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42 Cards in this Set
- Front
- Back
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What is generalized tonic-clonic seizure?
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AKA Grand mal
-involves both hemispheres -LOC -begins w/ tonic flexion, then extension, then postictal state |
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What is absence seizure?
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AKA Petit mal
-only happens in peds -lasts less than 45 sec -abrupt interruption of consciousness -can occur up to 100 times/day |
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What is partial seizure?
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-involves only 1 hemisphere
-may progress into tonic-clonic -2 subtypes -simple/complex partial |
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alternative treatments to antiepileptics
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-ketogenic diet
-vagal stimulation -ablation |
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3 main MOAs of antiepileptics
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-block neuronal Na channels
-augments action of GABA -block Ca2+ channels |
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antiepileptic drugs that have most learning impairment/sedation
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Phenobabital (Phb) and BZDs
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class of antiepileptics that has least cognitive impairment
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phenytoin (Pht)
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how long does it take to achieve steady state for antiepileptics?
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5.5 half lives (need to wait 5 days before you test levels to adjust dosage)
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T/F
It is important to TAPER dosages of antiepileptics |
TRUE
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most common causes of seizure activity
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-subtherapeutic anticonvulsant levels
-infection -hypothermia -EtOH -elicit drug use -head trauma |
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First line treatment for GENERALIZED TONIC-CLONIC seizures
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-carbamazepine
-valproic acid -phenytoin |
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First line treatment for PARTIAL seizures
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-carbamazepine
-valproic acid -phenytoin |
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First line treatment for ABSENCE seizures
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-ethosuxamide
-valproic acid |
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MOA of phenobarbital
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-augments action of GABA at GABA-A receptors
-inihibits postsynaptic neuron activity |
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ADEs of phenobarbital
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-dose-related - sedation, mental dullness, cognitive impairment, hyperactivity
-non-dose related -changes in sleep patterns, rash |
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Drug interactions of phenobarbital
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enzyme inducer, theophylline, warfarin, cyclosporine, VPA, haloperidol, TCA's, phenytoin
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MOA of Primidone
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metabolized to Phb (see MOA of Phb)
-same indications/ADE's as Phb |
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Drug interactions of primidone
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carbamazepine, phenytoin, VPA
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MOA of phenytoin
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blocks neuronal Na channels
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inidications of phenytoin
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tonic-clonic, partial; DOC in head injury; prophylaxis in brain tumor surgery
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drug interactions of phenytoin
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dose-related: nystagmus, lethargy, cognitive impairment
non-dose related: gingival hyperplasia, hirsuitism, folate deficiency, rash, acne |
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drug interactions of phenytoin
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warfarin, steroids, theophylline, antiepileptics
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Monitoring of phenytoin
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therapeutic concentration: 10-20 mcg/mL
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CARBAMAZEPINE
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MOA - blocks neuronal Na channels, blocks Ca2+, decreased rate of neurotransmitter release
-indications: generalized tonic-clonic or partial; migraine prophy, pain or neuropathy, bipolar disorder ADEs: dizziness, anorexia, drowsiness, nausea Drug intxns: theophylline, warfarin, VPA, OCs, cimetidine, erthromycin, isoniazid, non-DHP CCBs, Pht, Phb Monitoring: therapeutic concentration 4-12 mcg/mL |
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VALPROIC ACID
