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Neurology-Week 4 & 5 > Drugs-Seizure > Flashcards

Drugs-Seizure Flashcards

1
Q

array of electrodes applied to the surface of the scalp to detect electrical signals transmitted in brain; consists of waveforms of various frequencies that vary with the level of alertness of the patient; useful in evaluating patients for epileptic (seizure-producing) brain waves or for detecting widespread abnormalities in brain function

A

Electroencephalogram (EEG)

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2
Q

(Beta/Theta/Delta) waves are associated with consciousness and alertness

A

Beta

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3
Q

(Beta/Theta/Delta) waves are associated with reduced consciousness

A

Theta

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4
Q

(Beta/Theta/Delta) waves are associated with unconsciousness or deep sleep

A

Delta

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5
Q

When is an EEG indicated?

A

Epilepsy (most helpful)
Delirium
Coma
Brain Death

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6
Q

What characteristic rhythmic pattern of seizure appears on an EEG?

A

Electrical Storm

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7
Q

Genetic cause of seizures are initiated by mutations in ion channels that promote _____ by DECREASING the negative membrane potential of neurons

A

Depolarization

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8
Q

Mutations in ion channels…

  1. promote _______ influx or
  2. reduce _______ efflux or
  3. reduce _____ influx
A
  1. Na+ or Ca+2
  2. K+
  3. Cl-
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9
Q

Anti-seizure drugs act to reduce

A

the rate of neuronal DEPOLARIZATION

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10
Q

Anti-epileptic drugs that PRE-SYNAPTICALLY block VG Na+ channels

A

Carbamazepine
Phenytoin
Lamotrigine
Valproate

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11
Q

What is the MOA of VG Na+ channel blockers?

A

They bind to the inactivated (closed) Na+ channel configuration so that the channel cannot reset back to its resting configuration.

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12
Q

SPECIAL Side Effects of Phenytoin

A

Gingival Hyperplasia
Osteopenia
Liver toxicity

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13
Q

Class IB antiarrhythmic that can also be used for Seizures

A

Phenytoin

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14
Q

SPECIAL Side Effects of Carbamazepine

A

Diplopia/ataxia
Liver toxicity
Blood dyscrasia (disorder)
Hyponatremia (SIADH causing water retention)

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15
Q

How can Carbamazepine cause hyponatremia?

A

Carbamazepine –> increase the release of ADH –> Stimulate aquaporins –> Promote water retention –> hyponatremia

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16
Q

What seizure drug is also used to treat Trigeminal neuralgia?

A

Carbamazepine

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17
Q

Anti-epileptic drugs that PRE-SYNAPTICALLY block VG Ca+2 channels and NT (glutamate) release

A

Gabapentin
Pregabalin
Valproate

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18
Q

In spite of their names, Gabapentin and Pregabalin DO NOT affect _____ signaling but they are named like that b/c they are structurally similar to ______

A

GABA

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19
Q

SPECIAL Side Effects of Valproate

A

Alopecia

weight gain

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20
Q

What seizure drug is also used to treat migraine and bipolar disease; NOT in pregnancy EVER

A

Valproate

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21
Q

Anti-epileptic drugs that PRE-SYNAPTICALLY block a vesicle fusion protein (SV2A) and glutamate release

A

Levetiracetam

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22
Q

What is the MOA of Levetiracetam?

A

It inhibits SV2A protein from allowing glutamate-containing vesicles to fuse with the plasma membrane.

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23
Q

What seizure drug is the FIRST LINE in active seizure due to easy of use?

A

Levetiracetam

24
Q

What are the side effects of Levetiracetam?

