Antiepileptics

Front 1

What is the 3 step pathyphysiology of a seizure?

Back 1

1. Neurons can elaborate reponses leading to paroxymal bursts.
2. Abnormal neurons recuit normal ones to propagate the discharge of a seizure
3. Falure of normal inhibitory or enhancment of normal exicitatory activity.

Front 2

When treating pts with epilepsy, should they be started off on a single or multiple agents?

Back 2

Start on single agents with bolus for emergenices and start combinatino therapy if they fail 2 trials of single agents.

Front 3

What rx are used for pratial seizures?

Back 3

Carbamazepine
phenytoin
valproic acid
oxcarbazepine
lamotrigine
topiramate
Gabapentin

Front 4

What rx are used for general tonic-clonic sieizures?

Back 4

Phenytoin
carbamazepine/oxcarbazepine
valproic acid
topiramate

Front 5

What rx are used for absence seizures?

Back 5

Ethosuzimide
valproic acid
lamotrigine

Front 6

What rx are used for myoclonic seizures?

Back 6

Valproic acid

Front 7

What rx are used for mixed seizures?

Back 7

Lamotrigne and valpoic acid

Front 8

What is the MOA of all antiseizures?

Back 8

Elevate seixure threshold
Limit spread of abnormally discharged NTs
Stabilize cell membranes
Sucess depends on seizure type and pharacokinetic monitoring

Front 9

Hydantoins= Phenytoin (Dilanton) and fosphenytoin (cerebyx)
MOA:
used for?

Back 9

MOA:Limits spread of abnormally discharged NTs and stabilize cell membrane
Block Voltage dependent Na channels.
For partial and T/c seizures

Front 10

A/e of hydantoins:

Back 10

Secation, cognitive impairment, nystagums, ataxia
Peripherial neuropathy, gigivital hyperplasia, hirsutism, rash, bone loss

Front 11

What is the dosing situation like with hydantoins?

Back 11

One can give QD with ER capsules or suspension or multiple doses with chewables or parentral formulas. There is also IV available.

Front 12

Barbituates: Phenobarbital (Luminal)
MOA:
For what kind of seizures?

Back 12

MOA: Increases seizure threshold nad decreases excitatory NT activity (GABA binding)
Tonic clonic and partial seizures.

Front 13

A/e:

Back 13

Metabolized by liver so watch other meds.
Sedation,
depression
Hepatotoxicity
rash
hypotension and resp depression
hyperactivity in children

Front 14

Barbituates: Primidone
(Mysoline)
MOA:

Back 14

Same MOA as phenobarbital: increases seizure threashold nad decreases excitatory NT activity
Same a/e as phenobarbital

Front 15

Carbamzepine (carbatrol, tegretol)
MOA:

Back 15

MOA: Limits spread of abnormal NT discharge
Bloks V.G. Na channels
Liver metabolism: autoinducer, so increase dose

Front 16

A/e:

Back 16

n/v/d
Drowsiness, dizziness, blurred vision, *hematologic effects*
Rash, Hyponatremia and fluid retension

Front 17

Valproic acid (depacon, depakote)
MOA:

Back 17

Membrane stabilizer
Increases gaba levels
Blocks VG Na channels
Liver metabolism inhibitor

Front 18

A/e:

Back 18

GI
CNS: Drowsiness, ataxia, tremor
Increased liver fxn tests, hematologic
pancreatitis
wt gain
increase amonnia levels

Front 19

Different forms of valproic acid available:

Back 19

Sprincles, liquid, capsules, XR
injection

Front 20

Succinamides: Ethosuximide (Zarontin)
MOA:
For:

Back 20

MOA: Affects Na/K ATPase and calcium channels
Decreases Gamma-jydroxbutyrate
For ABSENCE SEIZURES ONLY

Front 21

A/e of succinamides:

Back 21

GI
CNS: drowsiness, parkinsonian movements...often goes away as therapy progresses

Front 22

Benzodiazepines (Klonapin, Valium, Ativan)
MOA:

Back 22

Enhances GABA activity

Front 23

A/E:
Metabolism

Back 23

Sedation, tolerance
Liver metabolism, no active metabolites

Front 24

NEW AGENTS: Felbamate
MOA:

Back 24

Limits spread of abnormal NT discharge and increases seizure threshold

Front 25

A/e

Back 25

CNS: Insomnia, dizziness, headache
GI: n.v.anorexia
Aoastic anemia
hepatic failure so monitor levels weekly and biweekly CBCs

Front 26

Gabapentin (Neurontin)
MOA:
Eliminated:

Back 26

Limits spread and uptake of excitatory NTs, increases GABA
*Renally eliminated*
Used for peripheral neuropathy

Front 27

A/e:

Back 27

CNS: Sedation, atxia, dizziness

Front 28

Lamotrigine
MOA:

Back 28

MOA:limits spread adn release of excitatory NTs by blocking Na chanels

Front 29

A/e:

Back 29

Rash! Titrate dose to avoid rash. (Steven-johnson syndrome)
Displopia, somnolence

Front 30

Topiramate (Topamax)
MOA:

Back 30

MOA:Potentiates GABA
Antagonizes glutamate
Blocks Na channels
Modulates Ca channels

Front 31

A/E:

Back 31

Parasthesias,
wt loss
GI
kidney stones

Front 32

Tigabine (Gabitril)
MOA:
A/e

Back 32

MOA: Inhibits GABA uptake
a/e: dizziness, sedation, HA depression GI

Front 33

Oxcarbazepine (Trileptal)
MOA:

Back 33

Similar to carbamazapine, limits spread of abnormally discharged NT through VG Na channels
*Does not induce own metabolism*

Front 34

a/e:

Back 34

CNS: nervousness, HA, dizziness
GI: Nausea
*HYPONATREMIA*
Rash

Front 35

Levetiracetam (Keppra)
MOA:
A/e:

Back 35

Unknown MOA
NO KNOWN RX INTERACTIONS
CNS: fatigue, altered behavior, anziety
infection

Front 36

Zonisamide (Zonegran)
MOA:
Precautions:

Back 36

Inhibits Na and Ca channels
CONTRAINDICATED IN PTS WITH ALLERGY TO SULFONAMIDES

Front 37

A/e:

Back 37

CNS: Somnolence, dizzziness, confusion
GI: Nausea, anorexia
Henatologic
Kidney stones

Front 38

Pregabalin: Lyrica
MOA:
A.e:

Back 38

Inhibits NT release
*Controlled substance*
CNS: Blurred vision, dizziness
GI: xerostomia

Front 39

Vigabatrin (Sabril)
MOA:
A/e:

Back 39

Increases GABA
Fatigue, headache, dizziness, drowsiness
agitation

Front 40

what 2 drubs will interact to produce neurotoxic symptoms?

Back 40

carbamazepine and lamotrigine

Front 41

Phenytoin with what will incresae plasma levels of phenytoin:

Back 41

Topiramate and Oxcarbazepine

Front 42

Lamotrigine and what increase lamot. concentrations:

Back 42

Valproic acid

Front 43

Phenytoin and what decreases phenytoin plasma concentrations:

Back 43

Valproic acid

Front 44

Carbamazepine and what increase levels of carbamazepine?

Back 44

valproic acid

Front 45

Valproic acid and what increase its cocentration?

Back 45

Felbamate

Front 46

Which drug causes fetal hydantoin syndrome and neotatal hemmorhage?
What other rx should be avoided in pregnancy?

Back 46

Phenytoin
Carbamazepine
valproic acid
phenobarbital

Front 47

Which rx should be used in pregnancy?

Back 47

Older agents are cat D, new ones are cat C, replete folic acid and Vit K