Anticonvulsant Drugs

Front 1

DOC for tonic-clonic seizures

Back 1

-carbamazepine
-phenytoin

Front 2

DOC for simple partial seizures

Back 2

-carbamazepine
-phenytoin

Front 3

DOC for complex partial seizures

Back 3

-carbamazepine
-phenytoin

Front 4

DOC for absence seizures

Back 4

-ethosuximide

Front 5

DOC for myoclonic

Back 5

-clonzazepam

Front 6

what drugs are ineffective in the tx of absence and myoclonic seizures?

Back 6

-carbamazepine
-phenytoin

Front 7

which drug is ineffective in simple and complex partial seizures?

Back 7

-ethosuximide

Front 8

what drug is considered 1st generation antiepileptic drug (AED)?

Back 8

phenytoin

Front 9

what are the major clinical uses of phenytoin?

Back 9

-1st line AED for chronic outpatient therapy
-2nd line drug in management of status epilepticus

Front 10

phenytoin sodium injection has been replaced with ______

Back 10

-fosphenytoin sodium

Front 11

fosphenytoin sodium injection

Back 11

-a water-soluble disodium phosphate ester prodrug of phenytoin that is rapidly converted to phenytoin in plasma

Front 12

fosphenytoin sodium injection is indicated for?

Back 12

-short-term tx of acute seizures (IV for status epilepticus)
-prevention of seizures during neurosurgery
-and as a substitute for oral phenytoin when oral dosing is not feasible

Front 13

suspension and tablet forms of phenytoin contain__________and are NOT intended for________

Back 13

1. the free acid form of phenytoin
2. once daily dosing

Front 14

capsule contain the ______ of phenytoin and are the only oral formulation approved for ________ due to its ________

Back 14

1. sodium salt
2. once-a-day dosing (extended release)
3. slow dissolution and absorption

Front 15

describe the biotransformation of phenytoin

Back 15

-dose-dependent metabolism
-saturates hepatic P450 enzymes responsible for metabolism
-small increases in dosage results in large increases in plasma levels

Front 16

ADR of the IV dosage forms of phenytoin

Back 16

-hypotension, bradycardia

Front 17

dose-related effects of phenytoin:
1. toxicity due to elevated plasma levels
2. overdose

Back 17

1. nystagmus, ataxia, decreased mentation
2. hypotension, seizures

Front 18

ADR due to chronic toxicity of phenytoin

Back 18

-gingival hyperplasia
-hypertrichosis
-coarsening,/thickening of facial features
-osteomalacia due to abnl vitD metabolism

Front 19

idiosyncratic rxns to phenytoin

Back 19

severe skin lesions

Front 20

teratogenicity of phenytoin?

Back 20

fetal hydantoin syndrome (FHS):
-cleft lip/palate
-craniofacial abnormalities
-mental and physical growth retardation
-congenital heart dz

Front 21

phenytoin use in pregnancy/lactation?

Back 21

-risk/benefit ratio favors continued use of phenytoin during pregnancy
-compatible with breast feeding

Front 22

indications for carbamazepine

Back 22

-DOC for mgmt of generalized tonic-clonic, simple or complex partial, mixed partial, or generalized seizure disorder
-pain relief of trigeminal neuralgia

Front 23

carbamazepine has ___________; it induces its own metabolism

Back 23

autoinduction

Front 24

common ADR of carbamazepine

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-GI distress
-CNS: sedation, dizziness, fatigue, nystagmus, ataxia

Front 25

occasional ADR of carbamazepine

Back 25

-rash, severe skin lesions
-fluid retention and causes SIADH

Front 26

rare ADR of carbamazepine

Back 26

-bone marrow suppression with aplastic anemia or agranulocytosis (extremely rare)
-hepatotoxicity

Front 27

Sx of carbamazepine overdose

Back 27

-ataxia, nystagmus, seizures

Front 28

__________ and ________ inhibit the metabolism of carbamazepine

Back 28

1. erythromycin
2. cimetidine

Front 29

carbamazepine is a potent P450 inducing agent and increases the clearance of _______

Back 29

-theophylline, oral contraceptives, warfarin, and other AEDs

Front 30

use of carbamazepine with pregnancy/lactation?