A

Fatigue/drowsiness
HA
Personality changes (hmmm)

25
Anti-epileptic drugs that POST-SYNAPTICALLY block LG Na+ channels by acting as competitive antagonists of ligand-gated glutamate receptors
Felbamate Topiramate * -mate
26
1. Felbamate binds to ______ LG glutamate receptor. | 2. Topiramate bind to ________ LG glutamate receptor.
1. NMDA | 2. AMPA
27
SPECIAL Side Effects of Felbamate
1. Aplastic Anemia - failure of bone marrow to produce blood cells 2. Acute Liver Failure
28
SPECIAL Side Effects of Topiramate
Renal Calculi Weight loss Glaucoma
29
Anti-epileptic drugs that POST-SYNAPTICALLY block VG Ca+2 channels (T-type)
Ethosuximide
30
How is Ethosuximide different than Gabapentin and Pregablin?
Ethosuximide blocks the T-type Ca+2 channels
31
________ is indicated ONLY for ABSENCE seizures
Ethosuximide
32
Anti-epileptic drugs that work PRE-SYNAPTICALLY to increase synpatic levels of GABA
Tiagabine Vigabatrin Valproate
33
What is the MOA of Tiagabine?
Inhibits the GABA transporter from re-uptaking GABA from the synapse
34
What is the MOA of Vigabatrin and Valproate?
Inhibits GABA transaminase from *normal metabolic break down of GABA so that more GABA can be released following AP *occurs before NT release from pre-synaptic neuron
35
SPECIAL Side Effects of Vigabatrin
permanent bilateral vision loss
36
B/c of its serious side effect, what drug is only indicated in patients who have failed other therapies?
Vigabatrin
37
Anti-epileptic drugs that work POST-SYNAPTICALLY to promote inhibitory effects of GABA
1. Clonazepam (Benzodiazepines) 2. Phenobarbital (Barbiturates) 3. Topiramate
38
What is the MOA of positive modulators of GABA receptor?
Their binding to GABA-A receptors increases GABA's ability to open Cl- channels and promote the influx of Cl- and hyperpolarization.
39
Why are they called Positive MODULATORS and not AGONISTS?
The drugs bind to a site on the GABA-A receptor that is different from GABA-binding site. The drugs DO NOT directly open the Cl- channels but ALTER the configuration to assist GABA.
40
Epileptic drug; used in Status Epilepticus; affects the Cl- transporter; also used in ECLAMPSIA (after mag. sulphate); side effects are sedation and respiratory depression
Benzodiazepines
41
What seizure drug is ideal in neonates?
phenobarbital
42
What are common GI toxicities from using anti-seizure drugs?
Nausea/vomiting
43
What are common neurologic toxicities from using anti-seizure drugs?
Somnolence/sedation Fatigue Ataxia Vision disruptions
44
What second generation seizure drug has a rash as a side effect?
Lamotrigine
45
B/c of its side effect, how would you start Lamotrigine?
start low and go slow
46
First generation "old" anticonvulsant drugs are all at risk for what adverse effect?
Stephens-Johnson Syndrome
47
Valproate is a CYP2C9 (inducer/inhibitor). This reduces the degradation of other drugs and increases toxicities.
Inhibitor
48
Ironically, valproate can increase risk of toxicities by decreasing degradation of other ______ drugs
anti-seizure
49
Carbamazepine and Phenytoin are CYP3A4 (inducers/inhibitors). This increases the degradation of other drugs and reduce their therapeutic effects.
Inducers
50
What drug is both an inducer and a substrate of CYP3A4, and therefore can induce its own metabolism leading to reduced effect within days of initation?
Carbamazepine
51
Phenytoin is metabolized by _____ order kinetics at high doses and _____ order kinetics at low doses.
Zero (drug in excess) First (CYP enzyme in excess)
52
At high doses, ______ saturates CYP enzymes (2C9 and 2C19) and prevents other drugs from binding to these enzymes for degradation. This can increase risk of toxicities.
Phenytoin
53
Carbamazepine and Phenytoin are CYP3A4 (inducers/inhibitors). This increases the degradation of ethinyl estradiol in OCP and reduce the contraception effectiveness.
inducers
54
What anti-seizure drugs are pregnancy Category D and can be teratogenic?
Carbamazepine Phenytoin Valproate Topiramate
55
What anti-seizure drugs can cause reduction in serum FOLATE and activity, and therefore patient taking them should increase their folate intake even more during pregnancy?
Carbamazepine | Phenytoin

Neurology-Week 4 & 5 (14 decks)

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