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66 Cards in this Set
- Front
- Back
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Which seisures do no have an pre-seisure "aura"?
A post-ictus? |
absence, myoclonic
absence |
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What are the therapeutic goals for AC's?
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arrest all seisure and minimizing side effects
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Why are serum levels important in AC therapy?
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avoid unpleasant side effects and toxicity, monitor dosage for adjustments, ensure patient compliance.
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Phenytoin (Dilantin) acts by 2 major pathways. What are they?
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Inhibit seisure spread by blocking CALCIUM channels and by enhancing CHLORIDE IPSP's
Inhibit seisure focus by binding and blocking depolarized SODIUM Channels |
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What is often the initial drug of choice for all types of epilepsy besides absence and atonic seisures?
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Phenytoin (Dilantin)
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What is the route of administration for phenytoin?
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Oral or IV.
NOT IM. |
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IV phenytoin cause lead to what complication?
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cardiovascular collapse
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What are some of the side effects of Phenytoin (Dilantin)?
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Hirsutism, gingival hyperplasia, osteomalacia, hyperglycemia, Steven-Johnson's syndrome, hematological reactions, CNS side effects (cerebellar).
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Allergic reaction to Phenytion (Dilantin) require what?
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supportive therapy and cessation of drug.
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What other anticonvulsant interacts with Phenytoin (Dilantin)?
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Carbamazepine - enhances Phenytoin (Dilantin) metabolism
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Phenytoin (Dilantin) can reduce the levels of what compounds/drugs?
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Vitamin K, Digoxin, steroids.
Patients on this drug should take extra Vitamin K in supplements to prevent clotting cascade problems. |
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What are the added benefits of Fosphenytoin (Cerebryx)?
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can be administered IM, and has improved side effect profile than IV administration.
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What is the MOA of Carbamazapine (Tegretol)?
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Not known exactly. Though to act to decrease SODIUM conductance.
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What types of seisures can Carbamazapine (Tegretol) be used?
What other use does Carbamazapine (Tegretol) have? |
Gen. Tonic Clonic, partials.
Trigeminal Neuralgia. |
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Pharmokinetically, what does Carbamazapine (Tegretol) do after absorption? (2 things)
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(HINT: Carbamazapine (Tegretol) has many "a's")
Autoinduction and formation of Active-metabolites |
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Carbamazapine (Tegretol) has one side effect that isn't present in the profile for Phenytoin (Dilantin), what is it?
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Hepatotoxicity
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What is the MOA for Phenobarbital (Luminol)?
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It binds the barbituate binding site on GABA channels and increase CHLORIDE flux.
Also increase firing threshold. |
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Phenobarbital (Luminol) has one use that isn't present in the indications for Phenytoin (Dilantin) and Carbamazapine (Tegretol), what is it?
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Prophylaxis for febril seisures
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What are some side effects for Phenobarbital (Luminol)?
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Sedation, withdrawl seisures, Mental slowing and hyperactivity in children.
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What other anticonvulsant alters Phenobarbital (Luminol) serum levels?
What other drugs can interact with the effects of Phenobarbital (Luminol)? |
Valprioc Acid (Depakene)/ Divalproex (Depakote) can increase Phenobarbital (Luminol) levels.
CNS depressants can have an additive effect on Phenobarbital (Luminol). |
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Phenytoin (Dilantin) can reduce the levels of what compounds/drugs?
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Vitamin K, Digoxin, steroids.
Patients on this drug should take extra Vitamin K in supplements to prevent clotting cascade problems. |
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What are the added benefits of Fosphenytoin (Cerebryx)?
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can be administered IM, and has improved side effect profile than IV administration.
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What is the MOA of Carbamazapine (Tegretol)?
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Not known exactly. Though to act to decrease SODIUM conductance.
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What types of seisures can Carbamazapine (Tegretol) be used?
What other use does Carbamazapine (Tegretol) have? |
Gen. Tonic Clonic, partials.
Trigeminal Neuralgia. |
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Pharmokinetically, what does Carbamazapine (Tegretol) do after absorption? (2 things)
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(HINT: Carbamazapine (Tegretol) has many "a's")
Autoinduction and formation of Active-metabolites |
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Carbamazapine (Tegretol) has one side effect that isn't present in the profile for Phenytoin (Dilantin), what is it?
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Hepatotoxicity
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What is the MOA for Phenobarbital (Luminol)?
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It binds the barbituate binding site on GABA channels and increase CHLORIDE flux.
Also increase firing threshold. |
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Phenobarbital (Luminol) has one use that isn't present in the indications for Phenytoin (Dilantin) and Carbamazapine (Tegretol), what is it?
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Prophylaxis for febril seisures
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What are some side effects for Phenobarbital (Luminol)?
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Sedation, withdrawl seisures, Mental slowing and hyperactivity in children.
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What other anticonvulsant alters Phenobarbital (Luminol) serum levels?
What other drugs can interact with the effects of Phenobarbital (Luminol)? |
Valprioc Acid (Depakene)/ Divalproex (Depakote) can increase Phenobarbital (Luminol) levels.
CNS depressants can have an additive effect on Phenobarbital (Luminol). |
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What is the MOA of Primidone (Mysoline)?
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Metabolized to 2 active compounds PEMA and Phenobarbital.
