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32 Cards in this Set
- Front
- Back
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What is epilepsy
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A CHRONIC recurrence of seizures w/intracerebral origin
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Who gets epilepsy?
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Curve is bimodal, more in neonates and elderly, 8th decade=highest risk; 2/3 of cases are genetic
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Non-epileptic seizure
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can be psychogenic or physiologic and the underlying cause must be treated!
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Simple partial seizure
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patient is conscious
Discharges don't spread through the brain |
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Complex partial seizure
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Most common site: medial temporal lobe (including hippocampus)
Patient has impaired consciousness with automatisms, staring, and autism. Partial seizures can secondarily generalize to become full-blown generalized seizures b/c of trauma, stroke, tumor, infection.... |
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Generalized seizures
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Absence (maintain posture, no post-ictal confusion); Myoclonic (usually worse in the AM); Tonic (Hypertone, stiff, "cry"); Clonic (Twitching, convulsions); Tonic-Clonic ("Grand Mal"); Atonic (suddenly flop over). Note in generalized that seizure activity is seen all over the brain; recall thalamus & brainstem=pacemaker for brain.
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Newer drugs
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Felbamate, Lamotrigine, Topiramate, Levetiracetam, Zonisamide
This "Newer" group of drugs does not affect CYP450 so are safer for patients taking oral contraceptives, statins (lipitor), warfarin/coumadin. They rely on kidney elimination; are safer for hepatic problems! Newer group has less idiosyncratic reactions as well. |
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Older drugs
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Benzodiazapines, Carbamazepine, Phenytoin, Valproate, Ethosuximide
These older drugs rely on hepatic elimination, so are better for kidney patients. Because they rely on liver though, they have many more drug interactions (OCP, statins, warfarin…). They also have more side effects. |
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Adverse Events:
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Stevens-Johnson's skin rash (also seen as a side effect to NSAIDS/sulfa/antibiotics).
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Why use Phenytoin (Dilantin)
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simple or complex partial, or generalized tonic-clonic
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Action of Phenytoin
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Na+ channel blockade
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PK of Phenytoin
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ZERO order kinetics (NON LINEAR); very high protein binding
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Drug interactions with Phenytoin
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other drugs w/significant protein binding
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What seizures is phenytoin not for
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phenytoin is NOT for absence, myoclonic, tonic/atonic, or infantile spasms
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Why use Carbamazapine (Tegretol)
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simple or complex partial, or generalized tonic-clonic, FIRST line for partial
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Drug action of Carbamazapine (Tegretol)
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Na+ channel blockade
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PK of Carbamazapine (Tegretol)
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autoinduction of metabolism occurs, t 1/2 reduced drastically, do level at 4 weeks!
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Adverse reactions to Carbamazapine (Tegretol)
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weight gain
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What times of seizures is Carbamazapine (Tegretol) not for
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carbamazapine is NOT for absence, myoclonic, tonic/atonic, or infantile spasms
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Why use Valproate
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any type of seizure; FIRST line for generalized, childhood absence
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Drug action of Valproate
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Na+ channel blockade "broad spectrum" AED
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Comparison of Valproate
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giving valproate for absence seizures also protects if the seizures develop into tonic-clonic
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PK of Valproate
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very high protein binding
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Contraindications for Valproate
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teratogenicity, not for use in FEMALES mainly
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Adverse effects of Valproate
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weight gain
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Drug interactions with Valproate
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other drugs w/significant protein binding
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Why use Ethosuximide
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only indicated in childhood absence seizures
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Drug action of Ethosuximide
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Ca++ channel blockade
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Why use Lamotrigine (Lamictal)
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FIRST LINE for partial or generalized
lamotrigine would be chosen over valproate in generalized seizures in females |
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Drug action of Lamotrigine (Lamictal)
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Ca++ channel blockade, newer generation broad spectrum AED
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Why use Topiramate (Topamax)
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any type of seizure
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Drug action of Topiramate (Topamax)
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Glutamate R, newer generation broad spectrum AED
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