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Neuro 3 > Drug Therapy of Seizure Disorders > Flashcards

Drug Therapy of Seizure Disorders Flashcards

1
Q

Injectable drugs

A

Phenytoin, phosphrnytoin, valproic acid, levetiracetam

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2
Q

1st vs. 2nd and 3rd gen

A

1st are mainstays but oftne have more SEs

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3
Q

Na blocker rationale

A

Act at presynaptic to suppress pre-synaptic generation of APs

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4
Q

Na blocker selectivity

A

Frequency dependent block

Bind in the open or inactivated state…if more often open or inactivated then more binding…drug accumulates and has greater effect

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5
Q

Pheny and fosphy MOA and uses

A

Ph - GTC, Status, focal

Fos - only Status

Phenytoin better for LT, fos better for status

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6
Q

Fos vs. pheny toin and how it is metabolized and drug interactions

A

Phenytoin is not as water soluble…fos is a prodrug

Hepatic metabolism

Induces CYP2C9 and enhances metabolism of other drugs

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7
Q

Phenytoin dosing

A

As a certain point, non-linear pharmacokinetics

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8
Q

SE of phenytoin

A

Hypotension/cardiac inhibition (limit rate of IV)
Decreased bone mineral density
Gingival overgrowht

Some CNS

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9
Q

SE of phnytoin more serious

A

SJS
DRESS - hepatic necrosis is danger

If it leaks out, could cause Purple Glove syndrome

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10
Q

Carbamzaepine MOA and uses

A

GTC, focal

Na channel blocker

Used for long term

Can aggrevate absence seizures

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11
Q

Carbamazepine metab and pharmacokinetics vs. phenytoin

A

Induces multiple CYP450 isozymes

First order elimination makes dosing safer…still tons of interactions

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12
Q

Carbamazepine dosing

A

It autoinduces the enzymes that metabolize it so need to start low and titrate high

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13
Q

Carbamazepine and serious side effects

A

SJS - Esp east asian (HLA-B*1502 genotype)

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14
Q

Carb other SEs

A

Ataxia and other CNS
Decreased bone mineral density

Other hypersensitivty

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15
Q

Lamotrigine MOA and what it works on

A

GTC and focal

Works on absence but not prefferred

Na blocker and weak Ca blocker

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16
Q

Lamotrigine elimintion and drug interactions

A

Hepatic glucuronidation

It has miniamal effects on other drugs

Carbamazepine decrease blood levels by inducing elimination

Valproic acid increases blood levels by inhibitng elimiantion

17
Q

Lamotrigine SEs

A

CNS

Hypersensitivity (SJS)…avoid in pediatrics…dose titrate

18
Q

Vaproic acid MOA and uses

A

Mostly absence and focal

Also GTC and status

Na channel blocker and Ca blocker

Best for complicated syndromes with multiple seizrue types

19
Q

Mech of valproic acid

A

Mostly on Na channels
Low-threshold Ca blocker
Enhancment of GABA

20
Q

Valproi acid elimination and drug interactions

A

Glucuronidation (also fatty acid)

Phenytoin and carbamazepine induce enzymes that metabolize so will decrease concentration

21
Q

Valrpoic acid SEs

A

Teratogenic
Hepatotoxicity/pancreatitis (younger)
CNS

22
Q

Topiramate MOA and uses

A

GTC and focal

Na nlocker
Glutmate antaginist
GABA nergic enhancer

23
Q

Topiramate SEs

A

Sedation, cog
Metabolic acidosis
Weight loss

24
Q

Topiramate elimination and drug interactions

A

Primarily renal elimination

Few drug interactions except with carbonic anhydrase inhibitors

25
Q

Ethosuximide MOA and use

A

Generalized absence

Blcoker of neuronal low-threshold Ca channels

26
Q

Mech of low threshold Ca channels

A

Ca channels open and depoalizre thalamic relay neurons
The PDS brings relay neuron closer to threshold for Na
Burst of APs
APs conducted to cortical neurons

Ethosuximide disrupts these Ca channels

27
Q

Ethosuximde drug interactions and SE

A

Mostly CYP3A4 but some renal

GI distress and bone marrow depression

Preferred for absence seizures because greater efficacy than lamotrigine and less effect on cog than valprpoci

28
Q

Levetiracetam MOA and use

A

GTC, status, Focal

Useful for combo

Synaptic transmission modulator

Binds to SV2A, secretory vesicle glycoprotein

29
Q

Levetiracetam eliminatioin and SEs

A

Renal excretion

Fatigue, asthenia, behavioral

30
Q

Mechs of

Pheny
Carba
Lamo
Topir
Valpro
Etho
Levetir
A 
Na channel
Na channel
Na, Ca channel
Na, gabanergic, glutamate antag
Na, Ca, enahnce Gaba 
Ca
Decrease vesicle release by binding to SV2A
31
Q

Protoypes that alter hepatic metabolism

A

Phenytoin - induces glucordination of lamotrigine and valproic acid

Carb - induces glucuronidation of lamotrigine and valproic acid

Valproic acid - inhibits glucuronidation of lamotrigine

Neuro 3 (31 decks)

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