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37 Cards in this Set
- Front
- Back
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What type receptor is thought to be abnormal in people who experiences absence seizures?
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GABA typeB receptor
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What is the mechanism of action of Phenytoin? It is used for what type of seizures?
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Prolong the inactivated state of Na+ channels.
It is used for most types of seizures except absence seizures, trigeminal neuralgia, and cardiac arrhtymia. The slow onset and prolonged action duration on status epilepticus makes it good after initial control is established by Diazapam. |
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People with which genetic disease should you be careful with Phenytoin dosage?
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AD defective phenytoin hydroxylase.
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What are some side effects of phenytoin?
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- ataxia (cerebellar-vestibular)
- gingival hyperplasia, hirsutism - horizontal nystagmus - osteomalacia (enhamced VitD metabolism or decreased calcium absorption) - decrease VitK: bleeding disorder in infants of mother taking phenytoin |
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What are some drug interations of phenytoin?
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Lots!
Drugs that increases phenytoin level: chlorampenicol dicumarol,disulfiram,isoniazid short-term valproic acid Drugs that decreases phenytoin level: carbamezepine clonazepam long-term valproic acid phenytoin decreases: primidone carbamezepine clonazepam |
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What is the mechanism of action of Valproic acid?
What is it useful for? |
Affect Na+ flux and T-type Ca2+ channel
Approved use for absence seizures, mania(rapid cycles), neuropathic pain, schizoaffective disorder, PTSD, migraine prophylaxis. May also be used for myoclonic, atonic, and grand mal(tonic-clonic) seizures. |
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Could valproic acid be used in children under 2 years old?
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No. Because of liver failure.
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What are some side effects of valproic acid?
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- liver toxicity (not recommended for children under 2)
- GI upset, sedation, ataxia, hair loss. - neural tube defects if taken during pregnancy. |
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What is Gabapentin used for?
What is the mechanism of action? |
used for partial seizures
neuropathic pain, bipolar disorder, parasthesia, restless leg syndrome, postoperative pain, vasomotor symptoms of pain. mechanism: increase GABA release and inhibit Na+ channels and high voltage activated Ca channels. |
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Which anticonvulsants are excreted unchanged in the urine?
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1. Gabapentin
2. Phenobabital: some inactivated in liver 3. Levetiracetam 4. Pregabalin |
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What are some side effects of gabapentin?
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mild.
sedation, ataxia, fatigue, nystagmus. May cause mood disorder in children. |
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What is Topamax(topiramate) used for?
What is the mechanism? |
Partial seizures
migraine prophylaxis, PTSD, binge eating. Mechanism: affect Na+ channel, potentiates GABA, blocks AMPA type glutamate receptors. |
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What are some side effects of topamax?
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drowsiness, fatigue, psychomotor slowing, speech problems.
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What is a good drug choice for treating obeise patients with partial seizures?
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Topamax: do not cause weight gain, in some causes weight loss.
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Name one anticonvulsants that is also a tricyclic antidepressant.
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Carbamezepine
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What is carbamezepine useful for?
What is its mechanism? |
Partial complex seizures
Trigeminal neuralgia, glossopharyngeal neuralgia, rapidly cycling manic-depressives resistant to lithium. mechanism similar to phenytoin: impairs Na+ flux. Also increase NE neuron firing. |
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What are some side effects of carbamezepine?
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Bad! sedation
GI upset, ataxia, blurred vision, hyperirritability, repiratory depression and dizziness. Important to do organ monitor. |
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Which drug is similar to carbamezepine but with milder side effects?
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Oxcarbazepine: take over carbamezepine
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Why is phenobabitol not used anymore?
What is its action? |
Too sedating!
long half life in the liver, some excreted unchanged. Action: GABA-like increased Cl- conductance. |
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What is a good addon drug for refractory partial seizures, absence seizures, grand mal seizures and bipolar disorder?
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Lamotrigine: phenytoin type action plus action on Ca2+ channel.
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What are some drug interactions of Lamotrigine?
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other anticonvulsants
oral contraceptives psychotropics: fluoxetine, olanzepine and lithium |
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What are some side effects of Lamotrigine?
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dizziness, ataxia
visual disturbance occational severe dermatological reactions |
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What is used for initial control of status epilepticus and febrile seizures?
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Benzodiazepines: diazapam or lorazepam.
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List 3 benzodiazepines.
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1. diazapam
2. lorazepam 3. clonazepam: absence, myoclonic, atonic, and akinetic seizures. Act on T type Ca2+ channels. |
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Which anticonvulsant is approved for uses in patients over 16?
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Levetiracetam:
prevention of secondary generalized seizures unknown mechanism mild side effects: hallucination excreted unchanged |
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Which drug acts on N-type Ca channel, thus reduces release of neurotransmitters?
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Pregabalin:
effective for generalized seizures. used in neuropathic pain |
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Which drug is used primarily for generalized seizures?
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Pregabalin
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Which anticonvulsants is safer for pregnant women?
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Ethosuximide
T-type ca channel |
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Which drug should never be used in pregnant women?
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Valproic acid: causes neural tube defects.
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What should be supplemented for pregnant women taking phenobarbital, primidone or phenytoin?
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Vitamine K: because they frequently develope Vit K deficiency.
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What is an alternative for people who do not respond to anticonvulsants?
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pacemaker that stimulates the left branch of vagus nerve.
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What is primidone used for?
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partial and generalized tonic clonic seizures.
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What is Zonisamide used for?
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A sulfonamide: adjunct for tonic clonic and partial seizures.
Blocks Na and Ca channels, increases DA and serotonine transmission. |
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What is the drug of choice for cortical focal grand mal seizures?
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Phenytoin, carbamazepine or valproic acid
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What is the drug of choice for partial complex seizures?
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carbamezepine or phenytoin
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What is the drug of choice for absence seizures? alternative?
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Valproic acid
Alternative: clonazepam or lamotrigine |
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What is the drug of choice for myoclonic or atonic seizures?
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Valproic acid
Alternative: clonazepam |
