(Neuro) Anticonvulsants

Front 1

Drug Name: Strychnine
Where applicable list:

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Back 1

USES: Induces tonic seizures (poisoning?)
MECHANISM: Blocks inhibitoy glycine receptors. Leaves motorneurons sensitive to all stimuli.
SIDE EFFECTS: TONIC SEIZURES!!! (Like those seen w/ tetanus)
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS:
OTHER: Strychnine not used clinically but taught us a lot about convulsants

Front 2

Drug Name: Phenytoin (Dilantin)
Where applicable list:

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Back 2

USES: Most seizures (except absence); neuralgia, arrhythmia
MECHANISM: Prolongs inactivation of Na channels thus reducing firing / recruitment of neurons.
SIDE EFFECTS: Gingival hyperplasia; Subtle ataxia; Vitamin deficiency (D, K, Ca++) leading to osteomalacia.
TOXICITY: Saturation kinetics in those w/ defective hydroxylation of drug
ANTIDOTES:
CONTRAINDICATIONS: Teratogenic
INTERACTIONS: Lots and lots! (Don't need to know 'em)
OTHER:

Front 3

Drug Name: Valproic Acid (Depakene)
Where applicable list:

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Back 3

USES: Primarily absence seizures; also grand mal, myoclonic and atonic seizures; Mania; PTSD; Migraines
MECHANISM: Affects Na+ and T-type Calcium channels. Drug is cleared by the liver
SIDE EFFECTS: Few
TOXICITY: Liver toxicity in younger pts
ANTIDOTES:
CONTRAINDICATIONS: Children under 2; pregnant women (neuro tube defects)
INTERACTIONS: Phenytoin among others. Liver damage seen w/ drug may be a result of drug interactions.
OTHER:

Front 4

Drug Name: Gabapentin (neurontin)
Where applicable list:

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Back 4

USES: Partial seizures; neuropathic pain, bipolar
MECHANISM: Increases GABA release and inhibits Na, high voltage Ca channels. Excreted unchanged in the urine.
SIDE EFFECTS: Mild: Sedation dizziness, ataxia, fatigue, nystagmous, mood disorders in children
TOXICITY: Monitor for renal toxicity
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS: Does not alter the levels of other drugs (makes this one a good choice!)
OTHER:

Front 5

Drug Name: Topiramate (Topamax)
Where applicable list:

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Back 5

USES: Partial seizures; migraine prophylaxis, PTSD, binge eating, anorexia
MECHANISM: Phenytoin like effect on Na+ channels; potentiates GAPA and blocks AMPA. Excreted unchanged in urine.
SIDE EFFECTS: Drowsiness, fatigue, psychomotor slowing, speech problems, sometimes weight loss
TOXICITY: Possible renal toxicity
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS: Does not alter levels of other drugs
OTHER:

Front 6

Drug Name: Carbamezepine (Tegretol) / Oxcarbazepine
Where applicable list:

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Back 6

USES: Complex, partial seizures; CN V, XII neuralgia, outbursts; bipolar
MECHANISM: Like phenytoin, inhibits Na flux. Also increases NE firing
SIDE EFFECTS: Sedation, GI upset, ataxia, dizziness, aplastic anemia, skin rashes
TOXICITY: Must monitor organs for damage (esp. liver).
ANTIDOTES:
CONTRAINDICATIONS: Teratogenic
INTERACTIONS:
OTHER: Oxycarbazepine is similar but w/ milder side effects, no known liver problems.

Front 7

Drug Name: Phenobarbital
Where applicable list:

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Back 7

USES: Partial seizures, grand mal seizures
MECHANISM: Barbiturate. Decreases discharge and seizure threshold. GBA like increased Cl- conductance. Very long half life. Inactivated by the liver.
SIDE EFFECTS: Marked sedation (makes use uncommon); osteomalacia (decreased Vit D, K)
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS: Acute intermittent porphyria. Drug allergy, Teratogenic
INTERACTIONS: Possible interactions between barbiturates and anticonvulsants.
OTHER: Often used in multiple drug therapy for difficult to control seizures

Front 8

Drug Name: Lamotrigine (Lamictal)
Where applicable list:

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Back 8

USES: Alternative/ add-on for refract partial seizures, absence, grand mal; also bipoolar
MECHANISM: Prolongs inactivation of Na+ channels (phenytoin like).
SIDE EFFECTS: Dizziness, ataxia, visual disturbances, skin rxns.
TOXICITY:
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CONTRAINDICATIONS:
INTERACTIONS: Many! Other anticonvulsants, contraceptives, psychotropics.
OTHER:

Front 9

Drug Name: Benzodiazepines (Diazepam/lorazepam/clonazepam)
Where applicable list:

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Back 9

USES: DOC- status epilepticus; Clonazepam- febrile, absence, atonic seizures,
MECHANISM: Acts on T-type Ca++ channels; GABA agonist
SIDE EFFECTS: Dependence
TOXICITY:
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CONTRAINDICATIONS:
INTERACTIONS: Yes - but not listed here
OTHER: Also used for muscle spasms, anxiety

Front 10

Drug Name: Levetiracetam (Keppra)
Where applicable list:

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Back 10

USES: Seizures (unspecified); prevention of 2ndary generalized seizures
MECHANISM: Unknown
SIDE EFFECTS: Mild: fatigue, asthena, coordination problems, emotional liability, hallucinations (not the fun type)
TOXICITY: Excreted unchanged
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS: No known interactions
OTHER:

Front 11

Drug Name: Pregabalin (Lyrica)
Where applicable list:

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Back 11

USES: Generalized seizures; Neuropathic pain
MECHANISM: Binds to N-type calcium channels leading to reduction of neurotransmitter release. Excreted in urine
SIDE EFFECTS: Mild (unspecified)
TOXICITY:
ANTIDOTES:
CONTRAINDICATIONS:
INTERACTIONS: Very few (unspecified)
OTHER: Very expensive!

Front 12

Drug Name: Primidone (Mysoline) / Zonisamide (Zonegran)
Where applicable list:

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Back 12

USES: Partial and generalized tonic-clonic seizures
MECHANISM: Drug itself is active, also converted to PEMA, and Phenobarbital. Zonisamide blocks Na and Ca channels and increases dopamine / serotonin transmission
SIDE EFFECTS: Similar to phenobarbital (sedation, osteomalacia)
TOXICITY:
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OTHER:

Front 13

Drug Name: Ethosuximide
Where applicable list:

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Back 13

USES: Absence
MECHANISM: Works on T-type calcium channels.
SIDE EFFECTS:
TOXICITY: NOT teratogenic (unlike valproic acid)
ANTIDOTES:
CONTRAINDICATIONS:
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OTHER: Use has been supplanted by valproic acid except in pregnancy