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Summer Pharm - Exam 2 > Antiseizure > Flashcards

Antiseizure Flashcards

1
Q

2 antisz drugs used for chronic pain

A

gabapentin

pregabalin

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2
Q

3 mood stabilizing drugs used for antisz

A

valproic acid

divalproex

lamotrigine

carbamazepine

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3
Q

3 drugs used for partial sz

A

carbamazepine

levetiracetam

lamotrigine

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4
Q

3 drugs used for tonic clonic sz

A

valproate

levetiracetam

lamotrigine

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5
Q

3 drugs used for atonic myoclonic sz

A

vaproate

levetiracetam

lamotrigine

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6
Q

2 drugs used for absence sz

A

ethosuximide

valproate

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7
Q

2 drugs used for status epilepticus

A

lorazepam

midazolam

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8
Q

add-ons for sz

A

valproate

phenytoin

gabapentin

phenobarbital

clonazepam

levetiracetam

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9
Q

2 antisz drugs that work on peripheral Na channels

A

carbamazepine

oxacarbazepine

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10
Q

2 anti sz drugs that work on central Ca channels

A

gabapentin

pregabalin

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11
Q

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

A

TCADs

SNRIs

tramadol

opioids

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12
Q

pharmacotherapy of bipolar disorder

A

stabilize mood: lithium AND valroate

mania: atypical antipsychotics

acute mania: bdz’s vs atypical antipsychotics

dpn: lamotrigine vs antidpn

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13
Q

management of menstrual migraines

A

NSAIDs

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14
Q

management of HTN

A

bb

ccbs

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15
Q

management of comorbid dpn

A

TCADs

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16
Q

management of comorbid sz d.o or bipolar

A

anticonvulsants

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17
Q

alternative for migraines if pharm is ineffective

A

botox

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18
Q

2 FDA approved prophylactic antisz meds for migraines

A

valproate

topiramate

gabapentin also effective

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19
Q

seizures are grouped in to (2)

A

generalized → bilateral convulsive sz

focal

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20
Q

4 types of generalized sz

A

tonic-clonic

absemce

atonic

myoclonic

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21
Q

excessive neuronal discharge characterized as brief, involuntary, episodic

A

seizure

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22
Q

violent involuntary contraction of voluntary muscles

A

convulsion

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23
Q

chronic sz disorder

A

epilepsy

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24
Q

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

A

MES

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25
Q

generalized/tonic-clonic sz’s are characterized by

A

LOC

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26
Q

two phases of generalized sz

A

tonic

clonic

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27
Q

rigid extension of tunk/limbs

A

tonic phase

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28
Q

rhythmic contractions of arms/legs

A

clonic phase

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29
Q

initiation of generalized sz’s occur due to loss of __

A

GABA inhibitory zone

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30
Q

propagation of generalized sz’s occur due to

A

decreased GABA tone over large area

PLUS

increased response to glutamate and Na channel excitation

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31
Q

generalized absence sz (petit mal) are characterized by

A

impaired consciousness w. staring spell

normal fxn after sz

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32
Q

generalized absence sz are caused by

A

activation of T-type Ca channels

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33
Q

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

A

PTZ

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34
Q

3 types of partial sz

A

simple

complex

secondary

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35
Q

partial sz are characterized by

A

preservation of consciousness

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36
Q

partial sz originate in

A

cortical restricted region

37
Q

simple partial sz are characterized by __

complex partial sz are characterized by

A

preservation of consciousness

loss or impaired consciousness

38
Q

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

A

secondary generalized

39
Q

partial sz’s begin

40
Q

sz pathophys pathway

A

increased O2 demand → ischemia → brain damage → more sz

41
Q

3 steps in sz

A

focal epileptogenesis → synchronization → propagation

42
Q

channel/receptor involved in epileptogenesis

A

VSSC/VSCC

GABA and GLU

43
Q

what leads to propagation of sz (4)

A

alterations in extracellular ions → Mg, Ca, H+

hypoxia

drug withdrawal

toxins

44
Q

2 goals of antisz drugs

A

elevating threshold

limiting proagation

45
Q

drugs are more effective in __

than __

A

sz propagation (generalized)

initiation (partial)

