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80 Cards in this Set
- Front
- Back
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What is the difference between a seizure and epilepsy?
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Seizure: isolated or provoked, single event. No underlying abnormality
Epilepsy: underlying abnormality in brain for repeated seizures |
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Generalized epilepsy usually occurs when in life?
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In childhood
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What kind of pattern does generalized epilepsy have on EEG?
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Generalized pattern
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Name a type of primary generalized epilepsy:
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Absence epilepsy
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Is the brain normal with primary epilepsy (Eg: absence epilepsy?)
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Yes the brain is otherwise normal
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"Staring Spells" epilepsy is primary or secondary generalized epilepsy?
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Primary generalized epilepsy
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What kind of epilepsy starts from multiple spots in the brain? (Generalized or localized?)
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Generalized epilepsy
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What is the most common epilepsy in adults (generalized or localized)?
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Localized
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What kind of epilepsy starts with a spark in 1 part of the brain?
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Localized epilepsy
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Can a spark in one part of the brain in localized epilepsy grow to other parts of the brain?
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Yes it can
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What are the two types of seizures?
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Partial and tonic-clonic
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Which drug should NOT be used for localization-related epilepsy?
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Ethosuximide
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Which drug can only be used for absence epilepsy?
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Ethosuximide
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Increased mechanism of actions of AEDs = increased use as broad spectrum AEDs (T/F)?
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True
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Clonazepam, diazepam, and lorazepam are all what class of AEDs?
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Benzodiazepines
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What is the mechanism of action of benzodiazepines?
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Enhances binding of GABA to its receptors
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Can BZDs be used to treat status epilepticus?
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Yes
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What is the mechanism of action for AEDs Carbamazepine and Oxcarbazepine?
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Stabilize voltage-gated sodium channels in the inactivated conformation.
Decrease voltage gated calcium conductance |
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How does stabilizing voltage-gated sodium channels in the inactivated conformation reduce seizures?
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Reduced sodium channel activity - reduced action potential - reduced excitability.
Result: Reduced spread of overactive nerve activity |
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What two drugs are indicated for trigeminal neuralgia?
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Carbamazepine and Oxcarbazepine
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What is the type of epilepsy is the main indication for use of carbamazepine and oxcarbazepine?
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Localization-related epilepsy
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What is the reason for nausea, headache, and other GI symptoms as side effects of carbamazepine and oxcarbazepine?
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Epoxide metabolite
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What is the mechanism of action for ethosuximide?
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Block t-type calcium channels
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What is the main indication for ethosuximide?
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Absence epilepsy
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Where is ethosuximide metabolized?
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Liver
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What is the mechanism of action of gabapentin?
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Binds to calcium channels
Enhanced GABA synthesis |
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Where is gabapentin metabolized?
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Excreted UNMETABOLIZED in the urine. This drug is NOT metabolized in the liver.
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What drug is used as adjunct in localization-related epilepsy and post-herpetic neuralgia?
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Gabapentin
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What is the mechanism of action of pregabalin?
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Binds to calcium channels
Enhances GABA transport |
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Both drugs bind to calcium channels. Which drug causes enhanced GABA synthesis and which drug causes enhanced GABA transport (Gabapentin vs. Pregabalin)?
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Gabapentin enhances GABA synthesis.
Pregabalin enhances GABA transport. |
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Where is pregabalin metabolized?
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Pregabalin is excreted unchanged in the urine. This drug is NOT metabolized in the liver.
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Aside from localization-related epilepsy and post-herpetic neuralgia, this drug is also indicated for fibromyalgia and diabetic neuropathy
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Pregabalin
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Which drug (Gabapentin vs. Pregabalin) is also indicated for fibromyalgia and diabetic nephropathy in addition to localization-related epilepsy and post-herpetic neuralgia?
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Pregabalin
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Which 2 AEDs are used as adjuncts for treatment of localization-related epilepsy because they are not strong enough to treat the epilepsy itself?
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Gabapentin and pregabalin
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Why are gabapentin and pregabalin commonly used and indicated for treatment of pain?
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Not strong enough as an AED itself, this is why it is used to treat the pain
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What is the mechanism of action of lacosamide?
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Stabilizes voltage gated sodium channels in the inactivated state
Binds cell proteins (CRMPs) that play a role in ion channel trafficking and neuronal sprouting |
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What is lacosamide indicated for?
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Localization-related epilepsy
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Why must you obtain an EKG from a patient before administering lacosamide?
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Can prolong the PR interval and lead to an AV block. (Due to the drug's interaction with sodium channels)
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What is the mechanism of action of Lamotrigine?
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Stabilizes voltage-gated sodium channels in the inactive state
Inhibits glutamate release Inhibits t-type calcium currents |
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Where is lamotrigine metabolized?
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Liver!
