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Pharm 2024 > Seizures > Flashcards

Seizures Flashcards

Exam 3

1
Q

Causes of seizures (6)

A
  • Infection
  • Neoplasm
  • Head injury
  • Heredity
  • Toxic effects
  • Metabolic disorder
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2
Q

Principle MOA of anti-seizure meds involve ________ and _______

A

voltage-operated ion channels and excitatory synaptic function

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3
Q

What are the 3 main MOA of AEDs?

A
  1. Modification of ion conductance - Na+, K+, Ca++
  2. Enhancing inhibition - GABA
  3. Inhibiting excitation - Glutamate
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4
Q

What are the 3 types of focal onset seizures?

A
  1. Focal aware - simple partial
  2. Focal impaired awareness - complex partial
  3. Focal to bilateral tonic-clonic - partial seizure secondarily generalized
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5
Q

What are the 5 types of generalized onset seizures?

A
  1. Generalized tonic-clonic (grand mal)
  2. Generalized absence (petite mal)
  3. Myoclonic
  4. Atonic/clonic (drop attack)
  5. Infantile spasms (West’s syndrome)
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6
Q

What are automatisms seen in complex focal seizures?

A
  • Lip smacking
  • Swallowing
  • Fumbling
  • Scratching
  • Walking about
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7
Q

Focal seizures secondarily generalized look like _______ seizures

A

tonic clonic

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8
Q

Differentiate between focal and generalized seizures

A

Focal - begin in specific area of brain
Generalized - begin over entire surface of brain

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9
Q

Generalized tonic-clonic automatisms

A
  • starts with aura
  • Person falls to ground
  • Entire body stiffens
  • Muscles jerk or spasm
  • Tongue or cheek may be bitten
  • Urinary incontinence
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10
Q

Seizures where muscles suddenly contract and stiffen

A

tonic

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11
Q

Seizures where there is a sudden loss of muscle tone

A

atonic

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12
Q

Seizures that make the body jerk like it is being shocked

A

Clonic and myoclonic seizure

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13
Q

What age do infantile spasms begin?

A

Usually begins before age of 6 months

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14
Q

Phenytoin MOA

A

all - mainly Na+, gaba, and glutamate receptors

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15
Q

What is the more soluble prodrug of phenytoin that can be administered IV?

A

Fosphenytoin

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16
Q

What type of seizures is phenytoin used to treat?

A

Partial and tonic-clonic seizures

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17
Q

Which drugs compete with phenytoin for albumin binding sites?

A

Carbamazepine, sulfonamides, valporic acid

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18
Q

Which drug can displace phenytoin from albumin binding sites?

A

valporic acid

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19
Q

Differentiate between therapeutic, free, toxic, and lethal levels of phenytoin

A
  • Therapeutic: 10-20 mcg/ml
  • Free phenytoin: 1-2.5 mcg/ml
  • Toxic: 30-50 mcg/ml
  • Lethal: >100 mcg/ml
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20
Q

What is the T1/2 of phenytoin?

A

12-36 hours

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21
Q

What are the toxic effects of phenytoin?

A
  • Nystagmus
  • Loss of extraocular pursuit of movement
  • Diplopia
  • Ataxia
  • Sedation
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22
Q

What are the toxic effects of phenytoin with chronic use?

A
  • Gingival hyperplasia
  • Hirsuitism
  • Coarsening of facial features
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23
Q

Carbamazepine (Tegretol) MOA

A

Blocks Na+ channels

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24
Q

What kind of antidepressant is carbamazepine?

A

TCA

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25
Q

What is the clinical use for carbamazepine?

A
  • Drug of choice for focal seizure
  • Can be used with phenytoin
  • Effective in trigeminal neuralgia
  • Also useful for bipolar disorder
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26
Q

What is the drug of choice for a focal seizue?

A

Carbamazepine (Tegretol)

27
Q

When does Carbamazepine (Tegretol) peak?

A

6-8 hours

28
Q

Carbamazepine (Tegretol) is ___% bound to plasma proteins

A

70%

29
Q

What is the T1/2 of Carbamazepine (Tegretol)?

A

T1/2 after one dose = 36 hours

T1/2 during continuous therapy = 20 hours

30
Q

______ is an autoinducer of hepatic enzymes (P450) used to treat seizures

A

Carbamazepine (Tegretol)

31
Q

What are the drug interactions for Carbamazepine (Tegretol)?

