Brain_FCs_Seizures Pharm Flashcards
Panic Disorder
Clonazepam
Contraindicated in Porphyria
Phenobarbitol
Irritability in children
Phenobarbitol
Not sedating (not CNS depressant)
Phenytoin
Many drug interactions, induces CYP3A4
Phenytoin
Metabolized to stable, active epoxide
Carbamazepine
Induce CYP enzymes
Phenytoin, Carbamazepine
AEs include vertigo & blurred vision
Carbamazepine
Used in bipolar disorder
Carbamazepine, Valproic acid, Lamotrigine
Used in neuropathic pain syndromes
Carbamazepine, Gabapentin
AEs include hypersensitivity rxns
Ethosuximide (SLE, urticarial), Topiramate (in persons w/ sulfonamide allergy)
AEs include GI Sx (Nausea, vomiting, anorexia)
Ethosuximide
AEs include dizziness
Ethosuximide, Lamotrigine
Common AE includes hepatotoxicity
Valproic acid
Used as prophylaxis of migraine
Valproic acid, Topiramate
Tolerance to sedative & anticonvulsant effects
Clonazepam
Useful in panic disorder
Clonazepam
Only approved in combination
Gabapentin & Levetiracetam
Decreases Glutamate release
Lamotrigine
Slows recovery rate of Na+ channels
Phenytoin, Carbamazepine, Valproic acid (& Ca++), Lamotrigine, Topiramate
AEs include skin rashes
Lamotrigine, Ethosuximide
AEs include nervousness
Topiramate
Potentiates GABA @ GABAA receptors
Phenobarbitol, Topiramate
Induces metabolism of estrogen
Topiramate
Used for weight loss
Topiramate (in combo w/ phentermine)
Commonly used as mood stabilizer
Lamotrigine
Minimal toxicity to which pt develops tolerance in few wks
GABApentin (Neurontin)
Status Epilepticus Tx
Diazepam or Pentobarbitol or Thiopental (which often causes apnea, hypotension — then, a longer acting anticonvulsant like Phenytoin is given)
Phenobarbitol treats what?”
Generalized Tonic-Clonic, Partial
Phenytoin treats what?”
Generalized Tonic-Clonic & Partial
Carbamazepine treats what?”
Generalized Tonic-Clonic, Partial seizures, Bipolar disorder, Neuropathic pain syndromes
Ethosuximide treats what?”
Absence
Valproic acid treats what?”
All seizures, Bipolar disorder, Prophylaxis of migraine
Clonazepam treats what?”
All, except Generalized Tonic-Clonic
Diazepam treats what?”
Status Epilepticus (drug of choice)
Gabapentin treats what?”
Partial seizures (in combo), Neuropathic pain syndromes
Lamotrigine treats what?”
Partial, Generalized Tonic-Clonic, Bipolar disorder
Levetiracetam treats what?”
Partial, Myoclonic, Generalized Tonic-Clonic
Carbamazepine AEs
Sedation, ataxia, vertigo, blurred vision
Short acting barbiturates (2)? Use?
Thiopental & Methohexital. Used as intravenous anesthetics
Phenobarbitol MOA
Inc’s binding of GABA to GABA(a) receptor. Also inc’s binding of benzodiazepines to benzodiazepine receptor
Phenobarbitol onset & half-life
Slow onset, long half-life
Phenobarbitol: tolerance develops to _____
sedation
Phenytoin MOA
slows rec. rate of Na+ channels
Phenytoin toxicity
GRAB Her suit
Carbamazepine MOA
slows rec. rate of Na+ channels
Ethosuximide MOA
Antagonizes Ca currents in thalamus
Ethosuximide AEs
(CNS): Sedation, dizziness, headache: (GI): Nausea, vomiting, anorexia; (Hypersensitivity): Urticaria, SLE, S-J syndrome, decreases bone marrow
Valproic acid MOA
slows rec. rate of Na+ channels & Antagonizes Ca currents in thalamus
Valproic acid AEs
Hepatotoxicity
GABApentin AEs
Sedation & ataxia to which tolerance develops
Lamotrigine Aes
Sedation, dizziness, ataxia (tolerance to all 3), & skin rashes (S-J)
Levetiracetam Aes
Sedation, ataxia
Topiramate Aes
Sedation & nervousness to which tolerance develops & hypersensitivity in persons w/ sulfa allergy
Topiramate MOA
Slows recovery rate of Na+ channels & potentiates GABA @ GABA(a) receptors
Topiramate treats what?
