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HLSC 220 - Pharmacotherapeutics for Healthcare Professionals > Chapter 27 - Drugs for Seizure Disorders > Flashcards

Chapter 27 - Drugs for Seizure Disorders Flashcards

1
Q

What is a seizure disorder?

A

a group of disorders characterized by excessive excitability of neurons in the CNS

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2
Q

Seizure symptoms:

A

-altered consciousness
-convulsions
-alterations in learning, memory, and mood

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3
Q

Is epilepsy more common in men or women?

A

both

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4
Q

What is a “focus”?

A

high-frequency discharge from hyper-excitable neurons that initiates a seizure

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5
Q

What can cause a “focus”?

A

-congenital defects
-hypoxia at birth
-head trauma
-brain infection
-stroke
-cancer
-genetic disorders
-fever
-disease states

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6
Q

Partial (focal) Seizures

A

seizure activity undergoes limited spread to areas beyond the focus

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7
Q

Generalized Seizures

A

focal seizure activity is conducted widely throughout both hemispheres

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8
Q

Simple Partial Seizures

A

-discrete symptoms that can be motor, sensory, autonomic, or psychoillusory
-NO loss of consciousness
-persist for 20-60s

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9
Q

Complex Partial Seizures

A

-impaired consciousness
-lack of responsiveness
-patient becomes motionless with a fixed gaze followed by automatism
-lasts 45-90s

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10
Q

Automatism

A

repetitive or purposeless movements (ie. lip smacking)

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11
Q

Secondary Generalized Seizures

A

-begin as simple or complex and become tonic-clonic
-consciousness is LOST
-last 1-2min

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12
Q

Tonic-Clonic (grand mal) Seizures

A

-immediate loss of consciousness
-major convulsions
-muscle rigidity (tonic)
-muscle jerks (clonic)
-often cause urination but not defecation
-postictal state
-lasts 90s or less

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13
Q

Postictal State

A

period of CNS depression after seizure

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14
Q

Absence Seizures (petit mal)

A

-brief loss of consciousness
-mild motor activity or no motor activity
-common in children

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15
Q

Atonic Seizures

A

-sudden loss of muscle tone
-neck may drop
-patient may collapse
-common in children

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16
Q

Myoclonic Seizures

A

-sudden muscle contraction lasting 1 second
-may involve one limb or entire body

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17
Q

Status Epilepticus Seizures

A

-persists for 15-30 mins or longer
-patient doesn’t regain consciousness
-several types

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18
Q

Febrile Seizures

A

-common in children age 6mo. to 5yr
-manifest as TC seizures
-not at high risk of later developing epilepsy

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19
Q

Mixed Seizures: Lennonx-Gastaut Syndrome

A

-severe epilepsy developing during preschool years
-various kinds of seizures

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20
Q

What do anti-seizure drugs do?

A

-suppress neuronal discharge in seizure focus
-suppress propagation of seizure activity away from focus

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21
Q

MOA of anti-seizure drugs:

A

-↓ sodium and calcium influx
-↑ potassium efflux
-antagonism of glutamate
-increased in strength of GABA

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22
Q

What is the goal of seizure treatment?

A

-↓ seizures to a manageable level
-balance seizure control with acceptable side effects

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23
Q

What are some other treatment options for epilepsy?

A

-surgery
-vagus nerve stimulation
-ketogenic diet
-cannabis

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24
Q

How is epilepsy diagnosed?

A

-physical, neuro, lab exam
-EEG

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25
Q

What is a major risk of anti-epileptic drugs?

A

suicide

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26
Q

Phenytoin, fosphenytoin, carbamazepine, valproic acid, ethosuximate, phenobarbital, and primidone are which category for AEDs?

A

traditional antieplieptic drugs

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27
Q

Gabapentin, lamotrigine, levitiracetam, oxacarbazepine, pregabalin, topiramate, and vigabatrin are which category of AEDs?

A

newer antiepileptic drugs

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28
Q

What does phenytoin inhibit? (MOA)

A

sodium channels

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29
Q

What makes phenytoin easily toxic?

