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24 Cards in this Set
- Front
- Back
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difs b/w simple partial and complex partial seizures?
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simple: awareness, consciousness and memory are all preserved
complex: consciousness or awareness is lost. memory may be lost. may display automatisms (lip smacking, etc) |
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list all the types of generalized seizures
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-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) |
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regarding the AEDs which block Na channels, what are the common SEs?
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-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 |
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what are the three DOC for tonic-clonic seizures? MOA?
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phenytoin, carbamazepine, valproic acid
-Na channel inactivators |
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phenytoin - main SEs
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gingival hyperplasia; osteopenia; cardiac arrhythmia
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describe phenytoin's pharmacokinetics? how can other drugs affect this?
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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] |
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carbamazapine: MOA? unique SEs? what is the new form? what unique SE can it induce?
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-Na channel inactivator
-rash, in addition to other expected SEs -oxcarbazepine -hyponatremia |
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valproic acid SE
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fat, shaky, bald, yellow
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what is a good drug choice if you are unsure if pt has partial or generalized seizure disorder?
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valproic acid. (though phenytoin and carbamazepine should handle both types of seizures too...)
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lamotrigine - MOA
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Na channel inactivator; same profile as phenytoin/carbamazepine yet apparently less used; can induce stevens-johnson syndrome (malaise and bad rash...)
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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?
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-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 |
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what two AEDs can lead to renal stones?
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topiramate, zonisamide
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an overweight person needs an AED for generalized seizures. what might be a good choice?
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zonisamide, as it can induce anorexia (UC did a study w/ zonisamide for binge eating disorder...)
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topiramate and zonisamide both inactivate Na channels, inhibit CA, and both have 1 more each. what are they
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topiramate - enhance GABA-A-R
zonisamide - inhibit t-type Ca channels |
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what are the two DOC for status epilepticus?
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benzodiazepine (diazepam/lorazepam)
IV phenytoin (Fosphenytoin) |
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ethosuximide MOA? uses?
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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 |
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what newer AED drugs affect NT release? names and MOA?
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-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 |
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although marketed as an AED, gabapentin and pregabalin are often used for:
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neuropathic pain; diabetic neuropathy
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AEDs: is it better to use one drug at near toxic levels, or to use two drugs are lower levels?
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docs prefer to use one drug at high levels before adding a second one - $/compliance/no drug interactions
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what drug to use if a pt has absence and some partial seizures or GTC seizures?
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valproic acid. ethosuximide covers only absence
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what class of antibiotics can affect phenytoin levels? howso
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macrolides (erythromycin) inhibit CYP3A4,
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what AED is associated w/ neural tube defects
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valproic acid
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how can a change of one's diet affect seizures
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eliminating carbohydrates and protein helps. eat mostly fats
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what AED is also recommended for tic doloureux aka trigeminal neuralgia?
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carbamazepine
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