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Neurology > Drugs for Seizures > Flashcards

Drugs for Seizures Flashcards

1
Q

Which types of seizures are indicated for use of drugs that inhibit Na+ channels?

A

Generalized tonic-clonic & Focal seizures (simple & complex)

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2
Q

Most Na+ channel blockers make which kind of seizures worse?

A

Absence seizures

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3
Q

What are the indications for using Ca 2+ ion channel blockers?

A

Simple absence seizures

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4
Q

Which type of seizure will worsen w/ use of Ca 2+ channel blockers?

A

Tonic-clonic seizures

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5
Q

What is a SE of drugs that enhance inhibition produced by GABA?

A

Sedation

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6
Q

What is seen w/ tolerance to pts on benzodiazepines?

A

Tolerance to anti-seizure effect w/ LT use

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7
Q

Which drug is the exception for benzodiazepine tolerance?

A

Clonazepam

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8
Q

What is Clonazepam used for?

A

Myoclonic, absence & atonic seizures

Bipolar affective disorder

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9
Q

What is the DOC for terminating status epilepticus?

A

Lorazepam

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10
Q

What are the 1st line drugs for generalized-onset Tonic-clonic seizures?

A
  • Valproic acid
  • Lamotrigine
  • Topiramate
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11
Q

What are the alternative or adjuncts to generalized-onset tonic-clonic seizures?

A
  • Zonisamide
  • Phenytoin
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12
Q

What are the 1st line drugs for Focal seizures?

A
  • Lamotrigine
  • Carbamazepine
  • Oxcarbazepine
  • Phenytoin
  • Levetiracetam
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13
Q

What are the alternatives or adjunts to Focal seizures?

A
  • Zonisamide
  • Valproic acid
  • Tiagabine
  • Gabapentin
  • Lacosamide
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14
Q

What are the 1st line drugs for Typical absence seizures?

A
  • Valproic acid
  • Ethosuximide
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15
Q

What are the alternatives or adjuncts to Typical absence seizures?

A
  • Lamotrigine
  • Clonazepam
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16
Q

What are the 1st line drugs for Atypical absence, Myoclonic or Atonic seizures?

A
  • Valproic acid
  • Lamotrigine
  • Topiramate
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17
Q

What are the alternatives or adjuncts to Atypical absence, Myoclonic or Atonic seizures?

A
  • Clonazepam
  • Felbamate
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18
Q

Which drugs are effective in all types of seizures?

A

Valproate & Lamotrigine

(not 1st line drug for every seizure)

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19
Q

What is a benefit of using Valproate as tx for generalized tonic-clonic seizures?

A

Little clouding of consciousness

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20
Q

What are the SE of Valproate?

A
  • G.I. (frequent, and troubling)**
  • Hepatic damage (monitor liver enzymes when starting the drug)
  • Teratogenic – doubles the probability of spina bifida
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21
Q

What can Valproate also be used for?

A

Migraines & bipolar affective disorder

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22
Q

What can reduce the epigastric distress caused by Valproate?

A

Depakote formulation (a mixture of Na-valproate + valproic acid)

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23
Q

Who is Valproate hepatotoxicity worse in?

A

Children

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24
Q

What FDA category does Valproate fall under?

A

Pregnancy category D

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25
Q

What is Lamotrigine effective against?

A

Broad spectrum of seizures

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26
Q

What is the MOA of Lamtotrigine?

A

Na+ channel blocker

(other actions)

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27
Q

What is the disadvantage of using Lamotrigine

A

Plateau conc has to be approached slowly. If dose is too high or conc are raised too quickly, the probability of allergic phenomena is increased

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28
Q

What should you warn pt who are using Lamotrigine about?

A

Rash→ impending Steven-Johnson synd

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29
Q

What are the SE of Lamotrigine?

A
  • Sedation
  • Insomnia
  • Vivid dreams & nightmares
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30
Q

Who is more effected by Lamotrigine SE?

A

Women

31
Q

What are the indications of Topiramate?

A

Tonic-clonic, absence, myoclonic & atonic seizures

Prophylaxis of migraines & tx of obesity

32
Q

What are the SE of topiramate?

A

Related to CNS sedation & appetite reduction

Low rate when used alone

33
Q

What are the GI SE of Carbamazepine & Oxcarbazepine?

A

N/V/D, constipation, & anorexia

34
Q

What are the skin SE of Carbamazepine & Oxcarbazepine?

A

Rashes, erythema – b/c of the blood dyscrasias issue with carbamazepine, the occurrence of a rash is usually a reason to stop this drug

35
Q

What are the CNS SE of Carbamazepine & Oxcarbazepine?

A

Toxicity leads to double vision (diplopia), dizziness, drowsiness, or confusion, ataxia in high doses

36
Q

What does Carbamazepine (Tegretol) cause?

A

Blood formation issues–allergic rxn produces BM depression. Also causes hyponatremia & makes absence seizures worse

37
Q

What are the indications for Phenytoin?

