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Pharmacology 2 > Exam #01i - Anticonvulsants > Flashcards

Exam #01i - Anticonvulsants Flashcards

1
Q

This condition is defined as an abnormal, synchronized, excessive discharge of a population of cortical neurons?

A

seizure

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2
Q

What condition is characterized by chronic, recurring seizures?

A

epilepsy

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3
Q

What criteria can you use to diagnose a patient with epilepsy (HINT: # of seizures in time period)?

A

occurrence of 2 unprovoked seizures separated by 24 hours

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4
Q

List (8) causes of seizures?

A
  1. illness (tumor, stroke, meningitis)
  2. infection
  3. injury/trauma
  4. genetic
  5. high fever
  6. children with cerebral palsy or mental retardation
  7. Alzheimer’s
  8. withdrawal from alcohol or drugs
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5
Q

What is a mutation in an ion channel called?

A

chanelopathy

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6
Q

True or False - anti-epileptic drugs (AEDs) are only meant to control epilepsy, not cure the disorder?

A

True

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7
Q

True or False AED CANNOT prevent the development of epilepsy in individuals who have acquired a risk for seizures?

A

True

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8
Q

Which seizure type may start as a small part of the brain thens spread to several areas of the brain?

A

Secondary generalized seizure

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9
Q

Which seizure type is characterized by motor, sensory, and speech disturbances, but NO loss of consciousness (in other words, the patient is fully aware of what is happening and can describe it)

A

partial (focal) seizure

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10
Q

What type of general seizure is characterized by a sudden jerk or so called “lightening bolt response?”

A

Myoclonic seizure

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11
Q

What phase of a grand mal seizure is characterized by quick loss of consciousness followed by sudden tensing of skeletal muscles, with the entire phase only lasting a few seconds?

A

tonic phase

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12
Q

What phase of a grand mal seizure is characterized by convulsions

A

clonic phase

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13
Q

What seizure type is characterized by loss of muscle tone?

A

atonic seizure

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14
Q

True or False - tonic-clonic (grand mal) seizure affects the entire brain?

A

True

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15
Q

Which type of seizure is the most common type associated with epilepsy?

A

Grand mal

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16
Q

What disorder does this describe: prolonged depolarization and dysfunction of Na+ channels (channelopathy)?

A

epilepsy

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17
Q

In the normal brain, what is excitatory neurotransmission modulated by? In the normal brain, what is inhibitory neurotransmission modulated by?

A

excitatory modulated by voltage-gated ion channels

inhibitory modulated by GABA

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18
Q

Name the (3) ways hyperexcitability can be normalized?

A
  1. inhibit activation of Na+ and Ca2+ channels
  2. prolong inactivation of Na+ channels
  3. increase inhibition by increasing [GABA]
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19
Q

What types of seizures are sodium channel blockers indicated for?

A

partial and generalized tonic-clonic seziures

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20
Q

List (7) Na+ channel blocker anti-seizure drugs?

A
  1. Carbamazepine
  2. Phenytoin
  3. Valproate
  4. Zonisamide
  5. Lamotrigine
  6. Lacosamide
  7. Rufinamide
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21
Q

Which (2) Na+ channel blocker anti-seizure drugs should not be given together b/c of risk of Stevens-Johnson syndrome?

A

Valproate + Lamotrigine

Valproate inhibits the metabolism of Lamotrigine

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22
Q

What type of anti-seizure drugs are important in treating absence seizures that originate in the thalamus?

A

Ca2+ channel blockers

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23
Q

Name the (2) T-type calcium channel blocker anti-seizure drugs for treatment of absence seizures (generalized petit mal)?

A
  1. Ethosuximide

2. Valproate

24
Q

Name the (1) L-type calcium channel blocker anti-seizure drug for treatment of focal seizures?

A
  1. Gabapentin (neurontin)
25
Q

Name (5) GABA agonists?

A
  1. Benzodiazepine
  2. Barbiturates
  3. Phenobarbital
  4. Diazepam (Valium)
  5. Clonazepam (Klonopin)
26
Q

Which GABA agonist is used for infantile spasms (generic and brand)?

A

Clonazepam (Klonopin)

27
Q

Name (1) GABA uptake inhibitor?

A
  1. Tiagabine (Gabitril) - increases [GABA] in synaptic cleft
28
Q

List (4) drugs that affect GABA metabolism

A
  1. Vigabatrin - inhibits GABA metabolism
  2. Valproate - inhibits GABA metabolism
  3. Gabapentin - increases synaptic [GABA]
  4. Pregabalin - decreases release of excitatory NT
29
Q

Describe Keppra’s unique MOA? What type of seizure is Keppra used for?

