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23 Cards in this Set

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What drugs would be used to treat simple partial seizures?
1. phenytoin, carbamezaepine and valproate
2. Gabapentin, Lamotrigine and topiramate newer drugs
How are absence seizures primarily treated?
1. Ethosuximide first line followed by valproate or lamotrigine
What are the two universal anticonvulsant medications?
Valproate & Lamotrigine are two newer broad spectrum anticonvulsants.
How are transmitters GABA and glutamate alike?
1. classical neurotransmission
2. Taken up by astrocytes
How are barbituates and benzodiazipines similar?
They both facilitate presynaptic inhibition via the GABA ionotropic channel
How does Valproic acid work? Gabapentin? Tigabine?
1. VA- universal AED works by altering the synthesis and breakdown of GABA
2. Gabapentin-enhances synthesis and release of GABA
3. Tigabine- blocks uptake of GABA
What diagnostic tests are essential before iniation of anticonvulsant drugs?
1. CBC and liver enzyme test
2. EEG
In general what types of drugs therapy is indicated for seizure?
1. Monodrug therapy- side effects of mltpl drugs are synergistic
What drug is most effective for tonic clonic seizures?
Phenytoin. It is also effective in partial seizures.
Discuss pharmacokinetics of phenytoin.
1. 90% is plasma protein bound.
2. Induces liver enzymes
3. Can lead to cognitive functions in hair, excessive gum growth and hirsuitism
Characterize carbamepazine.
1. Used for treatment of tonic-clonic seizures
2. low compliance because needs to be give 3-4x daily
3. Same family as tricyclics so treats depression.
4. Depress WBC...can lead to aplastic anemia
5. Teratogenic. Can cause spina bifida
What is the clinical utilizaton of phenobarbitol?
1. Tonic clonic seizures and simple partial.
2. Long half-life so its cheap take 1/day
3. Induces liver enzymes
Discuss the clincial utilization of primidone.
1. Partial seizures
2. tonic clonic
3. Metabolized to phenobarbitol and PEMA...dont combine with phenobarbitol due to heavy sedative effect.
In what clincial situation is valproic acid typically used?
When nothing else works.
What are some draw backs associated with the utilization of valproic acid?
1. interferes with action of other drugs, increases phenorbarbitol 40%
2. 20X chance of spina bifida (twice that of carbamepazine)
What drug is used for complex partial seizures? What are some of its advantages.
Gabapentin Neurontin). Not metabolized in the liver can be used with liver dz, and not bound to plasma proteins.
Discuss the clinical utility of topiramate.
1. Utilized for partial seizures and tonic-clonic seizures.
2. Excreted renally
3. Sideefkt of kidney stones
Why should women in particular be cautious while using anti-convulsant drugs.
1. Decrease the effectiveness of oral contraceptives
2. causes decrease of bone density
3. Carbamepazine and valproate are teratogens that induce spina bifida
4. ehtosuximide has zero protein binding and will pass directly into breast milk...valproate is highly bound and will not
What supplementary medications should women take when using valproate or carbamepazine?
1. Folic Acid to decrease
What anticonvulsant drugz have been implicated in causing vitamin K deficiency.
Phenytoin, Phenobarbitol and Primodone
What drugs are used to treat status epilepticus?
Lorazepam, Diazepam, or phenytoin.
List drugs that are highly protein bound.
Phenytoin, Valproic acid, tigabine and carbamazepine
What drugs are inducers of heptics microsomal activity?
PCP- phenytoin, phenobarbitol and carbamazepine