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NEUROLOGY > drugs for epilepsy > Flashcards

drugs for epilepsy Flashcards

1
Q

what are the 3 general mechanisms of action for anti-epilepsy drugs?

A
  1. promote the inactivated state of voltage gated Na+ channels
  2. Pre or post synaptic enhancement of GABA medicated inhibition
  3. inhibition of T-type voltage-activated Ca2+ channels (absence seizures)
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2
Q

FDA has issued a warning of what adverse effect with the use of anticonvulsants?

A

suicidal ideation

  • 2 fold increase
  • monitor all pts for emerging depression/suicidal thoughts
  • educate pts about risks
  • use minimum drug levels for epilepsy
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3
Q

current drugs control seizures only in what percentage of pts?

A

50%

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4
Q

the adverse effects of anti epileptic drugs can have what effect on pts?

A

responsible for limited pt adherence

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5
Q

instead of adding a drug to an exisint anticonvulsant monotherapy regimen, what should you do?

A

substitute rather than additive treatment

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6
Q

MOA of carbamazepine

A

blocks voltage gated Na channels and decreases glutamate release

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7
Q

MOA of clonazepam

A

enhance GABA-A receptor responses

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8
Q

MOA ethosuximide

A

decreases T-Type Ca2+ currents (used for absence seizures)

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9
Q

MOA felbamate

A

blocks NMDA receptors; increase GABA

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10
Q

MOA gabapentin

A

blocks alpha-2 delta-1 subunit of Ca2+ channels

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11
Q

MOA of lacosamide

A

blocks Na+ channels

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12
Q

MOA lamotrigene

A

blocks Na+ channels

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13
Q

MOA oxcarbazepine

A

blocks Na+ channels, possibly increases K+ & decreases Ca2+ effects

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14
Q

MOA Phenytoin

A

blocks voltage gated Na+ channels

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15
Q

MOA pregablin

A

blocks alpha-2 delta-1 subunit of Ca2+ channel

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16
Q

MOA Topiramate

A

blocks Na+ channels; increases K+ current, increases GABA; decreases glutamate activity

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17
Q

MOA valproate

A

increases GABA activity; also decreases Na+ channnels

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18
Q

MOA zonisamide

A

blocks Na+ channels, & decreases T-type Ca2+ actions

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19
Q

the anti-epileptic drug have limited protein binding except which two drugs?

A

phenytoin & valproate

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20
Q

which antiepileptic drug accumulates in erythrocytes?

A

zonisamide

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21
Q

which type of formulation for anti-epileptic drugs promotes adherence?

A

slow release products (fewer doses / day)

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22
Q

what happens to the half-life of carbamazepine as treatment progresses?

A

the half life decreases due to an increased rate of hepatic metabolism

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23
Q

which two anti-epileptic drugs are not metabolized?

A

gabapentin & pregabalin

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24
Q

which antiepileptic drug has no CYP activity and is metabolized by uridine glucuronosyl transferasewith subsequent induction of UGT (hint its metabolites are eliminated in urine)?

A

lamotrigine

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25
Q

which antiepileptic drug is metabolically conjugated, decreases CYP2C19& increases CYP3A4/5?

A

OXCARBAZEPINE

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26
Q

what is the only antiepileptic drug that is eliminated in the stool?

A

phenytoin

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27
Q

Phenytoin is metabolized by what CYP Enzymes?

A

CYP2C9»CYP2C19

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28
Q

Routine monitoring of serum drug levels is required with what 3 drugs?

A

carbamazepine
Phenytoin
Valproate

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29
Q

what should the physician do for a pt experiencing good seizure control and no signs or symptoms of significant drug toxicity, despite serum drug levels being high?

A

physician doesn’t have to reduce drug dose, but rather use clinical presentation to guide treatment

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30
Q

which two drugs are weak carbonic anhydrase inhibitors?

A

topiramate/zonisamide

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31
Q

what is the adverse effect you may predict with the weak carbonic anhydrase activity of topiramate/zonisamide therapy?

A

promotes stone formation by reducing urinary citrate excretion & by increasing urinary pH (monitor serum bicarbonate levels)

32
Q

discontinuation of antiepileptic drugs can precipitate what adverse effects?

A

status epilepticus, increased frequency of seizures & various neurologic issues, like anxiety (remember to taper the dose rather than stop it abruptly)

33
Q

what is the name of the phytoin prodrug?

A

fosphenytoin (remember dose adjustment is important when transitioning b/w the two)

34
Q

which antiepileptic drugs has zero order elimination?

A

phenytoin

35
Q

what are some of the ADME problems with phenytoin?

A

issues of protein binding displacement and CYP mediated drug-drug interactions

  • –highly variable induction of CYPs
  • –Age, cigarette smoking & hepatic status confounding factors
36
Q

what is the most common CNS adverse effect of phenytoin therapy?

A

nystagmus

37
Q

which antiepileptic drug can cause gingival hyperplasia?

A

phenytoin

38
Q

what are some of the dermatologic adverse effects of phenytoin therapy?

A

usually benign-measles-like rash, SJS, TEN, & DRES

Hypertrichosis or hirsutism (generally confined to extremities but can affect the trunk and face, may be irreversible)

39
Q

what are some of the CNS adverse effects of carbamazepine?

