N: Anticonvulsants

Front 1

Phenytoin
- class
- action
- indications
- contraindication
- side effects
- what might abrupt withdrawal cause in epileptic pts?

Back 1

- antiepileptic
- bl/Na channels, ^GABA inhib, \Ca influx
- generalized tonic-clonic (grand mal) and partial seizures
- slow HR or another conduction abnormalities
- nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism
- status epilepticus

Front 2

Carbamazepine
- class
- action
- indications
- contraindication
- side effects
- to what extent is it bound to plasma proteins?

Back 2

- antiepileptic
- bl/Na channels
- partial seizures and tonic-clonic seizures
- slow HR or another conduction abnormalities
- idiosyncratic blood dyscrasias, diplopia, ataxia
- 70-80%

Front 3

Phenobarbital
- class
- action
+ are these more general than benzodiazepines?
- indications
- contraindication
- side effects
- reduces the effects of which drugs?
- can it be habit forming?

Back 3

- antiepileptic, sedative
- potentiates GABA by ^duration of GABA Cl- channel open,
+yes, in that they also depress excitatory neurotransmission (Glutamate) to some extent, also block Na channels to some extent.
- sedation, hypnosis, anesthesia, epilepsy
- glaucoma or prostatic hypertrophy
- depression of CV/resp. sys, cough, laryngospasm, bronchospasm
- haloperidol, warfarin, nortriptyline... as well as some others.
- yes

Front 4

Ethosuximide
- class
- action
- indications
- contraindication
- side effects
- what fellow antiepileptic increases plasma ethosuximide lvls?

Back 4

- antiepileptic
- bl/ T-type Ca channels
- petit mal (absence) seizures
- if pt is hyperS to succinimides
- HA, dizziness, GI distress, parkinsonism, BMD
- valproate

Front 5

Valproate
- class
- action
- indications
- contraindication
- side effects
- increases concentrations of what?

Back 5

- antiepileptic
- enhances GABA inhibition in CNS; bl/Na channels, ^K+ currents, block T-type Ca channels
- all types of seizures
- pts with hepatic dz or significant dysfunction
- hair loss, not much else
- other protein bound antiepileptics like ethosuximide

Front 6

Gabapentin
- class
- action
- indications
- contraindication
- side effects
- brand name?

Back 6

- antiepileptic
- unknown
- partial seizures, post-herpetic neuralgia... other nerve pains.
- none
- mild sedation, dizziness, unsteadiness (not much else)
- Neurontin

Front 7

Diazepam (Valium)
- class
- action
- indications
+ long term use possible?
- contraindication
- side effects

Back 7

- benzodiazepine, anxiolytic, antiepileptic
- b/ benzo receptors, enhances GABA effects espec. in limbic sys, thalamus, & hypothalamus
- iv or rectally to stop continuous seizure activity (esp. general tonic-clonic status epilepticus)... cannot be used long-term for seizures b/c tolerance develops rapidly
- drowsiness, fatigue, ataxia, thrombosis/phelbitis @ injection site
-

Front 8

Lorazepam
- class
- action
- indications
- contraindication
- side effects
- brand name?

Back 8

- antiepileptic, benzo, anxiolytic, sedative
- facilitates GABA in CNS
- tx of status epilepticus
- myasthenia gravis, actue narrow angle glaucoma, hyperS to benzo's
- drowsiness, excessive sleepiness

Front 9

Lamotrigine
- class
- action
- indications
- contraindication
- side effects
- induction of hepatic drug-metabolizing enzymes does what?

Back 9

- antiepileptic
- bl/Na channels
- partial seizures and absence seizures
- pts sensitive to the medication
- can cause serious skin rashes (Stevens-Johnson syndrome and toxic epidermal necrolysis).... relatively free of side effect tho'.
- decreases half-life of this drug.

Front 10

Of the following, which inhibit P450 and which induce it?

Ethosuximide, Phenytoin, Carbamazepine, Valproate, Phenobarbital

Back 10

Induce: Phenytoin, Carbamazepine, Phenobarbital

Inhibit: Ethosuximide, Valproic Acid

Front 11

When on one of the traditional AED's, what labs must be checked periodically and why?

Which of the traditional AED's can cause a hyperS rash?

Back 11

- CBC b/c they can all cause BMD
- LFT's b/c they're all potentially hepatotoxic

All can.

Front 12

Epileptic women trying to get pregnant should be on what? why?

Back 12

folic acid; all traditional AED's can cause neural tube defects (esp. Valproate).

Front 13

What AED can cause gingival hyperplasia? Which is most famous for causing osteopenia (although all the trad. AED's can)?

Back 13

phenytoin, for both.

Front 14

Fulminant hepatitis can occur in children with seizures when tx'ed with what AED in the setting of polypharmacy?

Back 14

valproic acid.