A

Keppra inhibits the fusion of vesicles to the synaptic terminal via protein modulation, limiting the release of NT into synaptic cleft

GTC seizure

30
Q

Name (1) K+ channel activator anti-seizure drug that was approved in 2010, approved for adjunctive therapy for partial onset seizures, and can cause blue skin discoloration and eye abnormalities?

A

Retigabine (Ezogabine)

Promotes opening of K+ channels to depolarize cells and dissipate the hyperexcitability of seizing. This stabilizes resting membrane potential and reduces brain excitability

31
Q

What are the (5) most common AEs of Retigabine (K+ channel activator)?

A
  1. drowsiness
  2. dizziness
  3. vertigo
  4. confusion
  5. slurred speech
32
Q

Name (1) Glutamate receptor blocker?

A

Felbamate

Remember, glutamate is excitatory so blocking this binding will block excitation

33
Q

What (2) major AE’s are associated with Felbamate?

A
  1. aplastic anemia

2. liver failure

34
Q

Which anti-seizure drug’s use is limited to refractory patients who don’t respond to any other therapy?

A

Felbamate (glutamate receptor blocker)

35
Q

In what (3) ways does Valproate control seizures?

A
  1. Na+ channel blocker
  2. Ca2+ channel blocker
  3. increases GABA levels
36
Q

Which anti-seizure drug blocks Na+ and Ca2+ channels, enhances GABA, and blocks glutamate receptors?

A

Topiramate (Topamax)

37
Q

In what (2) ways does Levetiracetam (Keppra) control seizures?

A
  1. modulates release of GABA

2. modulates release of glutamate

38
Q

This term is defined as repeated convulsive seizures, is life threatening, and requires emergency treatment?

A

Status Epilepticus

39
Q

What benzodiazepine (given IV) would have the fastest onset of action to treat status epilepticus?

A

Diazepam (valium)….then quickest Lorazepam (Ativan)

40
Q

Which benzodiazepine (given IV) with a long duration of action would you transition to after initially treating a patient in status epilepticus with a fast onset action benzo?

A

Phenobarbital….next longest acting Phenytoin

41
Q

List the (11) major AE of anti-convulsant drugs?

A
  1. Sedation
  2. N
  3. HA
  4. dizziness
  5. somnolence (drowsiness)
  6. rash
  7. blurred vision
  8. visual field loss
  9. nystagmus
  10. tremor
  11. mood disturbance
42
Q

Which anti-convulsant drug is the only one with the AE of nystagmus?

A

Phenytoin

43
Q

Which anti-convulsant drug is the only one with the AE of visual field loss?

A

Retigabine (Ezogabine) - K+ channel activator

44
Q

Which anti-convulsant drugs (2) have an AE of developing a rash?

A
  1. Lamotrigine

2. Phenytoin

45
Q

Which (2) anti-seizure drugs should not be used to treat absence seizures?

A

Carbamazapine - exacerbates absence seizures

Phenobarbital - enhances T-type Ca channels

46
Q

Which anti-seizure drug has autoinduction (induces hepatic enzymes responsible for metabolizing itself)?

A

Carbamazapine

47
Q

Which anti-seizure drug has a non-linear relationship of drug dose and steady state plasma concentration and requires close monitoring to get drug levels correct?

A

Phenytoin

48
Q

What are the (4) DOC to treat Absence Seizures?

A
  1. Clonazepam
  2. Lamotrigine
  3. Ethosuximide
  4. Valproate

CLEV

49
Q

What are the (2) DOC to treat Myoclonic Seizures?

A
  1. Phenobarbital

2. Clonazepam

50
Q

What is the DOC to treat Status Epilepticus?

A

IV Benzodiazepines

51
Q

What are the (5) DOC to treat Primary GTC seizures?

A
  1. Carbamazapine
  2. Phenytoin
  3. Phenobarbital
  4. Primidone
  5. Topiramate
52
Q

List the 5 comorbidities of seizures?

A
  1. depression
  2. anxiety
  3. psychotic disorders
  4. learning disabilities
  5. cognitive impairment
53
Q

True or False - many anti-seizure drugs are teratogenic?

A

True

54
Q

Which anti-seizure drug is implicated as higher risk for pregnancy?

A

Valproate

55
Q

True or False - polytherapy with anti-seizure drugs increases teratogenic risk?

A

True

56
Q

What are 4 other uses for epileptic drugs?

A
  1. bipolar disorder and schizophrenia
  2. migraine prophylaxis
  3. neuropathic pain
  4. restless leg syndrome

Pharmacology 2 (16 decks)

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