A 
esp. during initial treatment phase
dizziness
drowsiness
ataxia
blurred vision
40
Q

which antiepileptic drug has a BBW for agranulocytosis?

A

carbamazepine

41
Q

the incidence of SJS while using antiepileptic drugs is higher in Asian pts because they carry which allele?

A

SNP change for HLAB-1502 (good idea for these pts to also avoid other structurally related anticonvulsants like phenytoin, oxcarbazepine, lamotrigene)

42
Q

the incidende of hepatotoxicity with valproic acid is more common in what pt population?

A

children

43
Q

what are some of the CNS adverse effects of valproic acid?

A

somnolence, dizziness

44
Q

what are the two main hematologic adverse effects of valproic acid?

A

thrombocytopenia

prolonged bleeding time

45
Q

what are the adverse effects of clonazepam?

A

somnolence, ataxia, dizziness, fatigue

46
Q

what are the AEs of ethosuximide?

A

somnolence, dizziness, headache, N/V, Diarrhea

47
Q

what are the BBWs for felbamate?

A

aplastic anemia, bone marrow suppression, hepatic disease

48
Q

what are 3 common adverse effects of antiepileptic drugs?

A

sedation, dizziness, ataxia

49
Q

what are some of the AEs of gabapentin?

A

somnolence, dizziness, fatigue

50
Q

what are some of the AEs of lacosamide?

A

diplopia, dizziness, headache

51
Q

what is the BBW for lamotrigine?

A 
serious rash (TEN/SJS)
other AEs are :  dizziness, diplopia, ataxia, blurred vision, rhinitis
52
Q

which antiepileptic drug has an adverse effect of causing URTIs?

A

levetiracetam

53
Q

name the antiepileptic drug: AEs including-dizziness/diplopia, headache, N/V, nystagmus/somnolence/ataxia

A

oxcarbazepine

54
Q

which antiepileptic drug has AEs that include ataxia/parasethesias/abnormal vision/psychomotor slowing?

A

topiramate

55
Q

which antiepileptic drug has these AEs: somnolence, anorexia, dizziness?

A

zonisamide

56
Q

which AED has the greatest risk of adverse outcomes in pregnancy?

A

valproate (cat. X)

57
Q

which two AEDs can cause fetal hydantoin syndrome?

A

carbamazepine & phenytoin

58
Q

what are the fetal abnormalities for valproate?

A

neural tube defects, clefts, skeletal abnormalities, developmental delay

59
Q

name the AED with these Adverse effects: cleft lip, cleft palate

A

topiramte

60
Q

name the AED with these adverse effects: inhibits dihydrofolate reductase lowering fetal folate levels. Registry data suggest increased risk for clefts

A

lamotrigine

61
Q

what are the fetal abnormalities seen with phenobarbital?

A

clefts, cardiac anomalies, urinary tract malformations

62
Q

what are some of the fetal abnormalities seen with phenytoin?

A

fetal hydantoin syndrome: craniofacial anomalies, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects, clefts

63
Q

what are the four drugs of choice for partial, including secondarily generalized seizures?

A

lamotrigine
carbamazepine
levetiracetam
oxycarbazepine

64
Q

what are the 3 drugs of choice for primary generalized tonic-clonic seizures?

A

valproate
lamotrigine
levetiraetam

65
Q

what are the 2 drugs of choice for absence seizures?

A

ethosuximide

valproate

66
Q

what are the 3 drugs of choice for atypical absence, myoclonic, atonic seizures?

A

valproate
lamotrigine
levatiracetam

67
Q

what are some of the predictors of mortaility for status epilepticus?

A

generalized seizure, increased pt age, anoxic brain injury, stroke, CNS infection or tumor, and lon duration of SE

68
Q

what is the treatment of choice for status epilepticus?

A

benzodiazepines

69
Q

what are the 3 benzodiazepines that are treatments of choice for status epilepticus?

A

IV lorazepam (first line for SE)
IM midazolam
Rectal dizepam

Followed by an IV AED: (valproate, phenytoin, midazolam, levetiracetam, phenobarbital)

70
Q

why is a benzodiazepine first line treatment for SE?

A

reinforcement of inhibitory effects of GABA and these drugs can be given rapidly IV

71
Q

only ___________ will induce CYP2B6 & CYP3A4 compared to benzodizepines

A

phenobarbital

72
Q

what do phenobarbital and benzodiazepines have in common?

A

both work on GABA receptor but at different sites
BOTH have issues of dependence & withdrawal
BOTH have tolerance development
BOTH produce dose-related sedation

73
Q

how are phenobarbital and benzodiazepines different?

A

barbiturates prolong opening time of Cl- channel (increased efficacy)
Benzodiazepines shift dose-response curve for GABA (potency)
-work at different sites of GABA receptor

74
Q

which 3 AEDs have blood toxicities?

A

carbamazepine, felbamate, & valproate

75
Q

name 5 AEDs that are big time teratogens?

A

lamotrigine, carbamazepine, phenytoin, topiramate, phenobarbital & valproate (worst one of all)

76
Q

which drug is first line for status epilepticus?

A

lorazepam IV

NEUROLOGY (9 decks)

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