complication in the newborn if the mother was taking anti-epilepsy drugs during pregnancy? Why? Prevention?
Bleeding
some anti-epileptics can increase degradation of vitamin K in the newborn
mother should take vitamin K supplementation during final month of pregnancy and also given to newborn
Many epilepsy drugs can be used for other things, what is another use for: Carbamazepine (2)
neuropathic pain and bipolar disorder
Many epilepsy drugs can be used for other things, what is another use for: Gabapentin
neuropathic pain
Many epilepsy drugs can be used for other things, what is another use for: Lamotrigine
Bipolar disorder
Many epilepsy drugs can be used for other things, what is another use for: Pregabalin
neuropathic pain
Many epilepsy drugs can be used for other things, what is another use for: Topiramate
Migraine
Many epilepsy drugs can be used for other things, what is another use for: Valproate (2)
Bipolar disorder and migraine
Almost 1/3 of patients being treated for epilepsy still continue to have seizures. Name 3 nonpharmacologic approaches to treat these patients
Surgery
Ketogenic Diet (high fat diet and low carbs -> ketosis which has a direct antiseizure effect)
Vagus nerve stimulation via implanted pacemaker that the patient can activate when they feel a seizure coming
