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Pharm 845 Exam #2 > Dr. Masserano > Flashcards

Dr. Masserano Flashcards

1
Q

Withdrawal from what types of drugs can lead to seizures?

A
  • Benzodiazepines
  • Barbiturates
  • Ethanol
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2
Q

Focal seizure onset

A
  • Localized onset
  • Excessive neuronal discharge
  • May lead to a tonic clonic seizure
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3
Q

Aura

A
  • Sensation felt by the patient immediately preceding, or hours/days before an epileptic attack
  • Sounds, smells, or colored visual patterns
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4
Q

Absence or petit mal seizure

A
  • No aura
  • Focus or postictal state
  • “freeze” behavior
  • Only lasts seconds
  • Spike and dome on EEG
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5
Q

Generalized tonic clonic/ grand mal seizure

A
  • Tonic = contraction of all the voluntary muscles
  • Clonic = altering contraction and relaxation of muscles
  • Loss of consciousness, awareness, and memory
  • Followed by prostictal state
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6
Q

Mechanism of action of antiepileptic drugs

A

1) Prolongs the inactivation period of Na+ channels
2) Enhance Neuronal GABA inhibition
3) Reduce Glutamate excitation
4) Inhibit Ca++ currents
5) Enhances outward potassium currents

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7
Q

Drugs that prolong the inactivation period of Na+ channels

A
  • Carbamazepine
  • Oxcarbazepine
  • Phenytoin
  • Fosphenytoin
  • Zonisamide
  • Lamotrigine
  • Valproic acid
  • Topiramate
  • Lacosamide
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8
Q

Drugs that enhance neuronal GABA inhibition

A
  • Benzodiazepines
  • Barbiturates
  • Vigabatrin
  • Tiagabine
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9
Q

Drugs that reduce glutamate excitation

A
  • Keppra
  • Felbamate
  • Topiramate
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10
Q

Drugs that inhibit Ca++ currents

A
  • Ethosuximide
  • Valproic acid
  • Gabapentin
  • Pregabalin
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11
Q

Drugs that enhance outward potassium currents

A

-Ezogabine

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12
Q

Things to note with Phenytoin, Carbamazepine, Topiramate, Oxcarbazepine, and Phenobarbital

A
  • Induction of hepatic enzymes
  • Decreases efficacy of oral contraceptives
  • Decreases blod calcium levels (supplement with Vit D. and Calcium)
  • Monitor bone density
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13
Q

What kind of seizures can you use Phenytoin (Dilantin) and Fosphenytoin (Cerebyx) for?

A
  • Focal Seizures
  • Generalized tonic clonic seizures
  • Trigeminal Neuralgia
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14
Q

Which drugs can be used to treat Trigeminal Neuralgia

A
  • Phenytoin
  • Carbamazepine
  • Oxcarbazepine
  • Lamotrigine
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15
Q

Pharmacokinetics of Phenytoin

A
  • 90% plasma bound
  • Hypoalbuminemia when given with valproic acid
  • Competes for CYP2C9
  • Inhibits warfarin metabolism (increases INR time)
  • Induces CYP2C and CYP3A4
  • Decreases oral contraceptive efficacy
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16
Q

Kinetics of Phenytoin

A
  • 1st order kinetics or low plasma concentrations
  • 0 order kinetics for high plasma concentrations
  • Monitor PLASMA levels of phenytoin
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17
Q

Side effects/ toxicities with phenytoin

A
  • Ataxia, nystagmus
  • Osteopenia
  • Gingival hyperplasia
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18
Q

Mechanism of Carbamazepine (Tegretol)

A

-Prolongs the inactivation period of Na+ channels

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19
Q

Uses of Carbamazepine (Tegretol)

A
  • Focal Seizures
  • Generalized tonic clonic
  • Trigeminal seizures
  • Neuropathic pain
  • Bipolar disorder
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20
Q

