Exam 2; Anti-Epileptic Agents Flashcards
Epilepsy is not a disease, but what
a condition; set of symptoms
True or False
epilepsy is generally not life threatening, the quality of life is greatly affected
True
What is an epileptic seizure
abnormal electrical activity originating in the brain; the brain equivalence of a heart arrthymia
What three things can an epileptic seizure result in
brief episodes of loss of consciousness
convulsive movements
disturbances of perception or behavior
What is a secondary cause of seizures
tumor/injury
What is a congenital cause of a seizure
site in the brain
What three different movements of ions can cause abnormal; focal activity in the brain
influx of Na
efflux of K
influx of Ca
Abnormal focal activity in the brain can lead to what
a spread of activity
inhibited by GABAergic neurons
activated by glutamate
This type of seizure lasts about 1-3 minutes
grand-mal (tonic-clonic)
What characterizes a grand mal seizure
severe muscle contraction
tonic; muscle contraction and extension
clonic; muscle twitching
What two things occur during a grand-mal seizure not related to muscle activity
aura; feeling like something is going to happen
loss of consciousness; confusion
These are 5-20 second lapses of consciousness; blank stare
petit-mal
Which group of people is most affected by petit-mal seizures
children
may end after puberty
a child could have hundreds of these a day
This is often the result of an injury of some kine; affects selective regions of the brain; defined by site of origin
partial seizures (40%)
What are the two types of generalized seizures (60%)
grand-mal
petit-mal
A simple partial seizure results in what
no loss of awareness
These partial seizures are in areas of the brain that control body motion
focal motor seizures
What are the two major symptoms of focal motor seizures
complex movements of the head and eyes
“march” starting in the finger and moving more proximally
What was the results of a sensory partial seizures
illusions
visual
auditory
olfactory
What are the results of behavioral partial seizures
laughter
nauseated
fearful
vocal patterns (like Tourette’s)
What two symptoms could be seen post-seizure
may have post-seizure numbness or blindness
A complex partial seizure results in what
loss of awareness
What are three symptoms of complex partial seizures
starting followed by bizarre behaviors
alteration in feeling or behavior
associated with amnesia and confusion
This is a medical emergency; when someone has long and repeated grand mal seizures
status epilepticus
When someone undergoes status epileptics, what is occurring in their muscles
every muscle in their body is constricted
need to get oxygenated blood and therefor they die of cerebral asphyxiation
All anti-seizure medications decrease what
neuronal firing rate
anti-seizure medications may cause an increase in what
suicidal behavior
anti-seizure agents may act on these three locations
GABA neurons
glutamate neurons
ion channels
This drug inhibits Na channels in the brain, slowing the recovery rate of neurons
phenytoin
What is the therapeutic index of phenytoin
it is relatively low; will see toxic effects
Phenytoin is generally not what
a CNS depressant
can cause some sedation
What three things can result from high doses of phenytoin
respiratory depression
cardiovascular collapse
may cause nausea and ataxia
What two things can result from chronic use of phenytoin
gingival hyperplasia
vestibular effects; diplopia, ataxia, blurred vision
What are two major toxicities of phenytoin
teratogenic (fetal hydantoin syndrome)
life-threatening rash (Steven-Johnson syndrome)
This is the drug of choice for partial seizures, acts on Na channels; induces P450
carbamazepine
What are some symptoms of carbamazepine toxicity
blurred vision diplopia drowsiness fetal defect (spina bifida) aplastic anemia
This is for all but petit mal, activates GABAergic neurons and induces P450
phenobarbital
What are two toxicities of phenobarbital
sedation
drowsiness
These drugs activate GABAergic neurons
benzodiazepines; diazepam
This is a diuretic; carbonic anhydrase inhibitor which may increase CO2 in the brain leading to decreased activity
acetazolamide
These are the DRUGS OF CHOICE to treat petit mal
succinimides, ethosuximide
What is the mechanism of succinimides; ethosuximide
inhibits Ca channels in the CNS, slowing down neurotransmitters
What are two side effects of succinimides
GI upset; nausea and vomiting
drowsiness
This drug is used for all seizure types, it has multiple mechanisms
sodium valproate
what are three mechanisms of sodium valproate
decreases GABA breakdown
increases GABA synthesis
may also act on Na and Ca channels
What are 5 toxicities of sodium valproate
GI upset CNS sedation tremors potentially fatal hepatitis perhaps fetal damage; drop in IQ
These four agents to treat partial seizures activate GABA
topriamite
gabapentin
tigabine
vigabine
These four agents to treat partial seizures act on Na
lamotrigine
zonisamie
rufinamide
lacosamide
This agent to treat partial seizures acts on Ca
pregabalin
This agent to treat partial seizures acts on K
ezogabine
This agent to treat partial seizures blocks glutamate activity
perampanel
This agent to treat partial seizures has an unknown mechanism
levetiracetam
This is a high therapeutic benzodiazepine used to status epileptics; it suppresses neuronal activity without killing the patient
Diazepine
What are four special considerations in the treatment of epileptic seizures
patient must be educated
patient must be always monitored
drugs taken for a long time
mixed type of seizures