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MOA: blocks neuronal Na channels, augments action of GABA, increases inhibition of postsynaptic neuron activity
Indications: tonic-clonic, partial, absence, febrile, migraine prophy, bipolar ADEs: DR - GI upset, lethargy NDR - wt gain, n/v, hepatitis Drug intxns: Phb, Pht, carbamazepine Monitoring: therapeutic conc. 50-150 mcg/mL |
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ETHOSUXIMIDE
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MOA: binds Ca2+ channels, dec rate of neurotransmitter release
Indications: absence ADEs: DR-GI upset, drowsiness, hiccups NDR-headache Drug Intxns: carbamazepine Monitoring: therapeutic conc. 40-150 mcg/mL |
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GABAPENTIN
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MOA: unknown
Indications: adjunctive tx for partial seizures, pain, bipolar, migraine prophy ADEs:solnolence, dizziness, fatigue, nystagmus Drug Intxns: antacids |
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PREGABALIN
(preGABAlin) |
MOA: GABA analog, modulates Ca channel function
Indications: adjunct for partial seizures ADEs:peripheral edema, wt gain, somnolence, dizziness Drug Interactions: none ID'd |
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LAMOTRIGINE
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MOA: blocks neuronal Na channels (dec. depolarization rate)
Indications: adjunct for partial szs, partial sz after withdrawal of primary antiepileptic, Lennox-Gastaut Syndrome ADEs: nystagmus, tremor, ataxia, incoordination, n/v, h/a, dizziness, rash Drug interactions: Pht, Phb, VPA, carbamazepine Monitoring: initiate slowly to avoid rash |
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TOPIRAMATE
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MOA: increases GABA activity at receptors
Indications: adjunct tx in partial szs, bipolardisorder ADEs:acute myopia, secondary angle closure glaucoma, drowsiness Drug Intxns: acetazolamide, carbamazepine, estradiol, POht, OCs, VPA Monitoring: ophthalmic exam q6mo |
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TIAGABINE
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MOA: enhances GABA activity (blocks presynaptic neuronal GABA uptake)
Indications:adjunct to partial szs ADEs:sedation, nervousness, tremor, depression, confusion, abnormal thinking, dizziness, h/a, fatigue, muscle weakness Monitoring: taper dosages |
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LEVETIRACETAM
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MOA: inhibits neuronal burst firing
Indications: adjunct tx for partial szs ADEs:somnolence, dizziness, asthenia, leukopenia Monitoring: CBC **May be effective in Pht failure |
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OXCARBAZEPINE
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MOA: blocks voltage-sensitive Na channels
Indications:adjunct for partial szs, monotherapy for adults w/ partial szs ADEs:dizziness, diplopia, ataxia, vomitting, somnolence, h/a, hyponatremia Drug Intxns: barbiturates, BZDs, CCBs, Pht, OCs Monitoring: therapeutic conc.50-125 mcg/mL |
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ZONISAMIDE
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MOA: block Na channels
Indications: adjunct tx for partial szs in adults ADEs: heat stroke, drowsiness, ataxia, loss of appetite, GI upset, kidney stones, cognitive slowing, parasthesias, blood dyscrasias,depression Drug Intxns: carbamazepine, Pht, Pht, OCs Monitoring: therapeutic conc. 10-40 mcg/mL CAUTION: sulfa allergies, hx renal stones |
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FELBAMATE
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MOA: blocks neuronal Na channels, dec. depolarization rate
Indications: partial seizures ADEs:wt loss, photosensitivity, n/v/c, altered taste sense, dizziness, insomnia Drug Intxns: estradiol, antiepileptic inducers |
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Management of acute seizures
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--secure airway
--give oxygen --iv access --lorazepam (Ativan) |
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BENZODIAZEPINES
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MOA: binds to GABA receptors w/o displacing GABA
Indications: acute seizure control ADEs:dizziness, sedation, unsteadiness, vertigo Drug Intxns: opiods |
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Seizures in pregnancy
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-need 2 forms of contraception
-most antiepileptics CI'd in pregnancy |
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Tx of febrile seizures
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--Phb, BZD's
--antipyretics (when temp >101) --intermittent diazepam at time of fever |
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Tx failure occurs when....
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--wrong drug selected
--poor compliance (maybe due to ADEs) --refractory patients |
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Unfavorable prognosis of DC'ing antiepileptics...
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-adult-onset szs
-frequent and severe szs -abnormal EEG -abrupt withdrawal of BZDs, Phb |
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Favorable prognosis of DC'ing antiepileptics...
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-pediatric onset
-long sz-free interval -normal/improved EEG during tx |