46
Q

4 drugs that inhibit Na channel fxn

A

phenytoin

carbamazepine

lamotrigine

topiramate

block repetitive firing

47
Q

Na blockage is __ dependent

48
Q

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

A

benzos

phenobarbital

valproate

49
Q

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

A

ethosuximide

50
Q

what is ethosuximide used for

A

absence sz

51
Q

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

A

lamotrigine

52
Q

drug that impairs Ca mediated NT release → inhibits synaptic release

A

levetiracetam → SV2A

gabapentin/pregabalin → a2 ligand

53
Q

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

A

carbamezepine → tegretol

54
Q

carbamazepine is a strong inducer of __

and has many __

A

CYP450

ddi

55
Q

rare but serious s.e of carbamazepine

A

aplastic anemia → agranulocytosis

hepatotoxicity

56
Q

2 monitoring tests for carbamazepine

A

CBC

liver fxn

57
Q

phenytoin is very effective against (2)

A

partial

tonic-clonic

58
Q

phenytoin → dilantin is a strong inducer of __

and has lots of __

A

CYP450

ddi

59
Q

dose related adverse rxn’s of phenytoin

A

nystagmus

diplopia

ataxia

sedation

60
Q

chronic adverse rxn’s of phenytoin

A

rash

ginigival hyperplasia

hirsutism

osteomalacia/OP

61
Q

what broad spectrum drug works on VSSC and decreases Glu release

A

lamotrigine (lamictal)

62
Q

lamotrigine is first line for (2)

and is better tolerated than (2)

A

partial sz

generalized sz

phenytoin

carbamazepine

63
Q

adr’s of lamotrigine are similar to acute adr’s of__ but lower incidence

A

phenytoin →

diplopia

ataxia

dizziness

skin rashes

sedation

64
Q

levetiracetam (keppra) is first line for

A

generalized tonic-clonic

65
Q

adr’s of levetiracetam

A

somnolence, asthenia,

dizziness

overall low ADRs

66
Q

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

67
Q

what limits s.e of gabapentin/pregabalin

A

saturable oral absorption

generally free from adr

68
Q

4 newer AEDs (anti epileptic drugs)

A

topiramate → topamax

zonisamide → zonegran

lacosamide → vimpat

69
Q

which newer AED drug is a schedule V controlled substance

A

lacosamide → vimpat

dt euphoria/inebriation like response

70
Q

lacosamide is well tolerated, but s.e include

A

dizzy

HA

nausea

diplopia

71
Q

drug of choice in absence sz

A

ethosuximide → zarontin

72
Q

mc s.e of ethosuximide

A

dose related GI

73
Q

broad spectrum drug w. efficacy against mc seizure types

A

valproate → depakote

74
Q

ddi of velproate

A

other AEDs

75
Q

2 common s.e of valproate

A

dose related GI

wt gain

76
Q

black box warnings for valproate (2)

A

hepatic failure

teratogenic

77
Q

4 benzos used for antisz

A

clonzepam → klonopin

lorazepam → ativan

midazolam → versed

diazepam → valium

78
Q

clonazepam is effective for

A

absence sz

PLUS

difficult cases → myoclonic, infantile, atonic

79
Q

drug of choice for status epilepticus

80
Q

phenobarbital is used for

A

neonatal status epilepticus

adjunct for partial and tonic-clonic

81
Q

does phenobarbital affect P450

A

yes!

classic inducer

82
Q

adverse ddi of phenobarbital

A

overactivity vs sedation in kids

83
Q

recurrent major sz between which pt does NOT regain consciousness

A

status epilepticus

mortality of 20-25%

84
Q

tx of status epilepticus

A

initial: IV lorazepam

then slow infusion: phenytoin or fosphenytoin

if persist: IV phenobarbital

refractory: phenobarbital or propofol

85
Q

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

86
Q

highest AED risk in pregnancy (2)

A

valproate

phenobarbital

87
Q

__therapy is preferred for AED use in pregnancy

88
Q

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

89
Q

what 2 AEDs can decrease efficacy of OCP

A

phenytoin

carbamazepine

enzyme inducing AEDs

Summer Pharm - Exam 2 (12 decks)

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