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Pharmacology- Exam #4 > Antiseizure/Status Epilepticus > Flashcards

Antiseizure/Status Epilepticus Flashcards

1
Q

When do you initiate anti seizure drug therapy in patients?

A

2+ unprovoked seizures

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2
Q

When do you consider discontinuing ASD therapy

A
  1. Seizure free for 2-4 years
  2. Complete seizure control within one year of onset
  3. Onset of seizure between 2-35 years of age
    AND normal neurologic exam/EEG
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3
Q

List the 3 MOA of ASDs

A
  1. Increase GABAeric inhibitory transmission
  2. Decrease Glutamatergic excitatory transmission
  3. Modify ionic conductance-nerve impulse propagation
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4
Q

List the presynaptic voltage gated Na+ channel drugs

A
  1. Phenytoin
  2. Carbamazepine
  3. Lamotrigine
  4. Lacosamide
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5
Q

List the presynaptic voltage gated Ca++ channel drugs

A
  1. Ethosurimide
  2. Lamotrigine
  3. Gabapentin
  4. Pregabalin
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6
Q

List the presynaptic voltage gated K+ channel drug

A

Retigabine

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7
Q

list the synaptic vesicle protein (SV24) drug

A

Levetiractam

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8
Q

List the two postsynaptic drugs

A
  1. AMPA Receptors

2. NMDA receptors

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9
Q

What drugs block the AMPA receptor

A
  1. Phenobarbital
  2. Topiramate
  3. Lamotrigine
  4. Perampanel
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10
Q

List the GABA A receptor drug

A

Benzodiazepines

  • Diazepam
  • Lorazepam
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11
Q

Absence treatment

A
  1. Ethosuximide
  2. Lamotrigine
  3. Valproic acid
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12
Q

Ethosuximide MOA

A
  1. Decrease VG-Ca++ currents

2. Decrease glutamate

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13
Q

Ethosuximide clinical application (what sz tx?)

A

Generalized Absence

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14
Q

Ethosuximide SEs

A
  1. Headache

2. Blood dyscrasias

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15
Q

Lamotrigine (Lamictal) MOA

A
  1. Blocks Na+ and Ca++ channels

2. Decreases glutamate

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16
Q

Lamotrigine (Lamictal) MOA clinical applications

A
  1. Generalized tonic-clonic
  2. Focal aware/impaired
  3. Focal or Generalized 4.Myoclonic
  4. Generalized Absence
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17
Q

Lamotrigine (Lamictal) SE’s

A
  1. Black box warning: Serious skin rash-start low and go slow
  2. Diplopia
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18
Q

Valporic acid (Depakote) MOA

A

Alters synthesis and degradation of GABA

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19
Q

Valporic acid (Depakote) clinical application

A
  1. Generalized tonic-clonic
  2. Focal aware/impaired
  3. Focal or Generalized 4.Myoclonic
  4. Generalized Absence
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20
Q

Valporic acid (Depakote) SEs

A
  1. Heptatotoxicity
  2. Pancreatitis
  3. Teratogenic-Don’t give to women of child bearing age
  4. Alopecia
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21
Q

Clonazepam MOA

A

Enhance GABAA receptor responses

22
Q

Clonazepam clinical application

A
  1. Generalized Absence
  2. Focal or Generalized
  3. Myoclonic
  4. Infantile spasms
23
Q

Clonazepam SEs

24
Q

Topiramate (Topamax) clinical application

A
  1. Generalized tonic-clonic
  2. Generalized absence
  3. Focal aware/impaired
  4. Migraine
25
Q

Topiramate (Topamax) SE’s

A
  1. Cognitive slowing

2. Confusion

26
Q

Drugs to avoid in absence seizures

A
  1. Carbamazepine
  2. Vigabatrin
  3. Gagapentin
  4. Tiagabin
27
Q

Ineffective drugs in absence seizures

A
  1. Phenytoin

2. Phenobarbital

28
Q

What are the 3 FDA approved meds to treat tonic-clonic seizures?

A
  1. Lamotrigine
  2. Levatriacetam
  3. Perampanel
29
Q

tonic-clonic seizure US guideline treatment

A

Topiramate (Topimax)

30
Q

Levatriacetam (Keppra) MOA

A

Binds synaptic protein

31
Q

Levatriacetam (Keppra) SE’s

A
  1. Behavioral problems

2. HA

32
Q

Carbamazepime (Tegretol) MOA

A
  1. Blocks voltage-gated Na+ channels

2. Decreases glutamate release

33
Q

Carbamazepime (Tegretol) Box warning

A
  1. Serious dermatologic reaction: TEN & SJS

2. Asians: Aplastic anemia and agranulocytosis

34
Q

Carbamazepime (Tegretol) ADEs

A
  1. Hyponatremia
  2. Metabolic Bone Dz (MBD)
  3. Ataxia
  4. Diplopia
35
Q

Lacosamide ADE’s

A

EKG changes- small increase in PR interval

36
Q

Phenytoin (Dilantin) MOA

A

Blocks voltage-gated Na+ channels

37
Q

Phenytoin (Dilantin) Box warning

A

CV risk associated with rapid infusion

38
Q

Phenytoin (Dilantin) ADEs

A
  1. Nystagmus-often the first sx of toxicity
  2. Gingival hyperplasia
  3. Hirsutism
  4. Folate deficiency (supplement with folate)
  5. Neuropathy
39
Q

Phenobarbitol ADEs

A
  1. Intellectual blunting
  2. MBD
  3. Behavior changes
40
Q

What is unique about the Phenobarbitol drug reaction?

A

Idiosyncratic- reactionspecific to pt

41
Q

What will happen if you continue to increase the Phenobarbitol dose?

A

Patient will die

42
Q

Gabapentin (Neurontin) ADEs

A
  1. Somnolence-“Brain fog’
  2. Ataxia
  3. Weight gain
43
Q

Pregablin (Lyrica) ADE’s

A
  1. Somnolence-“Brain fog’
  2. Ataxia
  3. Weight gain
44
Q

Vigabatrin (sabril) box warning

A

Permanent vision loss

45
Q

Perampanel (Fycompa) Box warning

A

Serious psychiatric and behavioral rxn

46
Q

Tiagabine (Gabitril) ADEs

A
  1. Concentration and attention difficulties
  2. Behavioral disturbances
  3. Increased appetite
47
Q

Zonisamide MOA

A

blocks Na+ channel

48
Q

Zonisamide ADEs

A
  1. Cognitive slowing
  2. Rash-Sulfa based drug
  3. Paresthesia
  4. Kidney stones
  5. Oligohydrosis
49
Q

What do you want to consider using in a female who takes Phenytoin d/t its drug interactions?

A

Interacts with oral contraceptives

-Consider IUD or patch

50
Q

If a patient comes in who takes Carbamazepine and is having a seizure, what do you want to check first? why?

A

Check serum level of Carbamazepine because this drug is induces it’s own metabolism

51
Q

What drug has rare or minimal drug interactions?

A

Lamotrigine

Pharmacology- Exam #4 (6 decks)

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