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Pharmacology 3 > E1- Anticonvulsants > Flashcards

E1- Anticonvulsants Flashcards

1
Q

What type of seizure is characterized by:

  • Focal, brief (20-90 sec)
  • Grimacing, focal clonic jerking of an extremity
  • No loss of consciousness
A

Partial simple seizure

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2
Q

What type of seizure is characterized by:

  • Longer (<2 min)
  • Automatic movements
  • Altered or loss of consciousness; hallucinations
A

Partial complex seizure

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3
Q

What type of seizure is characterized by:

  • Tonic-clonic with loss of consciousness
  • Muscle contractions alternating with relaxation
A

Partial with secondary general

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4
Q

What type of seizure is characterized by:

  • Sudden onset, brief
  • Loss of awareness, but not consciousness
A

Absence (petit mal)

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5
Q

What type of seizure is characterized by:

  • Initial tonic rigidity, subsequent tremor, eventual clonic jerking
  • Loss of consciousness
A

Tonic-clonic (grand mal)

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6
Q

What type of seizure is characterized by:

-Brief spasm or rigidity

A

Myoclonic

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7
Q

What type of seizure is characterized by:

-Sudden loss of postural tone, pt can fall down

A

Atonic

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8
Q

What is the general MOA of anticonvulsants?

A

Increase GABA activity or decrease excitatory glutamate activity

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9
Q

Which anticonvulsants inhibit Na+ channels? (6)

A 
Carbamazepine
Phenytoin
Topiramate
Lamotrigine
Valproate
Zonisamide
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10
Q

Which anticonvulsants inhibit Ca2+ channels? (2)

What are their uses?

A

Ethosuximide
Valproate
Absence seizures

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11
Q

Which anticonvulsant inhibits both Na+ and Ca2+ channels?

A

Valproate

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12
Q

What are common SE of anticonvulsants? (4)

A

Teratogenicity
Suicide
Hypersensitivity (SJS)- screen for HLA-B allele, discontinue if develop rash
Failure of contraceptives

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13
Q

What should an OD of an anticonvulsant not be treated with?

A

CNS stimulants

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14
Q

Which anticonvulsant inhibits CYP450s?

A

Valproate

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15
Q

Which anticonvulsants induce CYP450s? (3)

A

Phenytoin
Carbamazepine
Phenobarbital

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16
Q

What is the difference between Phenytoin and Fosphenytoin?

A

Phenytoin (oral)

Fosphenytoin (injectable)

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17
Q

What is the MOA of Phenytoin and Fosphenytoin?

A

Prolongs inactivation of Na+ channels –> decreases glutamate activity

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18
Q

What are the uses of Phenytoin and Fosphenytoin? (2)

A

Partial seizures

Generalized tonic clonic seizures

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19
Q

What is the pharmacokinetics of Phenytoin and Fosphenytoin elimination?

A

Elimination is 1st order at low doses but zero order at therapeutic and higher doses

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20
Q

What are SE specific to Phenytoin and Fosphenytoin? (5)

A 
Nystagmus
Diplopia
Ataxia
Sedation
Gingival hyperplasia
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21
Q

What is the MOA of Carbamazepine?

A

Blocks Na+ channels –> decreases glutamate activity

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22
Q

What is DOC for partial seizures?

A

Carbamazepine

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23
Q

What are uses of Carbamazepine? (4)

A

Partial seizures (DOC)
Generalized tonic-clonic seizures
Bipolar disorder
Trigeminal neuralgia

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24
Q

What are SE specific to Carbamazepine? (6)

A 
Diplopia
Ataxia
GI upset
Drowsiness
Aplastic anemia Agranulocytosis
25
Q

What is the MOA of Lamotrigine?

A

Inactivates Na+ channels –> decreases glutamate activity

26
Q

Which anticonvulsant has the highest risk of SJS?

