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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
Q

Therapeutic uses of Lamotrigine (Lamictal)

A
  • Focal Seizures
  • Tonic clonic seizures
  • Bipolar disorder
  • Preferred treatment during pregnancy
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26
Q

Drugs that effect the half life of Lamotrigine (Lamictal)

A
  • Valproic acid = double lamotrigine half life

- Carbamazepine, phenytoin, and phenobarbital = decrease half life of lamotrigine

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27
Q

Black box warning with Lamotrigine (Lamictal)

A
  • Steven johnson syndrom

- SLOW titration is needed

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28
Q

Zonisamide (Zonegran) mechanism of action

A
  • Prolongs the inactivation period of Na+ channels

- Half life = 60hrs

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29
Q

Therapeutic uses of Zonisamide (Zonegran)

A
  • Add on for focal seizures

- Helpful in tonic clonic seizures

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30
Q

Side effects of Zonisamide (Zonegran)

A
  • Kidney stones
  • Somnolence
  • Fatigue
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31
Q

Mechanism of action for Rufinamid (Banzel)

A

-Prolongation of the inactive state of Na+ channels

32
Q

Therapeutic uses of Rufinamide (Banzel)

A
  • Adjunctive treatment of seizures associated with lennox-gastaut syndrome
  • Ages 4+
33
Q

Side effects of Rufinamide (Banzel)

A

-Somnolence

34
Q

Lacosamide (Vimpat) mechanism of action

A

-Prolongation of inactive state

35
Q

Therapeutic use of Lacosamide (Vimpat)

A

-Focal seizure

36
Q

Side effects of Lacosamide (Vimpat)

A
  • Nausea
  • Dizziness
  • Headache
37
Q

Drug class of Lacosamide (Vimpat)

A

-Schedule V

38
Q

Valproic acid (Depakene) mechanism of action

A

1) Prolongs the inactivation period of Na+ channels

2) Reduces Ca++ T currents

39
Q

Therapeutic uses of Valproic acid (Depakene)

A
  • Focal seizures
  • Trigeminal neuralgia
  • Bipolar disorder
  • Migraine prophylaxis
  • Lennox gastaut syndrome
  • Generalized seizures
40
Q

Side effects of Valproic acid (Depakene)

A
  • GI symptoms
  • Weight gain
  • Hepatitis
  • Teratogenic
  • Pancreatitis
  • Pregnancy category D
41
Q

Phenobarbital (Luminal) mechanism of action

A
  • Facilitates GABA(a) receptor activity by binding to the beta subunit
  • Potentiating the effects of GABA
42
Q

Therapeutic uses of Phenobarbital (Luminal)

A
  • Focal seizures
  • Generalized tonic clonic seizures
  • Emergency control of certain acute convulsive episodes
43
Q

Diazepam (valium), Lorazepam (Ativan), Midazolam (Versed) mechanism of action

A
  • Benzodiazepines

- Bind to alpha subunit of GABA and potentiate its effects

44
Q

Therapeutic uses of benzodiazepines

A
  • Prolonged seizures

- Status epilepticus

45
Q

Clonazepam (Klonopin) uses

A

-Drug of choice for myoclonic seizures

46
Q

Clobazam (Onfi) uses

A

-Add on for lennox gastaut syndrome

47
Q

Tiagabine (Gabitril) mechanism of action

A

-Inhibits GABA transporter GAT1

48
Q

Therapeutic uses for Tiagabine (Gabitril)

A
  • Add on for focal seizures
  • Migraine prophylaxis
  • Neuropathic pain
  • Anxiety
49
Q

Side effects of Tiagabine (Gabitril)

A

-increased risk of suicidal ideation

50
Q

Vigabatrin (Sabril) mechanism of action

A

-Irreversible inhibition of GABA transaminase

51
Q

Uses of Vigabatrin (Sabril)

A
  • Add on for focal seizures
  • Infantile spasms
  • Minimal drug interactions
52
Q

Side effects of Vigabatrin (Sabril)

