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Pharm Unit 3 > Epilepsies > Flashcards

Epilepsies Flashcards

1
Q

What are the 4 drugs that belong to the voltage-gated sodium channel stabilizers?

A
  • Phenytoin
  • Carbamazepine
  • Oxcarbamazepine
  • Lamotrigine
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2
Q

What is the mechanism of the voltage-gated sodium channel stabilizers?

A

A little redundant but, they stabilize the inactive conformation of sodium channels!

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3
Q

What are the primary therapeutic uses of carbamazepine and oxcarbamazepine?

A
  • They are more effective for complex partial seizures than primary generalized.
  • bipolar disorder
  • neuropathic pain.
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4
Q

What is pheytoin effective at treating? Less effective at treating?

A
  • Tonic-clonics of primary generalized epilepsy
  • Partial onset
  • Secondarily generalized seizures
  • Less Effective: Absence (particularly pediatric), myoclonic, atonic seizures
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5
Q

What conditions is Lamotrigine used to treat?

A
  • Primary and Secondary Generalized Epilepsy
  • Partial complex
  • Absence seizures
  • Bipolar disorder
  • Neuropathic pain
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6
Q

A neurologist wants to prescribe a Na channel stabilizer for a pediatric patient who has absence seizures. What drug would be the best choice?

A

Lamotrigine

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7
Q

What are the side effects of phenytoin?

A

Rash

  • Gingival hyperplasia
  • Hirsutism
  • Lupus-like reaction
  • Contraceptive failure
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8
Q

What are the side effects of carbamazepine and oxcarbamazepine?

A
  • Rash (rarely Stevens-Johnson syndrome)
  • Mild myelosuppresion
  • Mild increase in LFTs
  • Contraceptive failure
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9
Q

For which sodium channel stabilizer is slow initial titration important? What are the side effects of this drug?

A

Lamotrigine

  • Rash (Rarely Stevens-Johnson syndrome)
  • Contraceptive failure
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10
Q

A patient has been taking a sodium channel stabilizer for years and is experiencing cerebellar degeneration, peripheral neuropathy and osteoporosis. What drug has he been on?

A

Phenytoin

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11
Q

What limits the IV infusion of phenytoin?

A

Hypotension; It is a hepatic enzyme inducer

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12
Q

Rank the Sodium channel stabilizers from most protein bound to least protein bound

A

Phenytoin ~ Carbamazepine > Oxcarbamazepine > Lamotrigine

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13
Q

Which sodium channel stabilizers cause hepatic enzyme induction?

A

All of them!

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14
Q

Which sodium channel blocker may exacerbate myoclonic seizures and competes with valproic acid for excretion?

A

Lamotrigine

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15
Q

What are the benefits of oxcarbamazepine over carbamazepine?

A
  • Bypasses carbamazepine epoxide
  • Less protein-bound
  • Less auto-induction
  • Fewer interactions
  • Less toxic
  • Longer half-life
  • Carbamazepine doses need to be increased every 1-2 weeks due to autoinduction
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16
Q

How does Valproate work?

A

MECHANISM UNKNOWN (but it likely affects Na-gated channels and GABA system)

17
Q

Valproate is great because it can be used therapeutically for many conditions. What conditions is it used for?

A
  • Absence
  • Myoclonic
  • Tonic-clonic
  • Primary generalized
  • Partial onset
  • Secondary generalize seizures
  • IV for Status Epilepticus
  • Bipolar disorder
  • Migraine
  • Long-term cluster headache prophylaxis
18
Q

What is the plethora of side effects that come with Valproate use?

A

Weight gain

  • Hair turnover
  • Hyperammonemia (which can be mitigated with oral carnitine)
  • Teratogenicity
  • Blood dyscrasias
  • Pancreatitis
19
Q

What are the three GABAergic anti-epileptic drugs? What are their mechanisms, respectively?

A

Vigabatrin, Tigabine, Benzos; GABA transaminase binder (slows down intracellular breakdown of GABA), GABA reuptake inhibitor, binds GABA-A

20
Q

I need a GABAergic anti-epileptic that won’t cause sedation, STAT! What two drugs could I use?

A

Vigabatrin or Tigabine

21
Q

Now I need a GABAergic anti-epileptic for Status Epilepticus (refactory) that causes sedation, STAT! Wow, I’m needy! What do you got? I want to use this med long term. What are your thoughts?

A

Benzos; Don’t do it! Patients can become tolerant to long-term benzo use!

22
Q

What is the class, mechanism and therapeutic uses of Gabapentin and Pregabalin?

A
  • GABA analog
  • Block presynaptic influx of Ca
  • Adjunct for partial complex epilepsy, neuropathic pain.
23
Q

My GABA analog is taking FOREVER to absorb into my patient! But I know that it has very few side effects (besides sedation) and therefore I used it. What drug am I using? Why is it taking so long to absorb? Why does its use result in minimal side effects?

A
  • Gabapentin
  • Its absorption is limited by the AA transporter
  • It has limited protein binding, no metabolism and no drug interactions in humans!
24
Q

What are my two Glutamate Receptor Blockers? How are their mechanisms different? Same?

A
  • Topiramate: Partial AMPA, Kainate Ca receptor blocker
  • Felbamate: NMDA receptor blocker
  • Both: Secondary effect at voltage-gated Na channel, GABA system
25
Q

Therapeutic uses for Topiramate?

A
  • Partial onset seizures
  • Secondary generalized seizures
  • Primary generalized epilepsy
  • Migraine prevention
  • Long-term prevention of cluster headaches
26
Q

Therapeutic uses for Felbamate?

A
  • Partial onset seizures with or without secondary generalization
  • Medically refractory epilepsy
27
Q

Why do I need to monitor my patient who is on Felbamate?

A

Uncommon but potentially fatal when used. Also aplastic anemia, acute hepatic failure is also possible

28
Q

What are the side effects of Topiramate?

A

Mild metabolic acidosis, kidney stones due to carbonic anhydrase activity, modest weight loss, rarely glaucoma and sedation

29
Q

What neurologic effects does Topiramate use cause?

A

Word-finding problems

30
Q

How does Topiramate result in peripheral sensory problems? How do you treat it?

A

Carbonic anhydrase activity&raquo_space; Mild Metabolic Acidosis&raquo_space; Respiratory Compensation&raquo_space; Mild Alkalosis&raquo_space; Calcium Ionization&raquo_space; Tingling; Treat with Vit C

31
Q

What type of drug is Levetiracetam and what is its mechanism of action?

A

Synaptic vesicle binder; Binds synaptic vesicle protein 2 leading to less NT release

32
Q

My patient has Absence seizures. I want to use a voltage-gated Ca channel blocker. What drug should I use?

A

Ethosuximide

33
Q

How does ethosuximide work?

A

Blocks T-type Ca-channels in thalamo-cortical circuits

34
Q

What are some of the benefits of Ethosuximide use? What are some of the negative side effects?

A
  • Readily absorbed, minimal first pass metabolism, no protein binding
  • transient nausea, sedation, and irritability
35
Q

Therapeutic uses of Levetiracetam? Even though it is generally well tolerated, what are the negative side effects?

A
  • Partial onset seizures
  • Secondary generalized seizures
  • Side Effects: Sedation mostly, rarely irritability, aphasia or thrombocytopenia

Pharm Unit 3 (14 decks)

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