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Test 2- Anti seizure Flashcards

1
Q

What is the etiology of epilepsy?

A

disturbed regulation of electrical activity in the brain resulting in synchronized and excessive neuronal discharge

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2
Q

How do we define status epilepticus?

A

Technically a seizure lasting more than five minutes

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3
Q

What is the postictal period?

A

Transition from the ictal state back to pre seizure baseline level of awareness and function

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4
Q

What is photosensitive epilepsy?

A

Visual stimuli that results in seizures

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5
Q

What is gravet syndrome?

A

Genetic mutation in sodium channels

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6
Q

What is neurocysticerosis?

A

Epilepsy as an infectious sequelae

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7
Q

What is the main difference in focal and generalized seizures?

A

Focal- involves usually one portion of the brain

Generalized- Both hemispheres of the brain involved

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8
Q

What can a focal progress to?

A

Secondarily generalized seizure

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9
Q

What are the different types of generalized seizures?

A

Absence, clonic, myoclonic, tonic, atonic seizure

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10
Q

Why is it important to know the type of seizure occuring?

A

Incorrect selection can worsen or elicite seizures

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11
Q

What are the three goals of therapy for seizure related pharmacology?

A

Termination of seizure, maintenance, and avoiding adverse drug effects

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12
Q

What is the MOA of sodium channel blockers?

A

Prevent AP’s from occurring by binding to the sodium channel when it’s inactivated

AP’s prevented, not allowing signal to travel down and cause release of NT’s via calcium

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13
Q

What is the use of carbamazepine (tegretol)?

A

Focal seizures

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14
Q

What is the adverse effects of carbamazepine?

A

Hyponatremia, dipolopia, dizziness, and ataxia, SJS

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15
Q

What is important to know about tegretols metabolism?

A

Autoinduces its own metabolism through upregulation of CYP3A4

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16
Q

What are the important ddi for carbamazepine?

A

Oral contraceptives, and many others

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17
Q

What is Oxcarbazepines MOA? (Trileptal)

A

Enhances fast inactivation of na channel, aka, sodium blocker

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18
Q

What is Trileptals ADE’s?

A

Similar to carbamazepine, hyponatremia more likely

dipolopia, dizziness, and ataxia, SJS

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19
Q

What is the anti seizure activity attributed to in Oxacarbazepine?

A

It’s metabolite, S-licarbazepine

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20
Q

How does Oxcarbazepine relate to carbamazepine?

A

Ox is a derivative of carb

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21
Q

Whats the benefit of Oxcarbazepine to Tegretol?

A

Ox DOES NOT autoinduce, less hepatic enzyme induction overall

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22
Q

What seizures are Lacosamide (vimpat) used for?

A

Focal

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23
Q

What are the adverse effects of Lacosamide (Vimpat)?

A

Dizziness, HA, Nausea, diplopia, can also cause QT prolongation

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24
Q

Why are DDI with Lacosamide (Vimpat) minimal?

A

It does no induce/inhibit CYP 450

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25
Q

What is now known about Lacosamide (Vimpat) MOA at the sodium channel?

A

It is a Na inactivator with SLOW binding

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26
Q

What is Lacosamides (Vimpat) BBW?

A

Suicidality

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27
Q

What is Phenytoid and Oxcarbazepines exact actions as a sodium channel blocker? Also, Lamotrigene (Lamictal)

A

Enhances fast inactivation of voltage gated sodium channels

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28
Q

What is phenytoin used for?

A

Focal, generalized, status epilepticus

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29
Q

What is phenytoins (Dilantin) ADE’s

A

Nystagmus, gingival hyperplasia, hirsutism, peripheral neuropathy, osteomalacia, diplopia, ataxia, SJS,

IV use is also associated with purple glove syndrome

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30
Q

What is phenytoin metabolized by?

A

CYP 450 inducer
Highly protein bound

But it varies on formulation. Metabolized by 2C9, 2C19 to inactive metabolites

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31
Q

What is the unique aspect of phenytoins metabolic considerations?