Carbamazepine (Tegretol) side effects

A
  • Syndrome of inappropriate antidiuretic hormone (SIADH)
  • Hyponatremia
  • Aplastic anemia
  • Dermatologic reactions (HLA-B*1502
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21
Q

Oxcarbazepine (Trileptal) mechanism of action

A

-Prolongs the inactivation period of Na+ channels

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22
Q

Therapeutic uses of Oxcarbazepine (Trileptal)

A
  • Epilepsy
  • Neuralgias
  • Bipolar disorder
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23
Q

Side effects of Oxcarbazepine (Trileptal)

A
  • SIADH = hyponatremia

- Steven johnson syndrome

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24
Q

Lamotrigine (Lamictal) Mechanism of action

A

-Prolongs the inactivation period of Na+ channels

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25
Therapeutic uses of Lamotrigine (Lamictal)
- Focal Seizures - Tonic clonic seizures - Bipolar disorder - Preferred treatment during pregnancy
26
Drugs that effect the half life of Lamotrigine (Lamictal)
- Valproic acid = double lamotrigine half life | - Carbamazepine, phenytoin, and phenobarbital = decrease half life of lamotrigine
27
Black box warning with Lamotrigine (Lamictal)
- Steven johnson syndrom | - SLOW titration is needed
28
Zonisamide (Zonegran) mechanism of action
- Prolongs the inactivation period of Na+ channels | - Half life = 60hrs
29
Therapeutic uses of Zonisamide (Zonegran)
- Add on for focal seizures | - Helpful in tonic clonic seizures
30
Side effects of Zonisamide (Zonegran)
- Kidney stones - Somnolence - Fatigue
31
Mechanism of action for Rufinamid (Banzel)
-Prolongation of the inactive state of Na+ channels
32
Therapeutic uses of Rufinamide (Banzel)
- Adjunctive treatment of seizures associated with lennox-gastaut syndrome - Ages 4+
33
Side effects of Rufinamide (Banzel)
-Somnolence
34
Lacosamide (Vimpat) mechanism of action
-Prolongation of inactive state
35
Therapeutic use of Lacosamide (Vimpat)
-Focal seizure
36
Side effects of Lacosamide (Vimpat)
- Nausea - Dizziness - Headache
37
Drug class of Lacosamide (Vimpat)
-Schedule V
38
Valproic acid (Depakene) mechanism of action
1) Prolongs the inactivation period of Na+ channels | 2) Reduces Ca++ T currents
39
Therapeutic uses of Valproic acid (Depakene)
- Focal seizures - Trigeminal neuralgia - Bipolar disorder - Migraine prophylaxis - Lennox gastaut syndrome - Generalized seizures
40
Side effects of Valproic acid (Depakene)
- GI symptoms - Weight gain - Hepatitis - Teratogenic - Pancreatitis - Pregnancy category D
41
Phenobarbital (Luminal) mechanism of action
- Facilitates GABA(a) receptor activity by binding to the beta subunit - Potentiating the effects of GABA
42
Therapeutic uses of Phenobarbital (Luminal)
- Focal seizures - Generalized tonic clonic seizures - Emergency control of certain acute convulsive episodes
43
Diazepam (valium), Lorazepam (Ativan), Midazolam (Versed) mechanism of action
- Benzodiazepines | - Bind to alpha subunit of GABA and potentiate its effects
44
Therapeutic uses of benzodiazepines
- Prolonged seizures | - Status epilepticus
45
Clonazepam (Klonopin) uses
-Drug of choice for myoclonic seizures
46
Clobazam (Onfi) uses
-Add on for lennox gastaut syndrome
47
Tiagabine (Gabitril) mechanism of action
-Inhibits GABA transporter GAT1
48
Therapeutic uses for Tiagabine (Gabitril)
- Add on for focal seizures - Migraine prophylaxis - Neuropathic pain - Anxiety
49
Side effects of Tiagabine (Gabitril)