PEMA acts on SODIUM channels and Phenobarbital potentiates GABA mediated CHLORIDE flux. |
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Which is better in treating complex partial seisures, Phenobarbital (Luminol) or Primidone (Mysoline)?
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Primidone (Mysoline) is preffered in complex partials.
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What other AC is often combined with Primidone (Mysoline)?
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Phenytoin (Dilantin)
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What are the drug interactions for Primidone (Mysoline)?
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Same as Phenobarbitol (Luminol). Divalproex (Depakote)/ Valproic Acid (Depakene) increase serum levels of Primidone (Mysoline).
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What is the MOA of Divalproex (Depakote)/ Valproic Acid (Depakene)?
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Complex. Divalproex (Depakote)/ Valproic Acid (Depakene) acts on SODIUM and POTASSIUM channels, potentials CHLORIDE flux at GABA channels, and inhibits T-type CALCIUM channels.
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What are the main uses for Divalproex (Depakote)/ Valproic Acid (Depakene)?
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Ethosuximde (Zarontin) resistant absence seisures, myoclonic seisures, Photosensitive epilepsy.
Also adjunct for generals/partials. |
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What non-AC disoreder can be treated with Divalproex (Depakote)/ Valproic Acid (Depakene)?
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Treatment for Bipolar Disorder
Migranes |
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What are some side effects for Divalproex (Depakote)/ Valproic Acid (Depakene)?
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Alopecia, Acute liver failure, decreased platelet and clotting function.
Its not a CNS depressant so less likely to cause CNS side effects. |
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Divalproex (Depakote)/ Valproic Acid (Depakene) increase the serum levels of what 3 AC's?
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Lamotrigine (Lamcital), Phenobarbital (Luminal), and Primidone (Mysoline).
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What is the MOA of Ethosuximide (Zarontin)?
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Blocks thalamic interneruon, T-type CALCIUM channels.
(lowers hypersynchronicity associated with absence seisures) |
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What is the use for Ethosuximide (Zarontin)?
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Absence seisures.
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What is the unique side effect for Ethosuximide (Zarontin)?
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blood dyscrasia
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What should be used for staus epilepticus (acute)?
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Chlorazepate
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What type of seisures can be treated with clonazepam?
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atonic, myotonic
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What are the side effects of benzodiazapines?
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sedation, withdrawl seisures
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What is the MOA for Felbamate (Felbatol)?
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Blocks GLYCINE activation of NMDA channels. This stops seisure initiation.
Minor effects at SODIUM and CALCIUM channels. |
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What are the uses for Felbamate (Felbatol)?
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Refractory partial seisures, and Lennox-Gastaut Syndrome
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What are the side effects for Felbamate (Felbatol)?
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CNS/cerebellar, GI, allergic,
Serious side effects include aplastic anemia and hepatotoxivcity. |
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What is the MOA of Gabapentin (Neurontin)?
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Looks like GABA, but does not work through GABA system. Increases GABA release (indirect action).
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What are the uses of Gabapentin (Neurontin)?
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partials (mono and adjunctive therapy).
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What are some non-AC uses for Gabapentin (Neurontin)?
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Postherpetic neuralgia
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What are the drug interactions of Gabapentin (Neurontin)?
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Does not alter other AC serum levels, but antacids can decrease absorption.
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What is the MOA of Lamotrigine (Lamictal)?
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Blocks presynaptic SODIUM channels, GLUTAMATE and ASPARTATE release, and CALCIUM channels.
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What are the uses for Lamotrigine (Lamictal)?
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Adjuct for partials, gen. tonic-clonic, atonic, absence, and add on therapy for Lennox-Gastaut syndrome.
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What are the contraindications for Lamotrigine (Lamictal)?
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Children under 16
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What are the Drug interactions for Lamotrigine (Lamictal)?
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Phenytoin (Dilantin) and Carbamazapine (Tegretol) decrease Lamotrigine (Lamictal) serum levels.
Lamotrigine (Lamictal) can induce its own metabolism. Divalproex (Depakote)/Valproic Acid (Depakene) increase serum levels of Lamotrigine (Lamictal). |
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What is the MOA of Topiramate (Topamax)?
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Binds to novel site on GABA channel, and inhibits sodium channels, and blocks excitatory amino acid release.
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What are the uses of Topiramate (Topamax)?
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Adjuncts for partials and generalized.
Can use for treatment of Lennox-Gastaut syndrome. |
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What are some important side effects of Topiramate (Topamax)?
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Kidney stones, parasthesia (as well as other common AC side effects)
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What is the MOA of Tiagabine (Gabatril)?
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GABA reuptake inhibitor
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What is unique about the use for Levetiracetam (Keppra)?
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It is not hepatically metabolized, allowing it to be used in patients that have liver disease or taking other hepatically metabolized drugs.
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What is a unique use for Oxcarbazine (Trileptal)?
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Effective in drug resistant epilepsy
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What are some unique uses for Pregabalin (Lyrica)?
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Neuropathic pain, diabetic peripheral neuropathy.
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What are some side effects of Zonisamide (Zonegran)?
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Fulminant hepatic necrosis, kidney stones, aplastic anemia,
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What is the MOA of Vigabatrin (Sabril)?
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Inhibition of GABA transaminase
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Which AC drugs should be avoided in pregnancy?
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Phenytoin (Dilantin) and Phenobarbital (Luminol).
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