Epilepsy drugs Flashcards
Ethosuximide - mech and indication
1st line: Absence seizures
Blocks T-type Ca channels
Ethosuximide - Side Effects
EFGHIJ
Fatigue, GI, Headache, Itching, Stevens-Johnson
What do you use for elcampsia seizures?
1st: magnesium
2nd: benzos
Phenytoin - mechanism and indiction
Inc. Na channel inactivation
All but absence seizures
Side effects of phenytoin
Gingival Hyperplasia Nystagmus Megaloblastic anemia Induces CYP450s Stevens-Johnson
Carbamazepine - mechanisms and indication
Inc. Na channel inactivation
All but absence
What do you treat trigeminal neuralgia with?
Carbamazepine
Side Effects of Carbamazepine
Blood dyscrasias, Hepatotoxicity,
Induce CYP450
SIADH
Stevens-Johnson
Valproic Acid
Inc. Na channel inactivation
All seizures, bipolar disorder
Side effects of valproic acid
GI distress, weight gain
Hepatotox - measure LFTs
Neural tube defects in fetus
Lamotrigine
Blocks voltage gated Na channels - all seizure types
Stevens Johnson syndrome
Stevens Johnson Syndrome
Malaise and fever followed by
Rapid onset of erythematous/purpuric macules
Epidermal skin necrosis and sloughing
Valproic acid inhibits __________ absorption
folic acid
Barbiturates
Phenobarbital, pentobarbital, secobarbital
Thiopental
When are the barbiturates contraindicated?
Porphyria
*CYP Inducer
What are the short acting benzos?
Midazolam
Oxazepam
Lorazepam
Triazolam
What are the long acting benzos
Chlordiazepoxide
Diazepam
How do you treat a benzo overdose?
Flumazenil
What are benzos used for?
Anxiety Spasticity Status epilepticus DT (detox) Night terrors, sleep walking General anesthetic Hypnotic
What are the non-benzo hynpotics
Zolpidem, Zaleplon, EsZopiclone
Flumazenil will reverse what?
Benzos and non-benzo hypnotics
Massive centrilobar necrosis seen 2 days - 4 weeks post surgery is indicative of what?
Hepatotoxicity from halothane
What drugs can cause Malignant Hyperthermia? How do you treat it?
Inhaled anesthetics (not nitrous)
Succinylcholine
Dantrolene
Thiopental
Barbiturate - induction of anesthesia (IV)
Midazolam
Benzo - endoscopy (IV)
Ketamine
PCP analog - blocks NMDA receptors
Dissociative anesthetic
CV stimulant
Propofol
Sedation in ICU - potentiates GABA
What is the order of loss of sensation with local anesthetic
Pain, temperature, touch, pressure
Amide Local anesthetics
Lidocaine, Mepivicaine, Bupivicaine (2 Is)
Ester local anesthetics
Procaine, cocaine, tetracaine
How do local anesthetics work?
Block Na channels - rapidly firing neurons - bind activated Na channels
What is the order of the nerve blockade?
Small myelinated
Small unmyelinated
Large myelinated
Large unmyelinated
What are complictions of succinylcholine?
HyperCa
HyperK
Malignant Hyperthermia
What is the only depolarizing neuromuscular blocking drug?
Succinylcholine
Phase I: prolong depol - no antidote
Phase II: repolarized but blocked - cholinesterase inhibitors
Tubocurarine, atracurium, mivacurium, “curonium”
Competitive antagonists for ACh receptors
Reverse with Neostigmine + Atropine
Dantrolene
Blocks release of Ca from SR of skeletal muscle
Malignant Hyperthermia
Neuroleptic Malignant Syndrome
Selegiline
MAO-B inhibitor - metabolizes dopamine - ↑availability of dopamine
Parkinson’s - may enhance adverse effects of L-dopa
Carbidopa
Inhibits DOPA decarboxylase peripherally
Bromocriptine
Dopamine agonist - ergot
Pramipexole, ropinirole
Dopaine agonist - non-ergot
*preferred
Memantine
NMDA receptor antagonist - prevents excitotoxicity - Alzheimers
Tetrabenazine and reserpine
Inhibit VMAT - limit dopamine vesicle packaging and release
Huntington
Haloperidol
Dopamine R antagonist - Huntington
Sumatriptan
Serotonin IB/ID agonist - inhibits trigeminal nerve activation
Vasoconstriction
Acute migraine and Cluster headaches