A

liver has limited ability to metabolize phenytoin

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30
Q

What is phenytoin used for?

A

epilepsy and cardiac dysrhytmias

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31
Q

What is unique about the aborption of phenytoin?

A

-variable (can easily be toxic)
-small changes in dose largely affect absorption
-narrow therapeutic range

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32
Q

What are the adverse effects of phenytoin?

A

-gingival hyperplasia
-nystagmus, diplopia
-sedation
-ataxia
-hirsutism
-cognitive impairment
-skin rash

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33
Q

What is gingival hyperplasia?

A

swelling, tenderness, and bleeding of the gums

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34
Q

What can be used to prevent gum overgrowth?

A

folic acids (0.5mg/day)

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35
Q

What can reduce risk of gingival hyperplasia?

A

-oral hygiene
-flossing
-gum massage

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36
Q

Skin rash from phenytoin is more common in people of what descent?

A

Asian

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37
Q

What makes phenytoin high risk?

A

when it is administered IV

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38
Q

What are some drugs that interact with phenytoin?

A

-OC’s
-warfarin
-glucocorticoids
-diazepam
-isoniazid
-cimetidine
-alcohol (acute ↑ and chronic ↓)
-valproic acid
-carbamazepine
-phenobarbital
-barbiturates and other CNS depressants

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39
Q

Dosing of phenytoin is…

A

highly individualized

40
Q

Should phenytoin be administered with or without food?

A

with food

41
Q

Is phenytoin safe during pregnancy?

A

no - it is teratogenic

42
Q

What are some rules about phenytoin admin via IV?

A

-never mix
-never piggyback onto dextrose
-administer directly into a large vein
-monitor for extravasation

43
Q

What infusion rate should not be exceeded with phenytoin?

A

50 mg/min

44
Q

What is the IV alternative to phenytoin?

A

fosphenytoin

45
Q

How does dosing of phenytoin and fosphenytoin compare?

A

equivalent to phenytoin

46
Q

What is a risk of IV fosphenytoin when administered faster than 150 mg/min?

A

-hypotension
-arrythmias

47
Q

What is required during fosphenytoin administration?

A

cardiac monitoring

48
Q

Fosphenytoin is a prodrug of phenytoin meaning…

A

it is converted to phenytoin when metabolized

49
Q

What is carbamazepine used for?

A

-epilepsy
-bipolar disorder
-trigeminal and glossopharyngeal neuralglias

50
Q

How does carbamazepine act?

A

suppresses high-frequency neuronal discharge around focus

51
Q

Ataxia

A

poor muscle control causing clumsy movements

52
Q

What are the adverse effects of carbamazepine?

A

-nystagmus
-ataxia
-leukopenia
-anemia
-thrombocytopenia
-teratogenic
-rash
-photosensitivity

53
Q

Is carbamazepine safe during pregnancy?

A

no - it is teratogenic

54
Q

Carbamazepine is not active against _________ seizures

A

absence

55
Q

What does carbamazepine interact with?

A

-OC’s
-warfarin
-phenytoin
-phenobarbital
-grapefruit juice

56
Q

How does valproic acid act?

A

-blocks sodium channels
-suppresses calcium (via T-type calcium channels)
-increases GABA

57
Q

What is valproic acid used for?

A

-epilepsy
-bipolar disorder
-migraines

58
Q

What are the adverse effects of valproic acid?

A

-GI effects
-liver failure
-pancreatitis
-teratogenic
-hair loss
-weight gain

59
Q

Is valproic acid safe during pregnancy?

A

no - teratogenic

60
Q

What is the drug of choice for absence seizures?

A

ethosuximide

61
Q

How does ethosuximide act?

A

suppress neurons in THALAMUS that are responsible for generation of absence seizures

62
Q

What are the adverse effects of ethosuximide?

A

-initially - drowsiness, dizziness, lethargy
-no significant AE

63
Q

What is the action of phenobarbital?

A

-reduces seizures by increasing effects of GABA

64
Q

What drug class is phenoBARBITal?