-increased risk of suicidal ideation
50
Vigabatrin (Sabril) mechanism of action
-Irreversible inhibition of GABA transaminase
51
Uses of Vigabatrin (Sabril)
- Add on for focal seizures - Infantile spasms - Minimal drug interactions
52
Side effects of Vigabatrin (Sabril)
- Vision loss | - Increased risk with increased dose/ duration
53
Levetiracetam (Keppra) mechanism of action
- Binds to synaptic vesicle protein 2a (SV2A) | - Main effect on glutamate transmission
54
Therapeutic uses of Levetiracetam (Keppra)
Add on for: - Focal seizures - Myoclonic seizures - Tonic clonic seizures
55
Gabapentin (Neurontin) and Pregabalin (Lyrica) mechanism of action
- Reduces calcium current by modulating the voltage gated calcium channel (VGCC) - Alpha subunit 1 indirectly through its association with alpha 2 delta subunit - Decreasing the release of glutamate
56
Therapeutic uses of Gabapentin (Neurontin) and Pregabalin (Lyrica)
Add on for: - Focal seizures - Tonic clonic seizures - Postherpatic neuralgia - Bipolar disorders - Neuropathic pain - Migraine prophylaxis
57
Topiramate (Topamax) mechanism of action
1) AMPA/kainate antagonist | 2) Prolongs the inactivation period of Na+
58
Therapeutic uses of Topiramate (Topamax)
- Focal seizures - Tonic clonic seizures - Migraine prophylaxis - Lennox gastaut syndrom
59
Side effects of Topiramate (Topamax)
- Pregnancy category D - Contraindicated in history of kidney stones - Weight loss
60
Perampanel (Fycompa) Mechanism of action
-Allosteric noncompetitive AMPA/glutamate receptor antagonist
61
Felbamate (Felbatol) mechanism of action
-Antagonist of glycine binding site on NMDA receptor
62
Therapeutic uses of Felbamate (Felbatol)
- Severe focal seizures - Lennox gastaut syndrome - Generalized seizures - NOT a first line agent
63
Black box warning for Felbamate (Felbatol)
- Life threatenin aplastic anemia | - Hepatic failure
64
Mechanism of action for Ethosuximinde (Zarontin)
- Binds to and inhibits Ca++ currents in the thalamus | - Preventing oscillatory firing
65
Therapeutic uses of Ethosuximide (Zarontin)
Drug of choice for: - Absence seizure - Focal seizures
66
Side effects of Ethosuximide (Zarontin)
- Blood dyscrasias | - Suicidal ideation
67
Ezogabine (Potiga) mechanism of action
- Enhances outward potassium currents 1) Promotes membrane repolarization 2) Hyperpolarizes neurons (stays open longer) - Schedule V controlled substance
68
What is Lennox-Gastuat syndrome
- Usually occurs in children < 8 years - Severe multiple seizures and impaired intellectual functioning - Along with developmental delays and behavioral disturbances
69
Drugs approved for treatment of Lennox-Gastuat Syndrome
- Valproate - Clonazepam - Lamotrigine - Topiramate - Felbamate - Clobazam - Rufinamide - Epidiolex - Resistance will occur over time
70
Epidiolex (Cannabidiol) indication
-Indicated for the treatment of seizures associated with Dravet syndrome (DS)
71
Epidiolex (Cannabidiol) mechanism of action
-Unknown
72
Side effects and schedule of Epidiolex (Cannabidiol)
- Risk of hepatocellular injury | - Schedule V drug
73
Minimal to no risk antiepileptic drugs in pregnancy
- Lamotrigine | - Levetiracetam (Keppra)
74
modest risk antiepileptic drugs in pregnancy
- Carbamazepine - Oxcarbazepine - Zonisamide
75
Moderate risk antiepileptic drugs in pregnancy
- Phenytoin - Phenobarbital - Topiramate
76
High risk antiepileptic drugs in pregnancy
-Valproic acid

Pharm 845 Exam #2 (8 decks)

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