Module 7 Pharm

Front 1

What is a tonic-clinic seizure?

Back 1

(grand mal)
-- manifest by sudden loss of consciousness
-- tonic contraction of body musculature followed by rhythmic jerking of the extremities
-- then depression of CNS fxn for varying periods

Front 2

What is an absence seizure?

Back 2

(petit mal)
-- brief loss of awareness
-- sometimes w/ eye-blinking or lip-smaking
-- w/o loss of consciousness of body tone
-- almost always seen in young children

Front 3

What is the DOC for absence seizures?

Back 3

Ethosuximide

Front 4

Treatment for generalized tonic-clonic seizures and partial seizures?

Back 4

Phenytoin

Ethotoin

Carbamazepine

Phenobarbital

Wide spectrum of antiseizure activity
Lamotrigine
Zonisamide
Valproate

Front 5

Treatment for status epilepticus?

Back 5

Phenytoin

Diazepam

Front 6

Explain the neuronal basis of epilepsy?

Back 6

1. seizures can result from either excessive excitatory neurotransmission or a decreased inhibitory neurotransmission in the brain.

2. antiepileptic drugs work to depress the excitability of the epileptic focus and to prevent the spread of the seizure

Front 7

MOA for anti-seizure medications?

Back 7

INHIBIT EXCITATORY NEUROTRANSMISSION
1. alter ion channel conductance
-- prolong state of Na channel inactivation and therefore reduce the frequency at which neurons may generate repetitive action potentials
-- reduce low threshold Ca currents; T currents have been implicated in the 3Hz spike-wave rhythm characteristic of absence seizures
2. blockade of excitatory amino acid (glutamate) receptors

ENHANCE INHIBITORY (GABA) NEUROTRANSMISSION
1. act at distinct allosteric binding sites on the GABAa receptor to enhance GABA-mediated increases in chloride conductance
2. increase GABA levels by stimulating synthetic enzyme, glutamic acid decarboxylase
3. promote release of GABA
4. inhibit degradation of GABA

Front 8

Which anti-seizure meds prolong the state of sodium channel inactivation?

Back 8

Phenytoin

Ethotoin

Valproate

Carbamazepine

Lamotrigine

Zonisamide

Front 9

Phenytoin therapeutic use?

Back 9

1. DOC for generalized tonic-clonic seizures

2. very effective in treatment of partial seizures

3. given i.v. for status epilepticus

4. NOT affective for active seizures

Front 10

Phenytoin side effects?

Back 10

At therapeutic doses, the liver metabolic enzymes are near saturation
-- small increase in dose may cause large increase in phenytoin concentration

Serious side effects include
1. increased hair growth -- hirsuitism
2. GINGIVAL HYPERPLASIA
3. osteomalacia (responds to VitaminD)
4. megaloblastic anemia (responds to folate)

Front 11

Valproate therapeutic use?

Back 11

1. WIDE SPECTRUM of antiseizure activity

2. DOC for atonic and myoclonic seizures, and for treating pts who experience multiple seizure types

3. effective for absence seizures

Front 12

Valproate side effects?

Back 12

HEPATOTOXICITY
-- especially when other antiseizure drugs are administered concurrently
-- serious concern due to the formation of toxic intermediates of valproate metabolism

Front 13

Carbamazepine therapeutic use?

Back 13

1. DOC for all partial seizures

2. Very effective in the treatment of generalized tonic-clonic seizures

3. NOT effective for absence seizures

4. DOC for treating trigeminal neuralgia

5. The 10,11-epoxide metabolite of carbamazepine has anticonvulsant activity

Front 14

Carbamazepine side effects?

Back 14

1. bone marrow depression

2. aplastic anemia

3. agranulocytosis

4. hyponatremia

5. water retention (a serious problem for elderly w/ cardiac disease)

Monitoring of bone marrow and renal and hepatic fxn are necessary

Front 15

Lamotrigine therapeutic use?

Back 15

1. WIDE SPECTRUM of antiseizure activity

2. Effective in trtmt of partial or generalized seizures and absence seizures

3. Effective in trtmt of refractory partial seizures in combo w/ other antiepileptic drugs

Front 16

Which antiepileptic drugs reduce low threshold calcium currents (T currents)?

Back 16

Succinimides
-- ETHOSUXIMIDE

Front 17

Ethosuximide therapeutic use?

Back 17

DOC for treatment of absence seizures

Front 18

Ethosuximide side effects?

Back 18

1. bone marrow depression

2. blood dyscrasias
-- aplastic anemia
-- thrombocytopenia
-- leucopenia
-- lupus erythematosis

Front 19

Which antiepileptic drug blocks excitatory amino acid (glutamate) receptors?

Back 19

Felbamate (even though not on drug list – need to know)
-- acts as an NMDA receptor antagonist

Front 20

Felbamate therapeutic use?

Back 20

NOT indicated as a first-line epileptic treatment
-- use in pts who respond inadequately to alternative treatments due to substantial risk of aplastic anemia or liver failure

Adjunctive therapy for the treatment of partial seizures that are controlled w/ phenytoin or carbamazepine

Front 21

Felbamate toxicity?

Back 21

Must monitor plasama anticonvulsant levels b/c felbamate is metabolized in the liver and will alter the metabolism of other drugs

Front 22

Drugs that enhance GABA-mediated increases in chloride conductance?

Back 22

Barbituates
-- DIAZEPAM
-- CLONAZEPAM

Front 23

Barbituate therapeutic use?

Back 23

1. generalized tonic-clonic seizures

2. all partial seizures

Ineffective in absence seizures

Front 24

Barbituate adverse effects?

Back 24

Associated w/ long-term use and at high doses are:
1. osteomalacia (responds to VitD)
2. megaloblastic anemia (responds to folate)
3. hemorrhage in the newborn (if mom on Phenobarbital)
4. porphyria

Barbituates combined w/ other depressants cause severe CNS depression
-- antihistamines
-- benzodiazepines
-- antipsychotics
-- sedative antidepressants
-- narcotics

Front 25

Which antiepileptic drug promotes the release of GABA?

Back 25

Gabapentin

Front 26

Gabapentin therapeutic use?

Back 26

1. Adjunctive therapy for the treatment of partial seizures and generalized tonic-clonic seizures

2. postherpetic neuralgia

Front 27

Gabapentin excretion and side effects?

Back 27

Excreted unchanged by the kidneys

Adverse effects:
1. dizziness
2. drowsiness