A

Saturation of metabolic enzymes results in zero order (NONLINEAR) kinetics

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32
Q

What is Lamotrigine (Lamictal) used for?

A

Focal, generalized, and absence seizures

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33
Q

What is Lamotrigine (Lamictal) ADE?

A

SJS, paradoxical insomnia, dizziness, HA, Diplopia, nausea, somnolence

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34
Q

What is lamotrigine (Lamical) metabolization through?

A

Glucuronidation

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35
Q

Which medication is preferred for absence seizures?

A

Valproate/ethosuximide

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36
Q

What medication is preferred for absence seizures in women that are of childbearing age?

A

Lamotrigene (Lamictal)

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37
Q

What is the only calcium channel blocker listed in this ppt?

A

Ethosuximide

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38
Q

How does ethosuximide specifically work?

A

Blockage of calcium channel, specifically T-type in the thalamus

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39
Q

What drug is considered a first line treatment for absence seizures?

A

Ethosuximide, which is the only thing it can treat

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40
Q

What is ethosuximdes ADE’s?

A

GI upset, fatigue, HA, dizziness, hiccup, euphoria

HICCUP
Also, some beneficial behavior changes possible?

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41
Q

How is ethosuximide metabolized?

42
Q

What is the only potassium channel opener listed?

43
Q

What is ezogabine used for?

A

Third line drug or focal seizures, but it’s no longer used in the US

44
Q

Why was ezogabine D/C in the US?

A

Major vision side effects

45
Q

What is the MOA of phenobarbital?

A

GABA a agonist, causes hyperpolarization through increased duration channel opening

46
Q

What is the use of phenobarbital? What can it also be technically used for as well?

A

Focal and generalized seizures

Also myoclonic, but must be careful because it can worsen absence and infantile

47
Q

What is important to know about phenobarbitals metabolism?

A

Metabolized by 2C19, Induces CYP enzymes

48
Q

What drug is Primidone similar to?

A

Phenobarbital

49
Q

What is primidone used for?

A

Focal and generalized

Also, essential tremor (Tremor during movement)

50
Q

What is primidones ADE’s?

A

Sedation, GI upset

51
Q

What is primidone metabolized to?

A

Phenobarbital and PEMA

52
Q

What is benzos MA?

A

GABA allosteruc agonist, increases the frequency of channel openings

53
Q

What is benzos used for in the seizure world?

A

Status epilepticus, cluster seizures

54
Q

Which benzo can be given rectally?

55
Q

Which benzo is approved for Lennoz Gastaut?

56
Q

What is Vigabatrin (Sabril, vigadrone) MOA?

A

Irreversible GABA transaminase (GABA-T )inhibitor

57
Q

What is vigabatrin used for?

A

Focal seizures

58
Q

What is vigabatrins ADE’s?

A

Irreversible retinal dysfunction, somnolences, HA, dizziness, weight gain, psychiatric issues

IRREVERSIBLE RETINAL DYSFUNCTION

59
Q

What is one broad category of diseases that would be containdicated with vigabatrin?

A

Psychiatric issues

60
Q

What is Tiagabine (Gabitril) MOA?

A

Inhibits GAT-1 GABA transporter, preventing the reuptake of GABA

61
Q

What is Tiagabine used for?

A

Focal seizures

62
Q

What is tiagabines ADE’s?

A

Nervousness, dizziness, tremor, difficulty concentrating, depression, confusion, ataxia

63
Q

What is tigabine contraindicated in?

A

Generalized seizures

64
Q

What is Tiagabine (gabitril) formulated with? why?

A

Lipohpilic tag to cross the BBB

65
Q

What is bromides for?

A

Epilepsy in dogs

66
Q

What is bromism?

