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Neuro IV > Antiseizure meds > Flashcards

Antiseizure meds Flashcards

1
Q

Mechanisms of seizures

A

Paroxysmal discharges –> synchronization and recruitment of large population of cortical/thalamic neurons

Enhanced glutamate/deficient GABA –> propagation of abnormal activity

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2
Q

Seizure sequence

A

focal epileptogenesis –> synchronization –> propagation

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3
Q

Primary causes of seizure

A

genetic, idiopathic

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4
Q

Secondary causes of seizure

A

mechanical (trauma, tumor), metabolic (hypoxia, hypoglycemia, hypocalcemia, alkalosis), withdrawal from CNS depressant, toxins

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5
Q

Tonic-clonic seizures

A

Grand mal. 30%. High amplitude EEG spikes at 15-40 Hz

loss of postural control; LOC; tonic phase (rigid extension of trunk and limbs), clonic phase (rhythmic contraction of arms and legs)

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6
Q

Tonic-clonic mechanism

A

Initiation: loss of GABA
Propagation: loss of GABA, increased glu response, Na channel excitation

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7
Q

Absence seizures

A

petit mal. 3 Hz EEG. Children.

Normal muscle tone; impaired consciousness with staring spells; no postictal state

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8
Q

Absence seizure mechanism

A

inappropriate activation of low-threshold T-type Ca channels

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9
Q

Simple partial seizure

A

preserved consciousness

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10
Q

Complex partial seizure

A

loss/impaired consciousness, psychomotor (limbic, temporal/frontal cortex)

can develop to secondary generalized

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11
Q

Partial seizure mechanism

A

involves initiation instead of propogation –> more difficult to treat

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12
Q

Primary generalized tonic-clonic seizure drug choice

A

Valproate or lamotrigine or levetiracetam

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13
Q

Partial seizure treatment

A

carbamazepine or lamotrigine or levetiracetam

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14
Q

Absence seizure treatment

A

Ethosuximide or valproate

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15
Q

Atypical absence, myoclonic, atonic seizure treatment

A

valproate or lamotrigine, or leviteracetam

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16
Q

Use of VSSC blockers

A

Tonic-clonic seizures. block high-frequency, repetitive firing of APs. Use-dependent

Phenytoin, carbamazepine, lamotrigine, topiramate, valproate,

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17
Q

T-type Ca channel blockers

A

ethosuximide

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18
Q

Use of high-voltage activated Ca channel blockers (N-type)

A

blocks neurotransmitter release

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19
Q

Benzos and phenobarbital action

A

facilitate GABA-mediated opening of Cl channels

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20
Q

Vigabatrin action

A

inhibits inactivation of GABA by GABA transaminase

21
Q

Tiagabine action

A

blocks GABA reuptake

22
Q

Gabapentin action

A

alters GABA metabolism, release, reuptake

23
Q

Carbamazepine (Tegretol) pharmacokinetics

A

complete oral absorption. P450 inducer –> 2-fold increase in clearance in first month

24
Q

Carbamazepine side effects

A

diplopia, ataxia, nausea/vomiting, drowsiness (higher doses)

Stevens-Johnson syndrome (associated with HLA-B 1502 allele–Asians)

Rare: aplastic anemia, agranulocytosis, hepatotoxicity

25
Q

Phenytoin (Dilantin) absorption

A

absorption dependent on formulation. Erratic IM absorption (fosphenytoin for IM/IV)
Food –> enhanced absorption, reduced GI upset

26
Q

Phenytoin metabolism

A

hepatic. P450 inducer. Zero-order kinetics

27
Q

Phenytoin adverse effects

A

nystagmus, diplopia and ataxia. Sedation at higher doses

rash most common. Gingival hyperplasia develops gradually

Long-term use –> mild peripheral neuropathy, osteomalacia

28
Q

Leviteracetam (Keppra) mechanism

A

Ca channel effects

29
Q

Keppra pharmacokinetics

A

rapid oral absorption, urinary excretion. PO/IV formulations

30
Q

Keppra ADRs

A

fatigue, somnolence, asthenia, dizziness

31
Q

Lamotrigine (Lamictal) pharmacokinetics

A

complete oral absorption. Phase II hepatic metabolism (high loading doses, rapid increase in dose –> increased side effect risk)

32
Q

Lamictal ADRs

A

similar to phenytoin, but lower rate of occurance

Stevens-Johnson syndrome

33
Q

Lamictal use

A

monotherapy for newly diagnosed partial or generalized seizures. Better tolerated than tegretol and dilantin

maintenance tx of bipolar
migraines

34
Q

Topiramate pharmacokinetics

A

Urinary excretion

35
Q

Topiramate ADRs

A

dose-related dizziness, somnolence, psychomotor slowing, impaired concentration, interference with memory

teratogenic

36
Q

Topiramate use

A

adjunctive therapy in partial seizures

37
Q

Zonisamide pharmacokinetics

A

complete oral absorption, long half life, excreted unchanged by kidneys and metabolized by CYP450

38
Q

Zonisamide ADRs

A

very well tolerated

Renal stones possible (mild carbonic anhydrase inhibitor)

39
Q

Zonisamide use

A

broad spectrum activity. Add-on for partial and generalized seizures

40
Q

Lacosamide pharmacokinetics

A

rapid, complete oral absorption, hepatic metabolism, but negligible DDIs

41
Q

Lasosamide ADRs

A

dizziness, headache, nausea, diplopia

42
Q

Lacosamide use

A

adjunct in partial seizures

43
Q

Ethosuximide pharmacokinetics

A

complete oral absorption, completely metabolized by CYP3A4 –> DDIs with inhibitors/inducers

44
Q

Ethosuximide ADRs

A

gastric distress

less common: headache, dizziness

45
Q

Valproic acid mechanism

A

potentiates GABA function, limits activity of T-type Ca channels

46
Q

Valproic acid pharmacokinetics

A

food delays absorption. can inhibit its own metabolism. extended release and IV formulations available

47
Q

Valproic acid ADRs

A

GI complaints (avoided when taken with food)

Rare: hepatotoxicity

contraindicated in pregnancy

48
Q

gabapentin use

A

certain treatment resistant epilepsies

49
Q

management of status epilepticus

A

Initial: IV lorazepam
If seizures persist: IV phenobarbital, then pentobarbital until they stop
If seizures still persist: propofol infusion with pressor support

Neuro IV (21 decks)

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