A
  • Vision loss

- Increased risk with increased dose/ duration

53
Q

Levetiracetam (Keppra) mechanism of action

A
  • Binds to synaptic vesicle protein 2a (SV2A)

- Main effect on glutamate transmission

54
Q

Therapeutic uses of Levetiracetam (Keppra)

A

Add on for:

  • Focal seizures
  • Myoclonic seizures
  • Tonic clonic seizures
55
Q

Gabapentin (Neurontin) and Pregabalin (Lyrica) mechanism of action

A
  • 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
Q

Therapeutic uses of Gabapentin (Neurontin) and Pregabalin (Lyrica)

A

Add on for:

  • Focal seizures
  • Tonic clonic seizures
  • Postherpatic neuralgia
  • Bipolar disorders
  • Neuropathic pain
  • Migraine prophylaxis
57
Q

Topiramate (Topamax) mechanism of action

A

1) AMPA/kainate antagonist

2) Prolongs the inactivation period of Na+

58
Q

Therapeutic uses of Topiramate (Topamax)

A
  • Focal seizures
  • Tonic clonic seizures
  • Migraine prophylaxis
  • Lennox gastaut syndrom
59
Q

Side effects of Topiramate (Topamax)

A
  • Pregnancy category D
  • Contraindicated in history of kidney stones
  • Weight loss
60
Q

Perampanel (Fycompa) Mechanism of action

A

-Allosteric noncompetitive AMPA/glutamate receptor antagonist

61
Q

Felbamate (Felbatol) mechanism of action

A

-Antagonist of glycine binding site on NMDA receptor

62
Q

Therapeutic uses of Felbamate (Felbatol)

A
  • Severe focal seizures
  • Lennox gastaut syndrome
  • Generalized seizures
  • NOT a first line agent
63
Q

Black box warning for Felbamate (Felbatol)

A
  • Life threatenin aplastic anemia

- Hepatic failure

64
Q

Mechanism of action for Ethosuximinde (Zarontin)

A
  • Binds to and inhibits Ca++ currents in the thalamus

- Preventing oscillatory firing

65
Q

Therapeutic uses of Ethosuximide (Zarontin)

A

Drug of choice for:

  • Absence seizure
  • Focal seizures
66
Q

Side effects of Ethosuximide (Zarontin)

A
  • Blood dyscrasias

- Suicidal ideation

67
Q

Ezogabine (Potiga) mechanism of action

A
  • Enhances outward potassium currents
    1) Promotes membrane repolarization
    2) Hyperpolarizes neurons (stays open longer)
  • Schedule V controlled substance
68
Q

What is Lennox-Gastuat syndrome

A
  • Usually occurs in children < 8 years
  • Severe multiple seizures and impaired intellectual functioning
  • Along with developmental delays and behavioral disturbances
69
Q

Drugs approved for treatment of Lennox-Gastuat Syndrome

A
  • Valproate
  • Clonazepam
  • Lamotrigine
  • Topiramate
  • Felbamate
  • Clobazam
  • Rufinamide
  • Epidiolex
  • Resistance will occur over time
70
Q

Epidiolex (Cannabidiol) indication

A

-Indicated for the treatment of seizures associated with Dravet syndrome (DS)

71
Q

Epidiolex (Cannabidiol) mechanism of action

A

-Unknown

72
Q

Side effects and schedule of Epidiolex (Cannabidiol)

A
  • Risk of hepatocellular injury

- Schedule V drug

73
Q

Minimal to no risk antiepileptic drugs in pregnancy

A
  • Lamotrigine

- Levetiracetam (Keppra)

74
Q

modest risk antiepileptic drugs in pregnancy

A
  • Carbamazepine
  • Oxcarbazepine
  • Zonisamide
75
Q

Moderate risk antiepileptic drugs in pregnancy

A
  • Phenytoin
  • Phenobarbital
  • Topiramate
76
Q

High risk antiepileptic drugs in pregnancy

A

-Valproic acid

Pharm 845 Exam #2 (8 decks)

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