A

Mental slowing, almost like a severe CNS depression

67
Q 
What is levetitacetam (Keppra) MOA?
Also Brivaracetam (Briviact)
A

Binds SV2A to modify release of NT’s

Note-SV2A is an integral membrance protein that promotes vesicles exocytosis

68
Q

How is Keppra metabolized?

A

In the blood, NO CYP INVOLVEMENT

69
Q

What is keppras ADEs?

A

Minimal, somnolence, asthenia, ataxia, and dizziness

70
Q

What is brivaracetam (Briviact) used for?

A

Focal, but perhaps generalized as well

71
Q

Should we use brivaracetam and keppra together?

A

Nah, no benefits to doing that

72
Q

What is Gabapentin (Neurontin) MOA?

A

Binds to subunit of a2 delta voltage dependent calcium channel

73
Q

What is gabapentin used for?

A

Add on therapy for focal seizures

74
Q

What is gabapentins ADEs?

A

Sedation, ataxia, weight gain

75
Q

What is gabapentin metabolized by?

A

No clue, but not the CYP system

76
Q

What is the sister drug of gabapentin?

A

Pregabalin (lyrica)

77
Q

What is the MOA of Perampanel (Fycompa)

A

Allosteric, noncopetitve AMPA receptor antagonist

PREVENTS CORTICAL SPREAS

78
Q

What is Perampanel (Fycompa) used for?

79
Q

What is Perampanel (Fycompa) ADEs?

A

Behavioral changes

dizziness, somnolence, HA

80
Q

How is Perampanel metabolized?

81
Q

What is valproate (Depakote) used for?

A

VERY VERSATILE
Focal, generalized, absence
Also bipolar and migraines

82
Q

What is valproates ADEs?

A

Tremor, weight gain, hair loss, hepatotoxic

Fat, yellow, and bald lol

83
Q

What is important to know about valporates metabolism?

A

Its highly protein bound, which effects the metabolism of many other drugs

84
Q

What is Dicalproex a combination of?

A

Valproic acid an sodium valproate

85
Q

What is valporates effects on newborns?

A

Teratogenic, category x

86
Q

What is felbamates (felbatol) MOA?

A

Blocks NMDA receptors, barbituate like potentiation of GABA a receptors

87
Q

What are the used for Felbamate (felbatol)?

A

Focal, Lennox-Gastaut

88
Q

What is Felbamates ADE’s?

A

Improved alertness, aplastic anemia, severe hepatitis

89
Q

How is felbamate metabolised?

A

3A4 an 2E1

90
Q

What is Topiramate (Topamax) used for?

A

Focal, generalized, Lennox-Gastuat, migraines

91
Q

What is topiramate ADEs?

A

Cognitive effects, parathesias, weight loss

92
Q

What is topitamate a weak inhibitor of?

A

Carbonic anhydrase, which can lead to metabolic acidosis

93
Q

What is Zonisamide (Zonegran) MOA?

A

Blocks voltage gated na channels, but likely more actions

94
Q

What is Zonisamide used for?

A

Focal, generalized

95
Q

What are the ADE’s for Zonisamide?

A

Drowsiness, cognitive impairment, renal stones, skin rashes, weight gain

96
Q

How is zonidamide metabolized?

97
Q

What does Zonidamide (Zonegran) contain?

A

Sulfur, which can elicit a sulfa allergy reaction

98
Q

What is Ruinamide (Banzel) used for?

A

Lennox-Gastaut, focal

99
Q

What is Rufinamides ADE’s?

A

HA, dizziness, somnolence, fatigue, nausea

100
Q

VOLT Cant Get Peanut Butter

A 
Vigabatrin
Oxcarmazepine
Lacosamide
Tiagabine
Carbamazepine
Gabapentin
Perampanel
Brivarecetam

Just Focal

101
Q

P3 LKZ

A 
Focal and Gernalized
Phenobarbital
Primidone
Phenytoin
Lamictal
Keppra
Zonisamide
102
Q

Forget The Refs

A

Felbremate
Topiramate
Rutinamide

Pharm 3 (6 decks)

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