A

Carbamazepine

27
Q

What are the uses of Lamotrigine? (2)

A

Partial seizures

Bipolar disorder

28
Q

What are SE specific to Lamotrigine? (5)

A 
Dizziness
Diplopia
Ataxia
Somnolence
N/V
29
Q

What is the MOA of Topiramate?

A

Blocks Na+ channels –> decreases glutamate activity

30
Q

What are the uses of Topiramate? (2)

A

Partial tonic-clonic seizures

Generalized tonic-clonic seizures

31
Q

What are SE specific to Topiramate? (2)

A

Acute myopia

Glaucoma

32
Q

What is the MOA of Levetiracetam?

A

Binds synaptic vesicular protein SV2A –> decreases glutamate activity and increases GABA release

33
Q

What are uses of Levetiracetam? (3)

A

Partial seizures
Myoclonic seizures
Tonic-clonic seizures

34
Q

What is the MOA of Phenobarbital?

A

Prolongs opening of Cl- channel at GABA receptor

35
Q

What are the uses of Phenobarbital? (2)

A

Partial seizures

Generalized tonic-clonic seizures

36
Q

What are possible drug interactions of Phenobarbital?

A

Induces CYP450s (increased metabolism of Phenytoin and Carbamazepine)

37
Q

What is the MOA of Gabapentin?

A

GABA analog, may increase GABA release

38
Q

What are the uses of Gabapentin? (3)

A

Adjunct for partial and generalized tonic-clonic seizures
Neuropathic pain
Bipolar disorder

39
Q

What is the pharmacokinetics regarding Gabapentin elimination?

A

Elimination is 1st order; excreted unchanged by the kidney

40
Q

What is useful about Gabapentin?

A

NO drug interactions

41
Q

What is the MOA of Pregabalin?

A

GABA analog; binds to Ca2+ channels inhibiting excitatory neurotransmitter release

42
Q

What are the uses of Pregabalin? (4)

A

Generalized anxiety disorder Neuropathic pain
Fibromyalgia
Post-op pain

43
Q

What anticonvulsants have minimal drug interactions?

A

Levetiracetam
Gabapentin
Pregabalin
Tiagabine

44
Q

What are SE specific to Pregabalin? (7)

A 
Peripheral edema
Dizziness
Weight gain
Xerostomia
Ataxia
Blurred vision
GI upset
45
Q

What is the MOA of Tiagabine?

A

Inhibits reuptake of GABA  enhances GABA activity

46
Q

What is the use of Tiagabine?

A

Adjunct for partial seizures

47
Q

What is the MOA of Vigabatrin?

A

Irreversibly inhibits GABA transaminase

48
Q

What are the uses of Vigabatrin? (2)

A 
Refractory complex partial seizures
Infantile spasm (West’s syndrome)
49
Q

What are SE specific to Vigabatrin? (2)

A

Visual field problems

Retinal damage

50
Q

What is the MOA of Ethosuximide?

A

Inhibits low-threshold (T-type) Ca2+ channels

51
Q

What is DOC for absence seizures?

A

Ethosuximide

52
Q

What SE is specific to Ethosuximide?

A

Hiccup

53
Q

What is the MOA of Valproic acid?

A

Blocks Ca2+ channels AND Na+ channels

54
Q

What are the uses of Valproic acid? (3)

A

Absence and general tonic-clonic seizures (“mixed” seizures”)
Bipolar disorder
Migraine prophylaxis

55
Q

What are SE specific to Valproic acid?

A

Hepatoxicity

Teratogenic- increase risk of spina bifida

56
Q

What is the MOA of Clonazepam (BZ)?

A

Stimulates GABA receptor and enhances GABA inhibition

57
Q

What are the uses of Clonazepam (BZ)? (3)

A

Absence seizures
Myoclonic seizures
Infantile spasms (West’s syndrome)

58
Q

What is the MOA of Diazepam (BZ) and Lorazepam (BZ)?

A

Stimulates GABA channel

59
Q

What is the DOC for Status Epilepticus?

A

Diazepam (BZ) and Lorazepam (BZ)

Pharmacology 3 (10 decks)

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