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MODULE 8 - Neurology > PHARMACLOGY - Antiepileptic Drugs > Flashcards

PHARMACLOGY - Antiepileptic Drugs Flashcards

1
Q

What are epileptic seizures?

A

Epileptic seizures are a disturbance of the neuronal environment which lowers the threshold for the firing of action potentials, leading to excessive electrical activity within the cerebral cortex

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2
Q

What are the two main causes of epileptic seizures?

A

Decreased neuronal inhibition
Increased neuronal excitation

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3
Q

What is the main inhibitory neurotransmitter in the central nervous system?

A

GABA

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4
Q

What is the main excitatory neurotransmitter in the central nervous system?

A

Glutamate

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5
Q

What are the two possible mechanisms of natural seizure termination?

A

Input from subcortical areas
Development of lactic acidosis

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6
Q

What are the eight main anti-epileptic drugs used in veterinary medicine?

A

Phenobarbital
Potassium bromide
Pexion
Levetiracetam
Zonisamide
Gabapentin
Diazepam
Midazolam

Leve-tri-cetam

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7
Q

Which classification of drugs does phenobarbital belong to?

A

Barbituates

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8
Q

Which classification of drugs do diazepam and midzolam belong to?

A

Benzodiazepines

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9
Q

Which three anti-epileptic drugs are licensed in dogs?

A

Phenobarbital
Potassium bromide
Pexion

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10
Q

Which anti-epileptic drugs are licensed in cats?

A

None of the anti-epileptic drugs are licensed in cats

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11
Q

Describe briefly how you should manage epileptic seizures

A

Address any underlying causes of the epileptic seizures along with symptomatic control of the seizures with antiepileptic drugs

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12
Q

What are the four main purposes of chronic therapy for epileptic seizures?

A

Reduce frequency, severity and duration of seizures
Delay progression of seizures
Minimise post-ictal effects of seizures
Minimise the demand on owners

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13
Q

Which anti-epileptic drugs could be used initially for chronic therapy in dogs?

A

Phenobarbital
Pexion

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14
Q

Which anti-epileptic drug should be used if a dog is refractory to phenobarbital or pexion?

A

Phenobarbital combined with potassium bromide

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15
Q

Which anti-epileptic drugs could be used initially for chronic therapy in cats?

A

Phenobarbital
Levetiracetam
Diazepam

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16
Q

What is the therapeutic range of anti-epileptic drugs?

A

Therapeutic range is the serum concentration of the drug which provides optimal epileptic seizure control whilst minimising side effects

17
Q

What is serum steady state?

A

Steady state occurs when the amount of a drug being absorbed is the same amount that’s being cleared from the body

18
Q

How many half lives are reached before a drug can reach steady state?

A

Five half lives

19
Q

What is the purpose of a loading dose of anti-epileptic drugs?

A

A loading dose would bring the serum concentrations of the anti-epileptic drug up to steady state quicker however is only used in emergencies due to the side affects associated with such a high dose

20
Q

What is the mechanism of action for phenobarbital?

A

Potentiates the inhibitory action of GABA neurotransmitters

21
Q

What are the five initial side affects of phenobarbital?

A

Polyuria
Polydipsia
Polyphagia
Sedation
Ataxia

22
Q

What are the four side affects associated with long-term administration of phenobarbital?

A

Hepatic toxicity
Reduction is serum albumin
Increased thyroid hormone metabolism
Induction of hepatic p450 enzymes

23
Q

How does the induction of hepatic p450 enzymes affect phenobarbital metabolism?

A

The induction of hepatic p450 enzymes speeds up the metabolism of phenobarbital

24
Q

What can be done to reduce the risk of hepatic toxicity associated with long-term administration of phenobarbital?

A

Maintain the serum concentrations of phenobarbital within the therapeutic range

25
Q

How often should you measure serum concentrations in patients on long term phenobarbital administration?

A

Every six months

26
Q

How often should you monitor hepatic function in patients on long term phenobarbital administration?

A

Every six to twelve months

27
Q

What is the best way to monitor hepatic function in patients on long term phenobarbital administration?

A

Bile acid assay

28
Q

What is the mechanism of action for potassium bromide?

A

Bromide will influx cells via GABA receptors in preference to chloride, potentiating the inhibitory effect of GABA neurotransmitters

29
Q

What are the two initial side effects of potassium bromide?

A

Vomiting
Anorexia

30
Q

Why should you never administer potassium bromide to cats?

A

Potassium bromide can cause fatal pneumonia in cats

31
Q

What are the four side affects associated with long-term administration of potassium bromide?

A

Sedation
Ataxia
Pancreatitis
Pruritis (itching)

32
Q

(T/F) Pexion serum concentrations do not need to be monitored

A

TRUE.

33
Q

What is the main purpose of emergency management of epileptic seizures?

A

Abolish the acute seizure activity

34
Q

What are the two indicators for emergency management of epileptic seizures?

A

Cluster seizures
Status epilepticus

35
Q

What are cluster seizures?

A

Cluster seizures are two or more seizures which occur within 24 hours

36
Q

What is status epilepticus?

A

Status epilepticus is a prolonged seizure which lasts over five minutes

37
Q

What are the three suitable anti-epileptic drugs for emergency treatment?

A

Diazepam
Midazolam
Levetiracetam

38
Q

Why can diazepam also be used for chronic therapy for epileptic seizures in cats?

A

Diazepam has a longer half life in cats

39
Q

What is the course of action if a status epilepticus seizure doesn’t terminate after emergency drug administration?

A

Patient should be put under sedation or general anaesthesia

MODULE 8 - Neurology (27 decks)

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