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24 Cards in this Set

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difs b/w simple partial and complex partial seizures?
simple: awareness, consciousness and memory are all preserved
complex: consciousness or awareness is lost. memory may be lost. may display automatisms (lip smacking, etc)
list all the types of generalized seizures
-all have loss of awareness/consciousness
-absence (blank gaze ~30 sec, normal immediately after)
-atonic (lose mm tone and collapse)
-tonic (body tenses up, frozen)
-clonic (involuntary mm contractions)
-tonic-clonic - aka grand mal, tonic first, then clonic.
-myoclonic - brief, rapid jerks (eg throw arms up)
regarding the AEDs which block Na channels, what are the common SEs?
-diplopia - due to blockade in the MLF (lateral gaze center). needs freq Na firing, so this will be compromised
-ataxia - due to compromising vestibular nn inputs - coordination is reduced
what are the three DOC for tonic-clonic seizures? MOA?
phenytoin, carbamazepine, valproic acid
-Na channel inactivators
phenytoin - main SEs
gingival hyperplasia; osteopenia; cardiac arrhythmia
describe phenytoin's pharmacokinetics? how can other drugs affect this?
is first order, but can become zero order at a therapeutic level as metabolizing enzymes (CYP2C9, 2C19) may be saturated by it.
-this is significant as it is 90% protein bound. drugs that compete with its binding on albumin (eg valproate) will increase its [free]
-or, drugs that inhibit CYP2C9, or are metabolized by CYP2C9 will increase its [free]
carbamazapine: MOA? unique SEs? what is the new form? what unique SE can it induce?
-Na channel inactivator
-rash, in addition to other expected SEs
-oxcarbazepine
-hyponatremia
valproic acid SE
fat, shaky, bald, yellow
what is a good drug choice if you are unsure if pt has partial or generalized seizure disorder?
valproic acid. (though phenytoin and carbamazepine should handle both types of seizures too...)
lamotrigine - MOA
Na channel inactivator; same profile as phenytoin/carbamazepine yet apparently less used; can induce stevens-johnson syndrome (malaise and bad rash...)
topiramate is a sodium channel inactivator, a GABA-A-R activator, and what third MOA? how does this affect tx choice in pts with a certain disorder?
-it's a CA inhibitor. don't give it to pts who already have renal stones, as it can lead to more
-separately, it can induce psychosis
what two AEDs can lead to renal stones?
topiramate, zonisamide
an overweight person needs an AED for generalized seizures. what might be a good choice?
zonisamide, as it can induce anorexia (UC did a study w/ zonisamide for binge eating disorder...)
topiramate and zonisamide both inactivate Na channels, inhibit CA, and both have 1 more each. what are they
topiramate - enhance GABA-A-R
zonisamide - inhibit t-type Ca channels
what are the two DOC for status epilepticus?
benzodiazepine (diazepam/lorazepam)
IV phenytoin (Fosphenytoin)
ethosuximide MOA? uses?
block T-type Ca channels.
-used only for absence seizures
-from katzung: The T-type calcium currents are thought to provide a pacemaker current in thalamic neurons responsible for generating the rhythmic cortical discharge of an absence attack
what newer AED drugs affect NT release? names and MOA?
-gabapentin and pregabalin bind to alpha2delta subunit of voltage gated Ca channel (not t type), slowing NT release via Ca influx
-levatiracetam binds SV2A, a protein on synaptic vesicles, to reduce NT release
-these both affect Glutamate release
although marketed as an AED, gabapentin and pregabalin are often used for:
neuropathic pain; diabetic neuropathy
AEDs: is it better to use one drug at near toxic levels, or to use two drugs are lower levels?
docs prefer to use one drug at high levels before adding a second one - $/compliance/no drug interactions
what drug to use if a pt has absence and some partial seizures or GTC seizures?
valproic acid. ethosuximide covers only absence
what class of antibiotics can affect phenytoin levels? howso
macrolides (erythromycin) inhibit CYP3A4,
what AED is associated w/ neural tube defects
valproic acid
how can a change of one's diet affect seizures
eliminating carbohydrates and protein helps. eat mostly fats
what AED is also recommended for tic doloureux aka trigeminal neuralgia?
carbamazepine