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Pharmacology 2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

A chronic disorder characterized by recurrent seizures

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2
Q

What is a seizure?

A

A short term episode of abnormal firing of cerebral neurons

Partial or generalized

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3
Q

What can cause seizures?

A

Fever, head injury, tumor, hereditary, alcohol withdrawal and metabolic disorder

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4
Q

What is a partial (focal) seizure?

A

Initiated in neurons in a localized area of one cerebral hemisphere
Simple, complex, secondary generalization

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5
Q

What is a simple partial seizure?

A

No loss of conciousness

Preceeded by an aura sometimes

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6
Q

What is complex partial seizure?

A

Impaired consciousness often with automatisms

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7
Q

What is a secondary generalized partial seizure?

A

Seizures that spread to activate both hemispheres

Part of body begins to tingle then jerk, then jerking spreads throughout body

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8
Q

What is a generalized seizure?

A

Simultaneous activation of both cerebral hemispheres

Tonic-clonic, absence

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9
Q

What is a tonic-clonic generalized seizure?

A

Loss of consciousness, extension then jerking of the body with stiffness finishing by passing out into a deep sleep

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10
Q

What is an absence generalized seizure?

A

Impaired consciousness sometimes with automatisms

Blanking out for a few seconds, blinking

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11
Q

What does a normal EEG look like?

A

Activity mostly in the left and right occipital lobes

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12
Q

What does the EEG of a partial seizure look like?

A

More activity in one side of the brain (left frontal and temporal)

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13
Q

What does the EEG of a complex partial seizure look like?

A

Similar to that of a simple partial seizure

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14
Q

What does the EEG of a generalized tonic-clonic seizure look like?

A

All parts of the brain show large spikes (close together then more spread apart throughout) in activity.

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15
Q

What does the EEG of a generalized absence seizure look like?

A

Very similar large, organized spikes throughout entire brain

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16
Q

What are the 4 mechanisms of action of anti-epileptic drugs?

A 
Block voltage-dependent sodium channels (decreases neuronal firing)
Inhibit excitatory (glutamate) transmission
Increase inhibitory (GABA) transmission
Block voltage-activated Ca channels (stops depolarization)
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17
Q

How does depolarization and hyperpolarization affect a Na cell?

A

Depolarization enhances channel opening (Gate A)
Hyperpolarization blocks channel opening
Channel then becomes inactive (Gate B closes)

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18
Q

Where do many anti-epileptic drugs work on the Na channel?

A

Prevent the conversion of the inactive channel to closed channel (From closed gate B to gate A)

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19
Q

What drugs are used to treat partial seizures?

A

Carbamazepine, phenytoin or valproate

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20
Q

What drugs are used to treat generalized tonic-clonic seizures?

A

Carbamazepine, phenytoin or valproate

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21
Q

What drugs are used to treat generalized absence seizures?

A

Ethosuximide

22
Q

What drugs are used to treat generalized tonic-clonic and absence seizures?

A

Valproate

23
Q

What drugs are used to treat atypical generalized seizures?

A

Valproate

24
Q

What can be added to drug therapy of partial seizures?

A

Lamotrigine, gabapentin or topiramate

25
Q

How does carbamazepine work?

A

Inhibits voltage-gated sodium channels and induces it’s own metabolism
Dose adjustments are required

26
Q

What are the drug interactions with carbamazepine?

A

Can enhance the metabolism of many other antiepileptics including phenytoin and valproate toxicity

27
Q

What are the adverse effects of carbamzepine?

A

Double vision, ataxia (poor balance, uncoordination), nausea
High doses: drowsiness
Skin rash and leukopenia (low white blood cells)

28
Q

How does phenytoin work?

A

Blocks voltage-gated sodium channels
Absorption differs among formulations
Dramatic increases in plasma levels with small increases in dose

29
Q

What are the drug interactions with phenytoin?

A

Highly bound to plasma proteins

Induces CYP 3A4 and thus the metabolism of carbamazepine, valproate, vitamin K and contraceptives

30
Q

What is the metabolism of phenytoin enhanced by?

A

Phenobarbital and carbamazepine, requires dose adjustment

31
Q

What are the adverse effects of phenytoin?

A

Double vision, ataxia, gingival hyperplasia, hirsutism (hair growth), mild peripheral neuropathy, megaloblastic anemia, osteomalacia

32
Q

How does phenobarbital and primidone work?

A

Enhance the inhibitory effects of GABA
Primidone is metabolized to phenobarbital
Induces it’s own metabolism

33
Q

What are the drug interactions with phenobarbital and primidone?

A

Induces liver microsomal enzymes so drug interactions are common with vitamin K and oral contraceptives

34
Q

What are the adverse effects of phenobarbital and primidone?

A

Drowsiness, ataxia, respiratory depression and decreased motor skills
Skin rash, dependence

35
Q

How does gabapentin work?

A

Increases the release of GABA and decrease the metabolism of GABA
Not metabolized, doesn’t induce hepatic enzymes
Adjunctive therapy

36
Q

What are the adverse effects of gabapentin?

A

Sedation, dizziness, headache, tremor, ataxia, nausea, constipation
Will resolve in 2 weeks

37
Q

How does topiramate work?

A

Inhibits voltage gated Na channels, increases GABA, inhibits glutamate
Adjunctive therapy or mono in partial and tonic-clonic

38
Q

What are the adverse effects of topiramate?

A

Fatigue, dizziness, mental slowing and nausea

39
Q

How does lamotrigine work?

A

Blocks voltage gated sodium channels

Adjunctive therapy or mono for partial and absence

40
Q

What are the adverse effects of lamotrigine?

A

Dizziness, headache, skin rashes

41
Q

How does ethosuximide work?

A

Blocks voltage activated calcium channels

42
Q

What are the adverse effects of ethosuximide?

A

Stomach aches and vomiting (tolerance will develop)

Rash, may increase tonic-clonic seizures

43
Q

How does clonazepam work?

A

Enhances the inhibitory effects of GABA

44
Q

What are the adverse effects of clonazepam?

A

Sedation and tolerance to anti-seizure effects

45
Q

How does valproate work?

A

Voltage gated sodium and calcium channels, enhances inhibitory effects of GABA

46
Q

What are the drug interactions with valproate?

A

Inhibits metabolism of other drugs including antiepileptics

47
Q

What are the adverse effects of valproate?

A

Nausea, vomiting (initiate therapy slowly)
Tremor at high concentrations
Spina bifida in babies if taken while pregnant

48
Q

What are the other uses of anti-epileptic drugs?

A

Bipolar disorder (carbamazepine, valproate), anxiety disorders, alcohol abuse, spasticity, migraine, cluster headache, neuropathic pain (gabapentin)

49
Q

What drugs are used in the case of status epilepticus?

A

IV diazepam or lorazepam are used to stop the seizures and phenytoin may be initiated for longer term control
have to gradually increase antiepilieptics

50
Q

What must be monitored while on antiepileptics?

A

Blood level monitoring to maintain therapeutic levels, especially for drugs that can affect drug metabolizing enzymes

51
Q

What should be done about seizures in pregnancy?

A

Uncontrolled seizures are a greater risk to the fetus than the drugs
Lowest effect dose should be used, one drug at a time (dose may need to be increased due to increased metabolism-monitor blood levels at least once a month)

Pharmacology 2 (23 decks)

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