Drugs For Epilepsy

Front 1

What is Epilepsy?

Back 1

Chronic recurrent seizures

Front 2

What is a seizure?

Back 2

Short term abnormal firing

Partial or Generalized

Front 3

What is a partial (focal) seizure?

Back 3

Initiated in neurons in one cerebral hemisphere

Front 4

What are the different types of Partial Seizures?

Back 4

1. Simple

2. Complex

3. Secondary Generalization

Front 5

What is a Generalized Seizure?

Back 5

Activation in both cerebral hemispheres

Front 6

What are the 2 types of Generalized Seizures?

Back 6

1. Tonic-clonic

2. Absence

Front 7

What does the motor homunculus tell you about seizures?

Back 7

Gives insight to the brain location of the seizure

Front 8

What are the characteristics of a Simple Partial Seizure?

Back 8

1. Aura

2. Initiated in one cerebral hemisphere

3. No loss of consiousness

Front 9

What are the characteristics of a Complex Partial Seizure?

Back 9

1. Initiated in one cerebral hemisphere

2. Altered LOC

3. Automatism (picking lint off)

Front 10

How do the spread of the seizure and EEG compare for simple and complex partial seizures?

Back 10

Spread and EEG are similar or identical for simple and complex seizure

Front 11

What are the characteristics of a Partial Seizure with Secondary Generalization?

Back 11

1. Initiated in one cerebral hemisphere but then spreads to thalamus and then activates both hemispheres

2. Person passes out

3. Whole body starts to jerk

Front 12

What are the characteristics of a Tonic-Clonic Seizure?

Back 12

1. Starts in the thalamus then activates both cerebral hemispheres

2. Loss of consciousness

3. Tonic = rigid extension of limbs

4. Clonic = muscles jerking

Front 13

What are the characteristics of an Absence seizure?

Back 13

1. Impaired consciousness (i.e. blanks out)

2. Maybe automatism

3. Often looks like "day dreaming"

Front 14

What are the 4 mechanism of actions Epileptic drugs have?

Back 14

1. Sodium channel block

2. Inhibit Glutamate (excitatory)

3. Increase GABA (inhibitory)(CL influx)

4. Calcium channel block (pacemaker in thalamus)

Front 15

What are 2 Glutamate Receptors called?

Back 15

1. NMDA

2. AMPA

Front 16

What is Carbamazepine used for?

Back 16

1. Partial Seizures

2. Generalized Tonic-Clonic

Front 17

How does Carbamazepine work? What should you be careful of?

Back 17

1.Inhibits Voltage gated Sodium channels

2. Can enhance metabolism of other anti epileptics like phenytoin and valproate toxicity

Front 18

What are the adverse effects of Carbamazepine?

Back 18

1. Double vision & ataxia

2. Nausea

3. Skin rash

4. Leukopenia

Front 19

What is the MOA for Phenytoin? What are some special characteristics?

Back 19

1. Blocks voltage gated sodium channels

2. Highly bound to Plasma Proteins

3. Induces CYP 3A4

4. Induces metabolism of carbamazepine, valporate, Vitamin K and contraceptives

Front 20

What is the relationship between phenytoin dosage and serum level?

Back 20

You get a dramatic increase in plasma phenytoin with small increase in dose

Front 21

What are some adverse affects for Phenytoin?

Back 21

1. Double vision & Ataxia

2. Gingival hyperplasia

3. Hirsutism

4. Peripheral Neuropathy

5. Megaloblastic anemia

6. Osteomalacia

Front 22

What is the MOA for Phenobarbital & Primidone? What are some characteristics?

Back 22

1. Enhance inhibitory effects of GABA

2. Primidone is metabolized to phenobarbital

3. Interactions are common: Vitamin K, Oral contraceptives

Front 23

What are some adverse effects for Phenobarbital and Primidone?

Back 23

1. Drowsiness

2. Ataxia

3. Respiratory depression

4. Decreased motor skills (don't give to truck driver)

5. Skin rash

6. Psychological and physiological Dependence

Front 24

What is the MOA for Gabapentin? What are some of its characteristics?

Back 24

1. Increases release of GABA

2. Minimal binding to plasma protein

3. Adjunct therapy

4. Not metabolized and does not induce hepatic enzymes

Front 25

What are some adverse effects of Gabapentin?

Back 25

1. Sedation, Dizzy, Headache

2. Tremor, Ataxia

3. GI

Adverse effects are mild and resolve in 2 weeks

Front 26

What is the MOA for Topiramate? What are some characteristics?

Back 26

1. Inhibits sodium channels

2. Increases GABA

3. Inhibits Glutamate (AMPA)

4. Use as adjunct therapy

Front 27

What are some adverse effects of Topiramate?

Back 27

1. Fatigue

2. Dizziness

3. Mental Slowing

4. Nausea

Front 28

What is the MOA of Lamotrigine? What are some characteristics?

Back 28

1. Blocks Sodium Channels

2. Adjunct Therapy

Front 29

What are the adverse effects of Lamotrigine?

Back 29

1. Dizziness & headache

2. Skin rash

3. 1-2% of kids develop serious srashes

Front 30

Which medication do you used for Generalized Absence Seizure?

Back 30

1. Ethosuximide

Front 31

What is the MOA of Ethosuximide?

Back 31

1. Blocks Calcium channels

Front 32

What are some adverse effects of Ethosuximide?

Back 32

1. Stomach ache, vomit

2. Skin Rash

3. May increase tonic-clonic seizures

Front 33

What is clonazepam used for?

Back 33

Generalized absence seizures

Front 34

What is the MOA for Clonazepam?

Back 34

Enhances inhibitory effects of BAGA

Front 35

What are the adverse effects of Clonazepam?

Back 35

1. Sedation

2. Tolerance

Front 36

What is Valproate used for?

Back 36

1. Generalized Tonic-clonic

2. Absence

Front 37

What is the MOA for Valproate?

Back 37

1. Sodium and calcium channel blocker

2. Enhances inhibitory effect of GABA

Front 38

What are the adverse effects of Valproate?

Back 38

1. Spina bifida

2. Hepatotoxicity - particularly in patients under 2 yrs old

Front 39

What else can anti-epileptic drugs be used for?

Back 39

1. Bipolar disorder (Carbamazepine, valproate, topirimate, lamotrigine, gabapentin)

2. Anxiety

3. Alcohol

4. Spasticity

5. Migraine/cluster headache

6. Neuropathic pain (especially Gabapentin)

Front 40

What is status epilepticus?

Back 40

Seizure that last longer than 15 min and is medical emergency

Front 41

What would you use for Status Epipeticus?

Back 41

1. IV Diazepam

2. IV Lorazepam

3. Phenytoin can then be used for long term control

Front 42

How should anti epileptics be prescribed and withdrawn?

Back 42

Gradually to minimize adverse effects

Front 43

What needs to be considered when prescribing Anti-epileptics?

Back 43

1. Blood level monitoring

2. Pregnancy

3. Oral contraceptives (Phenytoin, phenobarbital)

4. Increased Vitamin D = osteomalacia (phenytoin, phenobarbital)

5. Increase Vitamin D metabolism = bleeding (Phenytoin, phenobarbital)

6. Enhance other anti-epileptics (Phenytoin, carbamazepine, phenobarbital)

7. Inhibition of metabolism of anti-epileptic (Valproate)

Front 44

Who does Phenobarbital work well for?

Back 44

Has typically fallen out of favour but works well in people that have been on it for a long time

Front 45

Which drug is the best for Status Epilepticus?

Back 45

Lorazepam is better than diazepam or phenytoin