A
  • Phenytoin
  • Phenobarbital
  • Ethosuxemide
  • Valproic acid
  • Clonazepam
32
Q

What are the clinical uses for Lacosamide (Vimpat)?

A

focal seizures

33
Q

What is the MOA of Lacosamide (Vimpat)?

A

Blocks sodium channels

34
Q

What are the toxic effects of Lacosamide (Vimpat)?

A
  • Dizziness, nausea, HA, diplopia
  • Minimal drug interactions
35
Q

The oldest and safest AED available is _____

A

phenobarbital

36
Q

What is the MOA of Phenobarbital?

A

Unknown - Enhances inhibitory transmission (+ GABA), decreases excitatory transmission, may suppress abnormal neurons

37
Q

What is the AED drug of choice for infants?

A

Phenobarbital

38
Q

What are the clinical uses of Phenobarbital?

A
  • Focal seizures
  • Generalized tonic-clonic seizures
  • Tried in virtually every seizure type
39
Q

What seizure types can be made worse by phenobarbital?

A

Generalized seizures: absence, atonic attacks, or infantile spasms

40
Q

What is the #1 toxic effect of phenobarbital?

A

SEDATION

41
Q

What are symptoms of overdose of phenobarbital?

A
  • unsteady gait
  • slurred speech
  • confusion
  • respiratory depression
  • coma
42
Q

What type of seizures is Lacosamide used as an adjunct?

A

Focal seizure

43
Q

What is the MOA of Lamotrigine? What kind of seizures can it treat?

A

MOA –ion channel; partial & absence

44
Q

How can GABA analogs be used to treat seizures? What is an example?

A

adjunct, partial, neuralgia
(Vigabatrin)

45
Q

What are the main 4 drugs used to treat focal and generalized tonic-clonic seizures?

A

Phenytoin
Carbamazepine
Lacosamide
Phenobarbital

46
Q

How are infantile spasms treated?

A

palliative, steroids, Vigabatrin (GABA analog)

47
Q

What are the 2 main drugs used to treat generalized seizures (not tonic-clonic)?

A

Ethosuzimide and Valproic acid

48
Q

What is the drug of choice for absence seizures?

A

Ethosuximide

49
Q

What is the MOA of Ethosuximide?

A

Calcium channel inhibition

50
Q

What are the toxic effects of Ethosuximide?

A

Gastric distress (pain, N/V) and lethargy

51
Q

What is the MOA of valproic acid?

A

Unknown, hypotheses: All
- Blocks sustained high frequency firing
- Effects on Na+ currents
- Increase GABA
- Increase membrane K+ conductance (high levels)

52
Q

What is known as the “Broad spectrum AED”?

A

Valproic acid

53
Q

What are the clinical uses of valproic acid?

A
  • Absence seizures
  • Some types of myoclonic seizures
  • Generalized tonic-clonic
  • Bipolar disorder
  • Migraine prophylaxis
54
Q

What are the Valproic acid toxic effects?

A
  • GI
  • N/V
  • Pain
  • Heartburn
55
Q

What is the MOA of benzodiazepines?

A

Increased GABA – depresses all levels of the CNA

56
Q

Diazepam (Valium) pharmacokinetics

A

Long T1/2 (20-100 H), short duration (30 min.)

57
Q

What is the clinical use of benzodiazepines in seizure treatment?

A

Status epilepticus and absence

58
Q

What are the 4 options for seizure treatment?

A

– Antiepileptic drugs
– Surgery
– Vagus nerve stimulation
– Ketogenic diet (children)

59
Q

What is the most common form of status epilepticus seizures?

A

generalized tonic-clonic

60
Q

What is the treatment for status epilepticus?

A

Sedation – IV (diazepam, fosphenytoin, phenobarb)

61
Q

What are the drugs to avoid perioperatively that can stimulate seizure activity?

A

Methohexital, sevoflurane, meperidine (Demerol)

62
Q

The only narcotic that stimulates seizure activity is ______

A

meperidine (Demerol)

63
Q

What are the effects of phenytoin use on NMB?

A

Chronic phenytoin therapy makes patient resistant to neuromuscular blocking agents
Phenytoin can enhance NMB (acute)

Pharm 2024 (28 decks)

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