Unit 2- Anticonvulsants Flashcards
Anticonvulsants
Reduce frequency of neuron firing to block seizure initiation and propagation
Anticonvulsant Metabolism
Metabolized too quickly in dogs, cats metabolize slowly and poorly
Anticonvulsant MOA
Activate GABA Cl- channels, bind GABA A receptor, inactivate Na+ and Ca++ conductance
Anticonvulsant Adverse Effects
Rapid cessation effect, liver and serum enzyme induction, and hepatotoxicity in dogs
Barbiturate MOA
Phenobarbital, Pentobarbital, Primidone, activate GABA gated Cl- channels
Benzodiazepine MOA
Diazepam, Midazolam, Clonazepam, and Lorazepam GABA A receptor agonists
Hydantoin MOA
Phenytoin targets sodium channels
Valproic Acid MOA
Acts via Cl- channels
Gabapentin MOA
Synthetic GABA analog inhibiting voltage gated Ca++ channels
Levatiracetam MOA
Binds to synaptic vesicle protein 2A
Felbamate MOA
Unknown
Zonisamide MOA
Inhibits Na+ and Ca++ channels
GABA
Major inhibitory neurotransmitter, controls fear and anxiety, inhibits activity of neurons
Phenobarbital
Produces anticonvulsant effect at lower doses than those needed to cause sedation
Phenobarbital Uses
Long term seizure control
Phenobarbital Adverse Effects
Sedation, PU/PD, polyphagia, dogs develop a tolerance to sedative effects
Primidone
Metabolized to phenobarbital in dogs, not for use in cats
Primidone Adverse Effects
Decreased serum albumin, elevated liver enzymes, and serious liver damage
Pentobarbital
Terminates seizures at an anesthetic dose, used for status epilepticus
Status Epilepticus
Seizure lasting longer than 5 mins or more than one seizure within 5 minutes
Pentobarbital Adverse Effects
CNS Depressant, excitement during anesthesia recovery
Benzodiazepine Uses
Anticonvulsants, tolerance is built up quickly in dogs, may be a maintenance anticonvulsant in cats
Diazepam
Used in cats for seizure control, used in dogs for status epilepticus and cluster seizures
Diazepam Adverse Effects
Changes in behavior, cats can develop acute fatal hepatic necrosis
Midazolam
More potent than diazepam, used for status epilepticus, muscle relaxation, tranquilizer, and appetite stimulant, readily crosses BBB
Midazolam Adverse Effects
Mild respiratory depression, vomiting, restless behavior and agitation, local irritation
Clonazepam
Rapid development of drug tolerance
Clonazepam Adverse Effects
Drug resistance, GI disturbance
Lorazepam
Safely used in geriatric dogs and patients with liver disease, short term use in dogs, maintenance use in catss
Lorazepam Adverse Effects
Increased appetite, anxiety
Hydantoins
Impractical in dogs
Valproic Acid
Controls seizures in dogs short term, not evaluated in cats
Valproic Acid Adverse Effects
GI toxicity, hepatic toxicity, sedation, ataxia, behavioral changes, dermatologic effects, hematologic effects, pancreatitis, edema
Potassium Bromide MOA
Enters neurons via Cl- channels to cause hyperpolarization
Potassium Bromide
Takes months to achieve stable plasma combinations, used in combo with barbiturates and benzodiazepines to treat refractory seizures in dogs
Potassium Bromide Adverse Effects
Transient sedation, GI toxicity, PU/PD, polyphagia, lethargy, irritability, aimless walking, pancreatitis, asthma in cats
Gabapentin Adverse Effects
Sedation, ataxia, polyphagia, can cause seizures after rapid discontinuation
Levetiracetam
Used for refractory canine epilepsy
Levetiracetam Adverse Effects
GI disturbance, changes in behavior, drowsiness, may cause seizures after rapid disruption
Felbamate
Used for patients with local and generalized seizure, used in brain tumor or cerebral infarct
Felbamate Adverse Effects
Liver dysfunction, bone marrow depression, generalized tremor, dry eye
Zonisamide
Used for patients with local and generalized seizures, useful in brain tumor or cerebral infarct