Antiseizure Flashcards by Alice Richards

2 antisz drugs used for chronic pain

gabapentin

pregabalin

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3 mood stabilizing drugs used for antisz

valproic acid

divalproex

lamotrigine

carbamazepine

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3 drugs used for partial sz

carbamazepine

levetiracetam

lamotrigine

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3 drugs used for tonic clonic sz

valproate

levetiracetam

lamotrigine

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3 drugs used for atonic myoclonic sz

vaproate

levetiracetam

lamotrigine

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2 drugs used for absence sz

ethosuximide

valproate

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2 drugs used for status epilepticus

lorazepam

midazolam

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add-ons for sz

valproate

phenytoin

gabapentin

phenobarbital

clonazepam

levetiracetam

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2 antisz drugs that work on peripheral Na channels

carbamazepine

oxacarbazepine

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2 anti sz drugs that work on central Ca channels

gabapentin

pregabalin

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4 meds that work on NE/serotonin/opioid receptors (descending inhibition)

TCADs

SNRIs

tramadol

opioids

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pharmacotherapy of bipolar disorder

stabilize mood: lithium AND valroate

mania: atypical antipsychotics

acute mania: bdz’s vs atypical antipsychotics

dpn: lamotrigine vs antidpn

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management of menstrual migraines

NSAIDs

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management of HTN

ccbs

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management of comorbid dpn

TCADs

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management of comorbid sz d.o or bipolar

anticonvulsants

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alternative for migraines if pharm is ineffective

botox

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2 FDA approved prophylactic antisz meds for migraines

valproate

topiramate

gabapentin also effective

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seizures are grouped in to (2)

generalized → bilateral convulsive sz

focal

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4 types of generalized sz

tonic-clonic

absemce

atonic

myoclonic

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excessive neuronal discharge characterized as brief, involuntary, episodic

seizure

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violent involuntary contraction of voluntary muscles

convulsion

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chronic sz disorder

epilepsy

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effective drugs for generalized (tonic-clonic sz) are identified via __ test

MES

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generalized/tonic-clonic sz's are characterized by

LOC

two phases of generalized sz

tonic clonic

rigid extension of tunk/limbs

tonic phase

rhythmic contractions of arms/legs

clonic phase

initiation of generalized sz's occur due to loss of \_\_

GABA inhibitory zone

propagation of generalized sz's occur due to

decreased GABA tone over large area PLUS increased response to glutamate and Na channel excitation

generalized absence sz (petit mal) are characterized by

impaired consciousness w. staring spell normal fxn after sz

generalized absence sz are caused by

activation of T-type Ca channels

effective drugs for generalized absence (petit) mal sz are identified w. __ test

PTZ

3 types of partial sz

simple complex secondary

partial sz are characterized by

preservation of consciousness

partial sz originate in

cortical restricted region

simple partial sz are characterized by \_\_ complex partial sz are characterized by

preservation of consciousness loss or impaired consciousness

what type of partial sz is difficult to tx due to initiation rather than propagation

secondary generalized

partial sz's begin

focally

sz pathophys pathway

increased O2 demand → ischemia → brain damage → more sz

3 steps in sz

focal epileptogenesis → synchronization → propagation

channel/receptor involved in epileptogenesis

VSSC/VSCC GABA and GLU

what leads to propagation of sz (4)

alterations in extracellular ions → Mg, Ca, H+ hypoxia drug withdrawal toxins

2 goals of antisz drugs

elevating threshold limiting proagation

drugs are more effective in \_\_ than \_\_

sz propagation (generalized) initiation (partial)

4 drugs that inhibit Na channel fxn

phenytoin carbamazepine lamotrigine topiramate *block repetitive firing*

Na blockage is __ dependent

dose

3 drugs that enhance inhibitory effect of GABA → increase opening of Cl channels

benzos phenobarbital valproate

drug that decreases low-threshold (T-type) Ca channels

ethosuximide

what is ethosuximide used for

absence sz

drug that inhibits high voltage activated Ca channels (N-type) → decrease glutamate/NT release

lamotrigine

drug that impairs Ca mediated NT release → inhibits synaptic release

levetiracetam → SV2A gabapentin/pregabalin → a2 ligand

carbamazepine is often used first for partial sz and tonic-clonic sz

carbamezepine → tegretol

carbamazepine is a strong inducer of \_\_ and has many \_\_

CYP450 ddi

rare but serious s.e of carbamazepine

aplastic anemia → agranulocytosis hepatotoxicity

2 monitoring tests for carbamazepine

CBC liver fxn

phenytoin is very effective against (2)

partial tonic-clonic

phenytoin → dilantin is a strong inducer of \_\_ and has lots of \_\_

CYP450 ddi

dose related adverse rxn's of phenytoin

nystagmus diplopia ataxia sedation

chronic adverse rxn's of phenytoin

rash ginigival hyperplasia hirsutism osteomalacia/OP

what broad spectrum drug works on VSSC and decreases Glu release

lamotrigine (lamictal)

lamotrigine is first line for (2) and is better tolerated than (2)

partial sz generalized sz phenytoin carbamazepine

adr's of lamotrigine are similar to acute adr's of\_\_ but lower incidence

phenytoin → diplopia ataxia dizziness skin rashes sedation

levetiracetam (keppra) is first line for

generalized tonic-clonic

adr's of levetiracetam

somnolence, asthenia, dizziness *overall low ADRs*

t/f: levetiracetam does not have cognitive effects and does not effect CYP

what limits s.e of gabapentin/pregabalin

saturable oral absorption *generally free from adr*

4 newer AEDs (anti epileptic drugs)

topiramate → topamax zonisamide → zonegran lacosamide → vimpat

which newer AED drug is a schedule V controlled substance

lacosamide → vimpat *dt euphoria/inebriation like response*

lacosamide is well tolerated, but s.e include

dizzy HA nausea diplopia

drug of choice in absence sz

ethosuximide → zarontin

mc s.e of ethosuximide

dose related GI

broad spectrum drug w. efficacy against mc seizure types

valproate → depakote

ddi of velproate

other AEDs

2 common s.e of valproate

dose related GI wt gain

black box warnings for valproate (2)

hepatic failure teratogenic

4 benzos used for antisz

clonzepam → klonopin lorazepam → ativan midazolam → versed diazepam → valium

clonazepam is effective for

**absence sz** PLUS **difficult cases →** myoclonic, infantile, atonic

drug of choice for status epilepticus

benzos

phenobarbital is used for

neonatal status epilepticus adjunct for partial and tonic-clonic

does phenobarbital affect P450

yes! classic inducer

adverse ddi of phenobarbital

overactivity vs sedation in kids

recurrent major sz between which pt does NOT regain consciousness

status epilepticus mortality of 20-25%

tx of status epilepticus

**initial:** IV lorazepam **then slow infusion:** phenytoin or fosphenytoin **if persist:** IV phenobarbital **refractory:** phenobarbital or propofol

t/f: risk to offspring from AED is less than risk from maternal sz

highest AED risk in pregnancy (2)

valproate phenobarbital

\_\_therapy is preferred for AED use in pregnancy

mono

what should be give to MOC on AED in final month of pregnancy

vit K

what 2 AEDs can decrease efficacy of OCP

phenytoin carbamazepine *enzyme inducing AEDs*