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

Drugs-Seizure Flashcards

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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
Q

Anti-epileptic drugs that POST-SYNAPTICALLY block LG Na+ channels by acting as competitive antagonists of ligand-gated glutamate receptors

A

Felbamate
Topiramate

  • -mate
26
Q
  1. Felbamate binds to ______ LG glutamate receptor.

2. Topiramate bind to ________ LG glutamate receptor.

A
  1. NMDA

2. AMPA

27
Q

SPECIAL Side Effects of Felbamate

A
  1. Aplastic Anemia
    - failure of bone marrow to produce blood cells
  2. Acute Liver Failure
28
Q

SPECIAL Side Effects of Topiramate

A

Renal Calculi
Weight loss
Glaucoma

29
Q

Anti-epileptic drugs that POST-SYNAPTICALLY block VG Ca+2 channels (T-type)

A

Ethosuximide

30
Q

How is Ethosuximide different than Gabapentin and Pregablin?

A

Ethosuximide blocks the T-type Ca+2 channels

31
Q

________ is indicated ONLY for ABSENCE seizures

A

Ethosuximide

32
Q

Anti-epileptic drugs that work PRE-SYNAPTICALLY to increase synpatic levels of GABA

A

Tiagabine
Vigabatrin
Valproate

33
Q

What is the MOA of Tiagabine?

A

Inhibits the GABA transporter from re-uptaking GABA from the synapse

34
Q

What is the MOA of Vigabatrin and Valproate?

A

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
Q

SPECIAL Side Effects of Vigabatrin

A

permanent bilateral vision loss

36
Q

B/c of its serious side effect, what drug is only indicated in patients who have failed other therapies?

A

Vigabatrin

37
Q

Anti-epileptic drugs that work POST-SYNAPTICALLY to promote inhibitory effects of GABA

A
  1. Clonazepam (Benzodiazepines)
  2. Phenobarbital (Barbiturates)
  3. Topiramate
38
Q

What is the MOA of positive modulators of GABA receptor?

A

Their binding to GABA-A receptors increases GABA’s ability to open Cl- channels and promote the influx of Cl- and hyperpolarization.

39
Q

Why are they called Positive MODULATORS and not AGONISTS?

A

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
Q

Epileptic drug; used in Status Epilepticus; affects the Cl- transporter; also used in ECLAMPSIA (after mag. sulphate); side effects are sedation and respiratory depression

A

Benzodiazepines

41
Q

What seizure drug is ideal in neonates?

A

phenobarbital

42
Q

What are common GI toxicities from using anti-seizure drugs?

A

Nausea/vomiting

43
Q

What are common neurologic toxicities from using anti-seizure drugs?

A

Somnolence/sedation
Fatigue
Ataxia
Vision disruptions

44
Q

What second generation seizure drug has a rash as a side effect?

A

Lamotrigine

45
Q

B/c of its side effect, how would you start Lamotrigine?

A

start low and go slow

46
Q

First generation “old” anticonvulsant drugs are all at risk for what adverse effect?

A

Stephens-Johnson Syndrome

47
Q

Valproate is a CYP2C9 (inducer/inhibitor). This reduces the degradation of other drugs and increases toxicities.

A

Inhibitor

48
Q

Ironically, valproate can increase risk of toxicities by decreasing degradation of other ______ drugs

A

anti-seizure

49
Q

Carbamazepine and Phenytoin are CYP3A4 (inducers/inhibitors). This increases the degradation of other drugs and reduce their therapeutic effects.

A

Inducers

50
Q

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?

A

Carbamazepine

51
Q

Phenytoin is metabolized by _____ order kinetics at high doses and _____ order kinetics at low doses.

A

Zero (drug in excess)

First (CYP enzyme in excess)

52
Q

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.

A

Phenytoin

53
Q

Carbamazepine and Phenytoin are CYP3A4 (inducers/inhibitors). This increases the degradation of ethinyl estradiol in OCP and reduce the contraception effectiveness.

A

inducers

54
Q

What anti-seizure drugs are pregnancy Category D and can be teratogenic?

A

Carbamazepine Phenytoin
Valproate
Topiramate

55
Q

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?

A

Carbamazepine

Phenytoin

Neurology-Week 4 & 5 (14 decks)

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