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27 Cards in this Set

  • Front
  • Back
What is a tonic-clinic seizure?
(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
What is an absence seizure?
(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
What is the DOC for absence seizures?
Treatment for generalized tonic-clonic seizures and partial seizures?




Wide spectrum of antiseizure activity
Treatment for status epilepticus?

Explain the neuronal basis of epilepsy?
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
MOA for anti-seizure medications?
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

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





Phenytoin therapeutic use?
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
Phenytoin side effects?
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
3. osteomalacia (responds to VitaminD)
4. megaloblastic anemia (responds to folate)
Valproate therapeutic use?
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
Valproate side effects?
-- especially when other antiseizure drugs are administered concurrently
-- serious concern due to the formation of toxic intermediates of valproate metabolism
Carbamazepine therapeutic use?
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
Carbamazepine side effects?
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
Lamotrigine therapeutic use?
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
Which antiepileptic drugs reduce low threshold calcium currents (T currents)?
Ethosuximide therapeutic use?
DOC for treatment of absence seizures
Ethosuximide side effects?
1. bone marrow depression

2. blood dyscrasias
-- aplastic anemia
-- thrombocytopenia
-- leucopenia
-- lupus erythematosis
Which antiepileptic drug blocks excitatory amino acid (glutamate) receptors?
Felbamate (even though not on drug list – need to know)
-- acts as an NMDA receptor antagonist
Felbamate therapeutic use?
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
Felbamate toxicity?
Must monitor plasama anticonvulsant levels b/c felbamate is metabolized in the liver and will alter the metabolism of other drugs
Drugs that enhance GABA-mediated increases in chloride conductance?
Barbituate therapeutic use?
1. generalized tonic-clonic seizures

2. all partial seizures

Ineffective in absence seizures
Barbituate adverse effects?
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
Which antiepileptic drug promotes the release of GABA?
Gabapentin therapeutic use?
1. Adjunctive therapy for the treatment of partial seizures and generalized tonic-clonic seizures

2. postherpetic neuralgia
Gabapentin excretion and side effects?
Excreted unchanged by the kidneys

Adverse effects:
1. dizziness
2. drowsiness