A

anticonvulsant barbiturate

65
Q

What is phenobarbital used for?

A

-epilepsy
-sedation
-induction of sleep

66
Q

What are the adverse effects of phenobarbital?

A

-neuropsychologic effects
-dependency
-nystagmus
-ataxia

67
Q

Drug interactions of phenobarbital:

A

-OC’s
-warfarin
-alcohol
-benzodiazepines
-opiods
-valproic acid

68
Q

Withdrawal of phenobarbital:

A

-should be done gradually to avoid side effects

69
Q

Which seizure disorder is primidone not effective against?

A

absence seizures

70
Q

What components of primidone are similar to phenobarbital?

A

AE and DI

71
Q

What is oxcarbazepine used for?

A

seizures in adults and children

72
Q

Oxcarbazepine is similar to __________

A

carbamazepine

73
Q

What are the adverse effects of oxcarbazepine?

A

-dizziness
-drowsiness
-double vision
-nystagmus
-headache
-nausea
-vomiting
-ataxia
-skin reaction (stevens-johnson syndrome and toxic epidermal necrolysis)

74
Q

What electrolyte imbalance is clinically significant with oxcarbazepine?

A

hyponatremia

75
Q

Is oxcarbazepine safe during pregnancy?

A

no - teratogenic

76
Q

What drugs interact with oxcarbazepine?

A

-phenytoin
-perampanel
-phenobarbital
-valproic acid
-eslicarbazepine
-OCs
-sodium depleting drugs
-alcohol

77
Q

What is lamotrigine used for?

A

-broad spectrum of anti-seizure activity
-bipolar disorder

78
Q

What are the adverse effects of lamotrigine?

A

-dizziness
-diplopia
-blurred vision
-nausea
-vomiting
-headache
-severe skin reactions

79
Q

What is a major risk of lamotrigine?

A

suicide

80
Q

Which AED does lamotrigine interact with?

A

valproic acid

81
Q

Is lamotrigine safe during pregnancy?

A

no

82
Q

What are some off label uses of Gabapentin?

A

-neuropathic pain
-migraines
-fibromyalgia
-postmenopausal hot flashes

83
Q

What are the adverse reactions of gabapentin?

A

-somnolence (increased sleep)
-dizziness
-ataxia
-fatigue
-nystagmus
-peripheral edema

84
Q

Pregabalin is an analogue of _____

A

GABA

85
Q

What are the uses of pregabalin?

A

-diabetic neuropathy
-postherpetic neuralgia
-partial seizures
-fibromyalgia

86
Q

What are the adverse effects of pregabalin?

A

-dizziness
-somnolence
-blurred vision
-weight gain
-brain fog
-headache
-peripheral edema
-dry mouth
-angioedema
-rhabdomyolysis

87
Q

Pregabalin hypersensitivity causes ______________-

A

angioedema

88
Q

Whic AED is different from the rest?

A

levetiracetam

89
Q

What is the MOA of levetiracetam?

A

unknown

90
Q

What drugs does levetiracetam interact with?

A

not other AEDs

91
Q

What is topiramate used for?

A

-seizures
-bipolar disorder
-cluster headaches
-neuropathic pain
-diabetic neuropathy
-infantile spasms
-essential tremor
-binge-eating disorder
-bulimia
-alcohol and cocaine dependence

92
Q

What are the adverse effects of topiramate?

A

-somnolence
-dizziness
-ataxia
-nervousness
-diplopia
-nausea
-anorexia
-weight loss
-confusion
-memory difficulty
-kidney stones
-brain fog
-paresthesia
-metabolic acidosis
-glaucoma
-SUICIDE

93
Q

4 Goals of Treatment for Convulsive Status Epilepticus

A
  1. maintain ventilation
  2. correct HYPOglycemia
  3. terminate seizures (meds)
  4. long-term AEDs
94
Q

What is the medication used for first-line seizure management of continuous tonic-clonic seizures?

A

lorazepam

95
Q

What med is used if lorazepam is not available?

A

diazepam

HLSC 220 - Pharmacotherapeutics for Healthcare Professionals (4 decks)

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