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55 Cards in this Set

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List the Generalized seizures
Absence
Myoclonic
Tonic-Clonic
Tonic
Clonic
Atonic
describe a myoclonic seizure
Brief lightning-like jerking movements of the whole body or upper extremities
Describe the Tonic-Clonic seizures
Five phases:
Flexion
Extension
Tremor
Clonic
Postictal
What is Clonic?
Rhytmic jerking
what is tonic?
Flexion and extension
What type of NTS is GABA?
Inhibitory, therefore if there is a loss of GABA there will be more excitatatory NTS in brain
What is the ideal therapy for seizures?
monotherapy, although most patients require two drugs
What is the MOA of antiepilectic drugs?
Act on ion channels; enhances inhibitory NTS and neuroreceptors
Name 1st Gen. AEDs
Phenobarbital
Phenytoin
Valproic Acid
Carbamazepine
What is the MOA of Phenobarbital
Enhances GABA
Prolongs Cl channels
Blocks NA channels
what is the half-life of phenobarbital
75-125 hrs
T/F Phenobarb can be an inducer or inhibitor
TRUE
What are the side effects of Phenobarb
CNS depression
Lethargy/sedation
Cognitive impairment
Hyperactivity in children
What is the MOA of Phenytoin
Blocks NA channels
T/F Phenytoin can be an inducer of inhibitor
False: its only an inducer
how many half-lives will it take for phenobarb to get out of your system?
~5 half-lives
what AED is not effective with absence seizures?
Phenytoin
why is it important to monitor levels of phenytoin every few months?
because the drug can saturate all receptors and accumulate causing toxicity (Michaelis menten kinetics)
what test is best to assess protein level?
pre-albumin; measures last three days

Good for pts on phenytoin because drug is highly protein bound
What is the drug of choice for status epilepticus?
Lorazepan
Dose of phenytoin in status epilepticus
Loading dose: 500mg (smaller person)
1000mg (bigger person)

50mg/min
why do you never give phenytoin IV push?
causes extravasation and phlebitis
why do you NOT infuse phenytoin for longer than 30 min?
the drug crystalizes
what are the side effects of ORAL phenytoin
Hirtuism
Ataxia
Nystagmus
Drowsiness(dose related)


Rash(steven johnson)
Acne
Gingival hyperplasia
which drug is an inducer and autoinducer
Carbamazepine
what are the side effects of carbamazepine?
Rash
Hyponatremia
Aplastic anemia
Thrombocytopenia
SIADH
what is the MOA of Valproic acid?
Potentiates GABA
Blocks T-type Ca and Na channels
T/F Valproic Acid is an Inducer
False: its an inhibitor
If pt has a new onset of seizures, what drug would you use?
Phenytoin
This AED drug causes hepatotoxicity, N/V, Wt gain, pancreatitis, and alopecia
Valproic Acid

Get ALT and AST levels
your pt is a child that has Lennox-gestaut seizures, you've tried all other drugs with minimal effects, what can you try next?
Felbamate(used as last resort due to its liver and aplastic anemia effects)

Monitor LFTs and CBC

Must sign a consent form
What are the 2nd Gen. AEDs?
Felbamate
Ethosuximide
Gabapentin
Lamotrigine
Oxcabazepine
Topiramate
Zonisamide
Pregabalin
This 2nd Gen. drug is renally excreted, acts on GABA and calcium channels
Gabapentin
what are the side effects of Gabapentin
fatigue
dizzienss
sleepiness
This drug is a 2nd Gen AED and its MOA is by blocking Na channels which inhibits release of glutamate and aspartate; RASH is a major concern, must titrate and start at low dose
Lamotrigine
what does carbonic anhydrous inhibitors do?
Stimulates GABA release
which drug maily effects Na and GABA and has weak carbonic anhydrous inhibition?
Topiramate (topromax)
what the advantage of Fosphenytoin over phenytoin?
It can be given IM or IV
Phlebitis is minimized
Faster infusion
Can mix in D5 or NS
Name the Benzodiazepines
Clonazepan (klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
How do you treat status epilepticus?
Lorazepam 1 mg over 30 sec then phenytoin
What is oxcarbazepine?
an active metabolite of carbamazepine
S.E of oxcarbamezepine?
Hyponatremia
Blood dyscrasias
which 2nd Gen. AED is indicated for Absence seizures?
Ethosuximide
which 2nd Gen. causes kidney stones and causes depression?
Zonisamide
which 2nd Gen drug is used for seizures and pain management because it releases Glutamate and Substance P?
Pregabalin
What is unique about Pregabalin?
Works in the brain and spinal cord
what is the max dose you can give phenytoin?
50mg/min to avoid S.E
What is the dose of IM Fosphenytoin?
3 ml
What is the phenytoin equivalents?
1mg phenytoin = 1.5mg fosphenytoin
what are the advantages of fosphenytoin
can be given faster
IM or IV
What do the BZDs effect?
GABA
Blocks ascending RAS; leads to sedation and ataxia
What AED is used in children for status epilepticus?
rectal diazepan
What AED is used in adults for status epilepticus?
Lorazepan
A pt comes in status epilepticus, what do you do?
Give 1mg lorazepam over 30sec, repeat every 10-15 min, max of 4mg then

Phenytoin
what category AED is preferable in pregnant women?
Category B