Seizure and Dementia Drugs

Question 1

Do you remember Reisert’s slide about not panicking when someone is having a seizure?

Answer 1

It’s true. Panicking doesn’t help anything. Be the one who doesn’t panic. I know you can - I believe in you.

Question 2

Name the seizure drugs (7)

Answer 2

1. Lamotrigine
2. Carbamazepine
3. Phenytoin
4. Ethosuximide
5. Topiramate
6. Valproic acid
7. Lorazepam…which is also an anxiolytic and retrograde amnesia meds.

Question 3

Lamotrigine: MOA

Answer 3

Blocks sustained, repetitive neuron firing; inhibits Na+ channels and probably Ca++ channels

Question 4

Lamotrigine: indication

Answer 4

Mono- or add-on therapy for partial and generlaized seizures

Question 5

Lamotrigine: Side effects

Answer 5

SJS, osteoporosis

Question 6

What supplement do you prescribe for your Pt on Lamotrigine?

Answer 6

Folic acid

Question 7

Carbamazepine: MOA

Answer 7

Decreases synaptic glutamate; inhibits Na+ channels

Question 8

Carbamazepine: indication

Answer 8

Partial or generalized T-C seizures

Question 9

Carbamazepine: side effect

Answer 9

osteoporosis

Question 10

What sort of Dx-Dx interactions do you see with Carbamazepine?

Answer 10

Too many to count (CYP450)

Question 11

Phenytoin: MOA

Answer 11

Limits repetitive firing of neurons; inhibits Na+ channels

Question 12

Phenytoin: indication

Answer 12

Partial and generalized T-C seizures

Question 13

Phenytoin: side effect

Answer 13

Gingval hyperplasia

Question 14

Phenytoin: referral

Answer 14

The dentist for close monitoring

Question 15

Ethosuximide: MOA

Answer 15

Reduces low threshold Ca++ currents

Question 16

Ethosuximide: indication

Answer 16

Petit mal seizures in kids

Question 17

Ethosuximide: side effects

Answer 17

Hiccups, SLE

Question 18

Topiramate: MOA

Answer 18

Reduced Na+ currents
Enhances GABA receptors
Inhibits glutamate receptors

Question 19

Topiramate: indication

Answer 19

General T-C, partial, petit mal seizures; migraines

Question 20

Topiramate: side effect

Answer 20

Metabolic acidosis

Question 21

Valproic acid: MOA

Answer 21

Increase pre and post synaptic [GABA]

Question 22

Valproic acid: indication

Answer 22

Generalized T-C seizures, mania, mood stabilization; migraine Px

Question 23

Valproic acid: side effect

Answer 23

Hepatotoxicity

Question 24

Max daily dose of Valproic acid?

Answer 24

250mg - in divided doses

Question 25

Lorazepam: class

Answer 25

Benzodiazapine

Question 26

Are benzos your friend in a seizure?

Answer 26

Oh yes.

Question 27

Lorazepam: MOA

Answer 27

Potentiates GABA receptors

Question 28

Lorazepam: indications

Answer 28

Anxiety, operative amnesia, status epilepticus

Question 29

Lorazepam: side effect

Answer 29

Resp depression…that’s why we invented bag valve masks

Question 30

Dementia Drugs (2)

Answer 30

1. Aricept

2. Namenda

Question 31

Aricept: class

Answer 31

Acetylcholinesterase inhibitor

Question 32

Aricept: MOA

Answer 32

Inhibits AchE activity, thereby increasing Ach in the hippocampus

Question 33

Aricept: indication

Answer 33

Mild to moderate dementia

Question 34

Aricept: side effect

Answer 34

Cholinergic crisis

Question 35

Namenda: class

Answer 35

NMDA receptor antagonist

Question 36

Namenda: MOA

Answer 36

Blocks NMDA receptor preventing Ca++ influx

Question 37

Namenda: indication

Answer 37

Moderate to severe dementia

Question 38

With what can you co-administer Namenda?

Answer 38

Aricept