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Pharm1 > Antiepileptics > Flashcards

Antiepileptics Flashcards

1
Q

what are the two types of seizures

A

Focal

Generalized

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2
Q

What are the two criteria which determine Status Epilepticus?

A

If seizure lasts longer than 5 minutes or

2 or more seizures between which pt does not regain full consciousness

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3
Q

Anti-epileptic drugs (AEDs); class and names of drugs (5)

A 
Class = Benzodiazepines
Lorazepam
Diazepam
Clonazepam
Chlorazepate
Clobazam
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4
Q

What is the preferred benzodiazepine of choice for status epilepticus? and why

A

Lorazepam

due to long duration of action in CNS and better protection

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5
Q

Mode of action of Carbamazepine

A

Sodium channel blocker

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6
Q

What is a possible complication of Carbamazepine?

A

Rash;

can get as severe as Stevens-Johnson syndrome

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7
Q

What is the allele tested for before use of Carbamazepine? and what/which ethnicities are most likely to be effected?

A

HLA-B 1502 allele
(10 fold elevated risk of Stevens Johnson syndrome)
Asians and Indians

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8
Q

ADRs of Carbamazepine

A

Leukopenia, aplastic anemia
Stimulates release of ADH (SIADH, hyponatremia (Na))
decreased levels of Vit D (decreases Ca absorption, increases gradual bone loss)

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9
Q

MOA of Phenobarbital

A

binds to GABA receptor and opens Cl channels

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10
Q

ADRs of Phenobarbital

A 
Cognitive impairment
Drowsiness
Physiological dependence
CNS depression
-- Don't discontinue abruptly; Sz and withdrawal can occur
Vit D and Ca deficiency
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11
Q

MOA of Phenytoin

A

Sodium channel blocker

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12
Q

Phenytoin; if given via IV, what is max rate and complication if given too fast?

A

max rate: 50 mg/min, diluted in normal saline

Hypotension if too fast

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13
Q

Drug which has 90% albumin binding?

A

Phenytoin

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14
Q

ADRs of Phenytoin (Dose related)

A 
(Dose related)
Ataxia (dysfunctional muscle movements)
Dizziness
Nystagmus (involuntary eye movement)
Slurred speech
Diplopia (double vision)
Lethargy
Cognitive impairment
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15
Q

ADRs of Phenytoin (non-dose related)

A 
(non-dose related)
Gingival hyperplasia
Skin thickening
Hirsutism (excessive body hair)
Coarsening facial features
Ca and Vit D deficiency with bone loss
Folate deficiency
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16
Q

MOA of Fosphenytoin

A

Sodium channel blocker

pro-drug of phenytoin

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17
Q

MOA of Valproic Acid

A

Ca and Na channel blocker

Enhance GABA release and activity

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18
Q

ADRs of Valproate (Valproic acid)

A 
Hepatotoxicity
Thrombocytopenia
Interference with platelet aggregation
Alopecia
Weight gain
Menstrual irregulations
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19
Q

Major class and drugs that have drug interactions with Valproate, causing significant reduction in valproate serum concentrations and increase risk of seizures

A 
Class: "carbapenems"
Meropenem
Imipenem
Ertapenem
Doripenem
20
Q

MOA of Lamotrigine

A

Decreases glutamate and aspartate release

blocks Na channels

21
Q

ADRs (and considerations) of Lamotrigine

A

Estrogen containing Oral Contraceptives may increase lamotrigine clearance
Rash
Dose titration needed
Concomitant Valproate use increases lamotrigine levels and higher risk of ADRs including rash

22
Q

MOA of Levetiracetam

A

Ca channel blocker
Facilitate GABA inhibitory effects
(No significant drug interactions)

23
Q

MOA of Oxcarbazepine

A

Na channel blocker

24
Q

ADRs of Oxcarbazepine

A

Serious skin reactions (25-30% cross-reactivity if rash with carbamazepine)
Vit D and Ca deficiency, bone loss
(more hyponatremia than with carbamazepine; SIADH)
(Lower risk for leukopenia than with carba…)

25
Q

what is and MOA of Eslicarbazepine

A

active metabolite of oxcarbazepine

Na channel blocker

26
Q

ADRs of Eslicarbazepine

A

skin rash

hyponatremia

27
Q

MOA of Lacosamide

A

Na channel blocker

28
Q

ADRs of Lacosamide

A

Arrythmogenic agent
PR prolongation
EKG at the baseline and steady-state in patients with history of cardiac conduction problems

29
Q

MOA of Pregabalin

A

Inhibits excitatory neurotransmitters
Ca channel blocker
(no significant drug interactions)

30
Q

MOA of Gabapentin

A

Inhibits neurotransmitters
Ca channel blocker
(no significant drug interactions)

31
Q

ADRs of Pregabalin and Gabapentin

A 
Xerostomia
Weight gain
Peripheral edema
Dizziness
Blurred vision
32
Q

MOA of Topiramate

A

Na channel blocker

Enhances GABA activity

33
Q

ADRs of Topiramate

A 
Nephrolithiasis
Oligohydrosis
Metabolic acidosis
Weight loss (used off label for this)
Vit D and Ca deficiency, bone loss
34
Q

MOA of Zonisamide

A

Na and Ca channel blocker

35
Q

ADRs of Zonisamide

A 
avoid if sulfonamide allergy
Skin rash
Nephrolithiasis
Oligohydrosis
Weight loss
36
Q

MOA of Vigabatrin

A

Irreversibly inhibits GABA transainase

37
Q

ADRs of Vigabatrin

A

Optic nerve atrophy

Permanent vision loss (up to 30%)

38
Q

ADRs of Ezogabine

A

QT prolongation
Urinary retention
Pigment changes in retina, conjunctiva, skin, nails

39
Q

ADRs of Falbamate

A

Hepatotoxicity

Aplastic anemia

40
Q

ADRs of Perampanel

A

Neuropsychiatric: anger, irritation

41
Q

ADRs of Tiagabine

A

Associated with new onset of seizures and status epilepticus in pts without epilepsy

42
Q

anti-epileptic drugs that are Na channel blockers

A 
Carbamazepine
Phenytoin
Fosphenytoin
Valproic Acid
Lamotrigine
Oxcarbazepine
Eslicarbazepine
Lacosamide
Topiramate
Zonisamide
43
Q

anti-epileptic drugs that are Ca channel blockers

A 
Valproic acid
Levetiracetam
Pregabalin
Gabapentin
Zonisamide
44
Q

anti-epileptic drugs that are CY P450 INDUCERS

A 
Carbamaepine
Phenobarbital (and primidone)
Phenytoin
Fosphenytoin
Oxcarbazepine
45
Q

anti-epileptic drugs that are CY P450 INHIBITORS

A

Valproic acid

Vigabatrin (weak)

46
Q

Which anti-epileptic drug is a CYP 450 AUTO-INDUCER

A

Carbamazepine

Pharm1 (6 decks)

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