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Pharmacology > 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

short term episode of abnormal firing of cerebral neurons (hyper-synchrony)

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3
Q

what are some causes of seizures?

A 
fever
head injury
tumor
heredity
alcohol withdrawal
metabolic disorder
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4
Q

What are the two main classifications of seizures?

A

partial

generalized

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5
Q

what is a partial seizure?

A

initiated in neurons in a localized area of one cerebral hemisphere

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6
Q

what are 3 types of partial seizures?

A

simple
complex
secondary generalized

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7
Q

what is a simple partial seizure?

A

no loss of consciousness; may experience an aura prior to seizure

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8
Q

what is a complex partial seizure?

A

impaired consciousness often with automatisms (ex: picking at shirt repetitively)
unable to recall events afterwards

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9
Q

what is a partial seizure with secondary generalization?

A

starts off localized, then spreads to activate both hemispheres (goes to thalamus first)

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10
Q

what are 2 types of generalized seizures?

A

tonic-clonic

absence

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11
Q

what is a generalized seizure?

A

simultaneous activation of both cerebral hemispheres

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12
Q

what is a generalized of tonic-clonic seizure?

A 
tonic = rigid extension of limbs
clonic = spasms, jerking of extremities
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13
Q

what is status epilepticus?

A

if a seizure goes on longer than 5-10min

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14
Q

what is a generalized absence seizure?

A

impaired consciousness sometimes with automatisms
sx: blink rapidly, eyes may roll back, smacking of lips
no aura occurs; happens quickly

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15
Q

what are 4 different MoA’s for seizure drugs?

A

1) blockage of voltage-dependent sodium channels (reduce rate of sodium channel opening)
2) inhibit glutamate exposure and reduce neuronal firing (decr. glutamate exposure and reduce neuronal firing)
3) Increase inhibitory GABA neurotransmission (enhances Cl influx, hyperpolarizes neurons and reduces neuronal firing)
4) block voltage-gated calcium channels (depolarization of thalamic neurons activates cortical neurons)

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16
Q

where do anti-epileptics work on voltage-gated sodium channels?

A

work on the state of converting inactive channel to a closed channel (inhibit conversion)

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17
Q

what are 4 drugs that are used to treat seizures?

A

carbamazepine (tegretol)
phenytoin
valproate
ethosuximide

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18
Q

what types of seizures can carbamazepine treat?

A

partial

generalized tonic-clonic

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19
Q

what is the MoA for carbamazepine?

A

inhibits voltage gated sodium channels

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20
Q

What are some adverse effects of carbamazepine?

A 
double vision
ataxia (poor balance, uncoordinated movements)
nausea
drowsiness (high doses)
skin rash
leukopenia (low count of WBCs)
21
Q

what types of seizures can phenytoin treat?

A

phenytoin

22
Q

what is the MoA of phenytoin?

A

blocks voltage-gated sodium channels

23
Q

what are some adverse effects of phenytoin?

A 
double vision
ataxia 
eye movements
gingival hyperplasia (gum inflammation)
hirsutism (hair growth)
peripheral neuropathy (Chronic)
megaloblastic anemia (dysfunctional RBCs)
osteomalacia (decreased calcification of bone)
24
Q

What is the MoA of phenobarital and primidone?

A

enhance inhibitory effects of GABA

25
Q

What are some adverse effects of phenobarbital and primidone?

A 
drowsiness
ataxia
respiratory depression
decreased motor skills
skin rash 
psychological/physiological dependence
26
Q

what is the MoA of gabapentin?

A

increases release of GABA from neurons; decreases GABA metabolism

27
Q

what are some adverse effects of gabapentin?

A 
sedation
dizziness
headache
tremor
ataxia
GI (nausea, constipation)
28
Q

what can topiramate be used for?

A

adjunctive therapy

monotherapy in partial and tonic-clonic seizures

29
Q

what is the MoA of topiramate?

A

inhibits voltage sensitive sodium channels, incrases GABA effects and inhibits glutamate (AMPA) receptors

30
Q

briefly describe the metabolism of topiramate

A

metabolism is affected by other anti-epileptics

31
Q

what are some adverse effects of topiramate?

A

fatigue
dizziness
mental slowing
nausea

32
Q

what can lamotrigine be used for?

A

adjunctive therapy

monotherapy for partial and absence seizures

33
Q

what is the MoA of lamotrigine?

A

blocks voltage-gated sodium channels

34
Q

what are some adverse effects of lamotrigine?

A

dizziness
headache
skin rashes

35
Q

what kind of seizures can ethosuximide be used to treat?

A

generalized absence seizures

36
Q

what is the MoA of ethosuximide?

A

blocks voltage-gated calcium channels

37
Q

what are some adverse effects of ethosuximide?

A

stomach aches
vomiting
skin rash
may increase tonic-clonic seizures

38
Q

what kind of seizure can clonazepam be used to treat?

A

generalized absence

39
Q

what is the MoA of clonazepam?

A

enhances inhibitory effects of GABA

40
Q

what are some adverse effects of clonazepam?

A

sedation

tolerance to anti-seizure effects

41
Q

what kinds of seizures can valproate be used to treat?

A

generalized tonic-clonic
absence
mixed seizures (partial seizures, atypical generalized seizure)

42
Q

what is the MoA of valproate?

A

voltage gated sodium and channel blocker

enhances inhibitory effects of GABA

43
Q

what are some adverse effects of valproate?

A

risk of spina bifida
hepatotoxicity (pts under 2)
N/V
tremor

44
Q

what are some other medical conditions anti-epileptics can be used for?

A 
bipolar disorder (approved = carbamazepine, valproate)
anxiety disorder
alcohol abuse
spascity
migraine, cluster headache
neuropathic pain (gabapentin)
45
Q

what are two different meds used to treat status epilepticus?

A 
IV diazepam (Valium)
IV lorazepam
phenytoin used for longer term control
46
Q

can AEDs be used in pregnant women?

A

AEDs can harm the fetus, but risk/harm from uncontrolled seizures is greater

47
Q

which meds enhance metabolism of oral contraceptives?

A

phenytoin

phenobarbital

48
Q

which meds can cause enhanced vitamin D metabolism leading to osteomalacia and enhanced vitamin K metabolism leading to bleeding disorder?

A

phenytoin

phenobarbital

Pharmacology (9 decks)

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