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What is the main adverse reaction with lamotrigine?
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Severe and life-threatening Rash!
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What AED causes a severe and life-threatening rash?
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Lamotrigine
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Which AED is also used as a mood stabilizer?
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Lamotrigine
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What is the mechanism of action of Levetiracetam
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Inhibit calcium channels
Interaction with a unique synaptic vesicle protein |
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Where is levetiracetam metabolized?
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Renal excretion, unchanged
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What is the main adverse reaction with levetiracetam?
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Behavioral difficulties: irritability and instability
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What AED causes behavioral difficulties like irritability and instability?
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Levetiracetam
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What is the mechanism of action for phenobarbital?
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Prolongs the length of time GABA-activated chloride channels remain open.
blocks voltage gated calcium channels Direct inhibitory effect on NMDA-type glutamate receptors |
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Phenobarbital has a very short or very long half life?
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Very long half life (60-110 hours)
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Phenobarbital is/is not an enzyme inducer
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It is an enzyme inducer. It competitively inhibits the metabolism of other drugs.
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Carbamazepine, oxcarbazepine, phenytoin, and phenobarbital all have what in common (hint: enzyme effects)
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Enzyme inducers
Increased enzymes can lead to the drug's own metabolism |
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Name an AED that is an enzyme inhibitor
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Valproate
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What is the mechanism of action of phenytoin?
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Stabilizes voltage-gated sodium channels in the inactivated conformation
Inhibits voltage-gated calcium channels Stimulates Na/K ATPase activity |
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Phenytoin has 1st order (linear) or 0 order (nonlinear) pharmacokinetics?
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0 order (non linear) pharmacokinetics
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Phenytoin is an enzyme inducer or enzyme inhibitor?
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Enzyme inducer (along with carbemazepine, oxcarbazepine, and phenobarbital)
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Nystagmus, ataxia, gingival hyperplasia, rash, blood dyscrasias, skin necrosis, and cardiac arrhythmias are all adverse side effects of what AED?
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Phenytoin
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Which drug is very soluble in water and the dilutant is very toxic?
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Phenytoin
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What is a more soluble pro-drug of phenytoin?
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Fosphenytoin
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Which drug can be given faster, phenytoin or fosphenytoin?
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Fosphenytoin (IV or IM)
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Which drug has fewer adverse reactions, phenytoin or fosphenytion?
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Fosphenytoin
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What is the mechanism of action of tigabine?
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Inhibits the reuptake of GABA
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What is the mechanism of action of topiramate
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Direct potentiating actions on the GABA receptor at a unique site
Inactivates voltage gated sodium channels Prevents calcium influx |
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What AED can also be used for migraine headache prevention?
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Topiramate
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Topiramate is metabolized through the liver or kidney?
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Kidney (renal metabolism)
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Psychomotor slowing and weight loss are adverse reactions of what AED?
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Topiramate
People like the weight loss aspect, people do not like the psychomotor slowing |
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Which AED do people complain of making them feel "stupid"?
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Topiramate
Causes psychomotor slowing |
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What is the mechanism of action of valproate?
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Inhibits the metabolism and promotes the synthesis of GABA
Inactivates voltage-gated sodium channel Blocks t-type calcium channels |
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Valproate is an enzyme inducer or an enzyme inhibitor?
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Enzyme inhibitor
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Aside from topiramate, what other AED can also be used for migraine headache prevention?
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Valproate
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What drug if given with lamotrigine can increased the likelihood of rash?
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Valproate
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Valproate and lamotrigine together can have what effect on rash?
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Increased likelihood of rash
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Weight gain, hair loss, tremor, liver failure, pancreatitis, thrombocytopenia, and neural tube defects are all ADRs of what AED?
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Valproate
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What is the mechanism of action of Zonisamide?
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Similar to Valproate:
Inhibit the metabolism and promotes synthesis of GABA Inactivates voltage-gated sodium channels Blocks t-type calcium channels |
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Zonisamide is used as an adjuvant therapy (T/F)
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True
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After securing ABCs and treating underlying chemical derangements in a patient with status epilepticus, what is the first drug (AED) to try?
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Benzodiazepine
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Name the three drugs in order to give to a patient in status epilepticus after securing ABC and correct any underlying chemical derangements?
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1. Benzodiazepines
2. Phenytoin/fosphenytoin 3. Phenobarbital |
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What must you do after giving a patient in status epilepticus phenobarbital?
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Must intubate the patient because phenobarbital will depress the respiratory system
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What is the final treatment for status epilepticus if all else fails?
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Paralysis and coma
to prevent muscle damage, acidemia, and prevent rhabdomyolysis and renal failure |
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During pregnancy the risk of seizure is worse and far outweighs the risks of AEDs, T/F?
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True
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There is an increased risk of NTDs with use of AED, T/F?
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True
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