Back 30

-risk/benefit ratio favors continued use during pregnancy
-compatible with breast-feeding

Front 31

_____________is GABAergic/GABAmimetic

Back 31

valproic acid

Front 32

anticonvulsant indications for valproic acid

Back 32

-monotherapy and adjunctive therapy in simple and complex absence seizures
-adjunct in multiple seizure types that include absence seizures
-monotherapy and adjunctive therapy of pts with complex partial seizures that occur either in isolation or in association with other seizure types

Front 33

unlabeled indications for valproic acid

Back 33

-alone or in combo tx of myoclonic and tonic-clonic seizures
-may be effective in status epilepticus intractable to other agents

Front 34

ADR of valproic acid

Back 34

-GI distress: take with food or use enteric coated form

Front 35

boxed warnings for valproic acid

Back 35

-rare, but life-threatening toxicities
-hepatoxicity
-teratogenicity

Front 36

use of valproic acid in pregnancy/lactation

Back 36

-teratogenic (must be essential to seizure mgmt to justify use)
-compatible with breast feeding

Front 37

___________ is the DOC for absence seizures

Back 37

ethosuximide

Front 38

indications for clonazepam in seizure mgmt

Back 38

-tx of absence seizures unresponsive to ethosuxamide
-alone or as adjunctive tx of the Lennox-Gestaut syndrome (petit mal variant), akinetic, and myoclonic seizures

Front 39

prolonged (30-60 min) and continuous, rapidly repeating seizures without recovery from epileptic state

Back 39

status epilepticus (medical emergency)

Front 40

convulsive status epilepticus

Back 40

80% cases are the secondary generalized type with focal onset

Front 41

management of convulsive status epilepticus

Back 41

-dextrose to correct hypoglycemia
-IV lorazepam or diazepam
-concurrent admin of a longer-acting anticonvulsant: IV loading dose of phenytoin sodium or fosphenytoin sodium

Front 42

DOC for terminating seizures in convulsive status epilepticus are _____

Back 42

-IV lorazepam or diazepam

Front 43

IV lorazepam or diazepam in the tx of status epilepticus are contraindicated in__________

Back 43

acute alcohol intoxication with depression of vital signs

Front 44

typical anticonvulsant indications for adjuvants (2nd generation anticonvulsants)

Back 44

-adjunct therapy for partial seizures in adults
-adjunct therapy for patial seizures in kids
-adjunct therapy for seizures associated with Lennox-Gestaut syndrome

Front 45

Lennox-Gestatut syndrome characteristics

Back 45

-multiple seizure types, mentalretardation
-permanent intellectual, cognitive, and psychological defects
-status epilepticus is common

Front 46

gabapentin (adjuvant) indications in Lennox-Gestaut syndrome

Back 46

-adjunctive tx of partial seizures with/without secondary generalization in pts >12
-adjunctive tx of partial seizures in children 3-12yrs

Front 47

metabolism of gabapentin

Back 47

-excreted renally unchanged
-doesn't interact with other anticonvulsants which depend on P450 Sx for hepatic metabolism

Front 48

hypersensitivity rxns with zonisamide (adjuvant)

Back 48

-may have cross-reactivity with other sulfa drugs, with hematological and dermatological toxicity

Front 49

ADR of zonisamide (adjuvant)

Back 49

-hypersensitivity rxns
-tendency for renal stone formation
-psychiatric Sx
-oligohydrosis-induced hyperthermia

Front 50

additive toxicity of zonisamide (adjuvant) with _________ can occur causing stone formation

Back 50

topiramate

Front 51

indications for pregabalin (adjuvant)

Back 51

-adjunctive therapy in adults with partial onset seizures
-mgmt of postherpetic neuralgia
-neuropathic pain associated with diabetic peripheral neuropathy
-fibromyalgia

Front 52

metabolism of pregabalin (adjuvant)

Back 52

-nonmetabolized; excreted unchanged in the urine

Front 53

ADR of pregabalin (adjuvant)

Back 53

-euphoria
-withdrawal symptoms when abruptly d/c

Front 54

adjuvant agents with monotherapy indications (3)

Back 54

-felbamate
-lamotrigine
-topiramate

Front 55

indications for felamate

Back 55

-monotherapy or adjuncitve therapy of partial and generalized seizures associated with Lennox-gestaut syndrome in children >2yrs
-rrecommended only in pts where other txs have failed such that the risk of hepatic failure and aplastic anemia is justified

Front 56

boxed warnings for felbamate

Back 56

-aplastic anemia
-acute hepatitis and hepatic failure
-use only if benefit outweighs risk

Front 57

iondications for lamotrigine

Back 57

-adjunctive therapy in generalized seizures of Lennox-Gestaut syndrome in adult and pediatric pts >2yr
-conversion to monotherapy in adults >16yrs with partial seizures who are on tx with a single AED

Front 58

boxed warning for lamotrigine

Back 58

-rash due to hypersensitivity rxn
-potential for severe, life-threatening rash
-children are at high risk

Front 59

indications for topiramate

Back 59

-adjunctive therapy for pts >2 with partial onset seizures (primary generalized tonic-clonic seizures) and seizures associated with Lennox-Gestaut syndrome
-initial monotherapy of partial onset or primary generalized tonic-clonic seizures in pts >10yrs

Front 60

topiramate is a _________________ which increases the risk of urolithiasis, particularly if used concurrently with _______; pt must maintain adequate fluid intake

Back 60

1. weak carbonic anhydrase inhibitor (CAI)
2. another CAI