A

All types of epilepsy except absence

now 2nd line drug

38
Q

What is a CI of Phenytoin use?

A

Pregnancy

39
Q

What are the unusal pharmokinetics of Phenytoin?

A
  • 1st-order elimination in the low to mid-therapeutic range
  • Zero-order elimination at high therapeutic range and above
40
Q

What is the oral absorption of Phenytoin like?

A

Slow & incomplete

41
Q

How is Phenytoin transported in the body?

A

70-90% bound

Salicylicates & thyroxine will displace from albumin

42
Q

Where is Phenytoin metabolized?

A

Liver

susceptible to drug interactions (warfarin & disulfiram)

43
Q

What is the MOA of Phenytoin (Dilantin)?

A

Na+ channel antagonist

44
Q

What happens in Phenytoin toxicity?

A
  • Cerebellar & vestibular systems (diplopia)—look drunk
  • Gingival hyperplasia (20% of pts on chronic med)
  • Hypertrichosis, hirsutism
  • Osteomalacia
  • Hypersensitivity, hyperexcitability in children
  • Teratogen: Cardiac damage, cleft palate
45
Q

Why is Levetiracetam not a 1st line drug?

A

It is not as effective for focal seizures when used alone & has a lot of SE

46
Q

What is the primary drug for typical absence seizures?

A

Ethosuximide

47
Q

What are the SE of Ethosuximide?

A
  • GI: pain, N/V.Tolerance dev
  • CNS sedative SE Tolerance dev
  • Blood dyscrasias (some have been fatal). Monitor blood.
  • Behavioral changes (increased aggressiveness; restlessness; anxiety)
48
Q

What is the MOA of Ethosuximide (Zarontin)?

A

Inhibits T-type Ca current in thalamic neurons

49
Q

What is Ethosuximide (Zarontin) used for?

A

Absence seizures (petit mal)

50
Q

What can Ethosuximide (Zarontin) worsen?

A

Generalized tonic-clonic

no effect on seizure spread

51
Q

What is Lorazepam used for?

A

DOC for Status Epilepticus

52
Q

What is the MOA of Lorazepam?

A

Benzodiazepine – enhances neurotransmission at GABA-A synapses

53
Q

Why is Diazepam no longer the DOC for status epilepticus?

A

Highly lipid soluble, enters the brain extremely rapidly & redistributes to tissues in the periphery extremely rapidly

54
Q

Why is Lorazepam a better choice than diazepam?

A

More water soluble→ slower onset of action, but a much slower offset of action

55
Q

What are the SE of Benzodiazepines when given IV to tx status epilepticus?

A

Cardiovascular & respiratory depression

Usually requires very rapid administration

56
Q

What are the SE of chronic oral benzodiazepine use?

A

Sedation & ataxia

(some tolerance)

57
Q

What are the behavior disturbances assoc w/ Benzodiazepine use?

A

Disinhibition of behvaior

58
Q

What is Levetiracetam (Keppra) used for?

A

Variety of types of seizures

Pediatric & refractory seizures

59
Q

Can Levetiracetam (Keppra) be used as monotherapy?

A

Yes but more adverse SE

60
Q

What is Zonisamide (Zonegran) used for?

A

Adjuctive therapy for refractory partial seizures

61
Q

What is the MOA of Vigabatrin (Sabril)?

A

Irreversible inhibitor of GABA-transaminase

62
Q

What is Vigabatrin (Sabril) used for?

A

Adjunctive or 2nd-line therapy of partial seizures, West’s Syndrome.

63
Q

Why must a drug never be stopped abruptly?

A

Danger of seizure increased

Replace drug gradually

64
Q

When are combinations of anti-seizure drugs appropriate?

A
  • Not controlled w/ single drug
  • 2 or more seizure types present
  • Potentiate seizure control while reducing adverse effects by permitting lower doses
65
Q

What is West’s syndrome?

A

Infantile spasms

66
Q

What is used for tx of West’s syndrome?

A
  • Corticosteroids (corticotropin, prednisone, dexamethasone)
  • Benzodiazepines (clonazepam)
  • Vigabatrin (Sabril)
67
Q

What is the cause of Status Epilepticus?

A
  • MC d/t cessation of anti-convulsant medication
  • In infants, likely due to high fever
68
Q

What is the initial tx of Status Epilepticus?

A

IV Lorazepam

69
Q

What is the continuing tx of Status Epilepticus?

A

IV fosphenytoin (minimum 15 minute onset, so must start with a benzodiazepine)

70
Q

What tx should be used if pt is unreponsive to Fosphenytoin?

A
  • IV phenobarbital
  • Midazolam
  • Diazepam
71
Q

What tx is used in Absence status epilepticus?

A

IV valproate

72
Q

Why is alcohol use CI in epilepsy?

A

Lowers seizure thresholds

73
Q

What does binge drinking trigger?

A

Microseizures

(makers further seizures more likely)

74
Q

What does cessation of drinking cause?

A

Inc risk of seizure d/t up regulation of glutamate & down regulation of GABA

Neurology (9 decks)

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