Partial, Generalized Tonic-Clonic, prophylaxis of migraine, weight loss (in combo w/ phentermine)
Risk factors for reoccurence of seizures includes epilepsy onset before or after childhood?
After
Status Epilepticus 1st line Tx
Lorazepam IV
Temporal lobe epilepsy –> Type of seizure?
Complex partial seizure with automatisms
Tx for epilepsy includes how many drugs?
Monotherapy
Seizure med that’s only used for focal seizures?
Carbamazepine
Causes of seizures in infancy (0-2 yrs)
Intracranial birth injury, acute metabolic insult, congenital malformations/genetic disorders
Causes of seizures in childhood (2-10 yrs)
Idiopathic
Causes of seizures in adolescence (10-18 yrs)
Idiopathic, Trauma
Causes of seizures in early adulthood (18-35 yrs)
Trauma, Drug/alcohol withdrawal
Causes of seizures in middle age (35-60)
Brain tumor, Trauma
Causes of seizures in older age (>60 yrs)
Stroke, Degenerative disease, Brain tumor
Evaluation of patient w/ seizure
HISTORY & PE, Neuroimaging, EEG, (LP)
Differential diagnosis of seizures (5)
Syncope, Cerebrovascular disorders, Migraine, Sleep disorders, Psychogenic disturbances
1 Commonly found lesion after resective surgery for medically refractory partial epilepsy?
Medial Temporal Sclerosis
6 ligand-gated ion channels (all others are G protein-coupled receptors)
Nicotinic ACh, GABA(a), most glutamate, aspartate, glycine, 5HT(3)
Ligand gated ion channels: Ion channel is a ____
tetramer or pentamer
Ligand gated ion channels: each subunit has _____ transmembrane domains
four
ACh blockade often causes _____ (3 things)
Sedation, Amnesia, Antiemetic activity
What increases affinity of GABA receptor for GABA?
Endozepine
Baclofen MOA
GABA(b) agonist
Baclofen effect/use
Centrally-acting muscle relaxant
Excessive activity of _____ ass’d w/ neuronal death
NMDA receptor
NMDA antagonists produce ____ (2 things)
Analgesia & Dissociative anesthesia
Dopamine prevalent in what 3 structures of brain?
Basal ganglia, nucleus accumbens, amygdala
Neurotransmitter important in regulating movement & behavior
Dopamine
Dopamine antagonists effective in ____ (2 conditions) & have a ______ effect
Mania & Schizophrenia ; antiemetic effect
CNS alpha-1 adrenoceptor agonists (NE) effects
Increase alertness, arousal, mood. Decrease appetite
CNS alpha-2 adrenoceptor agonists (NE) effects
Antihypertensive & Sedation
CNS beta-1 adrenoceptor agonists (NE) effects
increase mood
5HT(1) agonists effect
migraine & anxiety
5HT(2) agonists effect
Cause hallucinations
5HT(2) antagonists effect
Treat psychoses & migraine
5HT(3) antagonists effect
Treat severe nausea
Histamine receptor effects (H1-H4)
H1: Allergy, H2: Gastric secretion, H3 agonist: Sleep, H3 antagonist: Wakefulness & Anticonvulsant, H4: Hematopoietic cells
Enkephalins
Primarily in spinal cord. Endogenous δ-opioid agonists
Dynorphins
endogenous κ-opioid agonists. κ-opioid receptor most prevalent opioid receptor in CNS
Most prevalent opioid receptor in CNS
k-opioid receptor
Endorphins
endogenous μ-opioid agonists
Endorphins effect
Decrease BP both centrally & peripherally
Where are glycine receptors primarily located?
Brain stem & spinal cord
Inhibition of ______ release is an important mechanism of opioid analgesia
substance P