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49 Cards in this Set

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What do seizures result from?
Imbalance between excitatory & inhibitory systems
Describe Partial Seizures
1. involve only 1 area of the brain

2. No loss of consciousness
What are the 2 types of Partial Seizures?
1. Simple Partial (Elementary Symptomatology) = Cortical focal

2. Complex Partial = Psychomotor
Describe Generalized Seizures
1. Diffuse

2. always involves loss of consciousness
List the type of Generalized Seizures
1. Absence = Petit Mal = Blank Stare

2. Tonic-clonic = Grand Mal = alternating stiffness & movement

3. Status Epilepticus
List the 5 Anticonvulsants that prolong inactivation of Na+ channels & thereby reduce ability of neurons to fire at high frequencies
1. Phenytoin
2. Carbamazepine
3. Valproic Acid
4. Lamotrigine
5. Topiramate

PVC-LT
What mechanisms of action does Topiramate possess?
1. increases Na+ channel inactivation

2. enhances GABA action

3. decreases Glutamatergic activity
List the two Anticonvulsants that inhibit T-type Ca+ Channels
1. Ethosuximide

2. Valproic Acid
What 3 mechanisms of action does Valproic Acid possess?
1. increases Na+ channel inactivation

2. enhances GABA

3. inhibits T-type Ca+ channels
List the 4 anticonvulsants that enhance GABAergic activity
1. Phenobarbital

2. Primidone

3. Diazepam

4. Clonazepam
Anticonvulsant that increases the synaptic availability of GABA by inhibiting its reuptake
Tiagabine
2 Anticonvulsants that enhance depolarization induced GABA release
1. Gabapentin

2. Pregabalin
What is the DOC for treatment of Status Epilepticus?
Diazepam I.V.
This is one of the most effective drugs in Infantile Myoclonus, but tolerance is a problem
Diazepam
What is the downfall when using Benzodiazepines (Diazepam & Clonazepam) for Grand Mal seizures?
Only effective for 2-3 weeks due to tolerance = cannot be used for long term seizure treatment
What groups of drugs are used to treat Grand Mal, Partial, & Status Epilepticus seizures?
1. Benzodiazepines
-Diazepam
-Clonazepam

2. Barbiturates
-Phenobarbital
-Primidone

3. Hydantoins
-Phenytoin

4. Valproic Acid

5. Carbamazepine

6. Add-ons: Lamotrigine, Topiramate, Gabapentin/Pregabalin, Tiagabine
Benzodiazepine that may have some efficacy in Petit Mal seizures
Clonazepam
One of the drugs of choice for Grand Mal seizures but is very sedating, induces microsomal enzymes, & is a possible teratogen
Phenobarbital
What may happen if abrupt withdrawal from Phenobarbital occurs?
precipitated Status Epilepticus
Barbiturate that is converted to Phenobarbitol & Phenylethylmalonamide (PEMA) which are both active products
Primidone
What are the possible side effects of Primidone?
1. Ataxia
2. Nausea
3. Vomiting

"the Prima donna is nauseaous & vomits & she can't walk straight"
Anticonvulsant that is frequently effective in patients not responding to Phenytoin or Phenobarbital
Primidone
What is Primidone often given in combination with? What should it never be given in combo with?
Phenytoin

Phenobarbital = both are Barbiturates & induce metabolism of each other
Arguable is a drug of choice for Grand Mal & Partial seizures & is generally less sedating than Barbiturates
Phenytoin
What are drug interactions that Phenytoin possesses?
1. highly bound to plasma proteins = displaces drugs
2. Induces P450 & other enzymes
-increased metabolism of Barbiturates
-Vitamin D deficiency
List the side effects of Phenytoin (9)
1. Diplopia = double vision
2. Ataxia
3. Nystagmus
4. N/V
5. Hyperplasia of the gums
6. Hirsutism
7. Blood dyscrasias
8. Peripheral Neuropathy
9. Teratogenic = Fetal Hydantoin Syndrome
A DOC for Grand Mal seizuires but is Hepatotoxic, especially in children
Valproic Acid
What are the drug toxicities of Valproic Acid?
1. N/V
2. Teratogen = Neural Tube Defects = Spina Bifida
3. can inhibit metabolism of other drugs = increases their levels
This is a drug of choice for Partial Seizures & is relatively safe & nontoxic
Carbamazepine
What are the side effects of Carbamazepine?
1. Diplopia
2. Ataxia
3. N/V
4. Blood Dyscrasias = agranulocytosis, aplastic anemia
5. incudes microsomal enzymes
6. Possible teratogen

"driving in a Partial Car-bamazepine for so long makes you:
-cross-eyed
-ataxic when you get out
-nauseous
-have no Granulocytes
Typically used as an add-on in Partial & possibly Petit Mal seizures
Lamotrigine
With what drug must Lamotrigine be given in reduced doses due to the drug increasing its half-life?
Valproic Acid
What are the possible side effects of Lamotrigine?
1. Stevens-Johnson syndrome = inflammatory eruption of skin & mucous membranes
2. dizziness
3. Diplopia
4. Nausea
5. Sedation
6. Rashes

"Steve Jones is Lame"
Typically used as an add-on for Partial & Generalized Tonic-Clonic seizures & perhaps also Absence seizures
Topiramate
What are the side effects of Topiramate?
1. Teratogenic in animals
2. may decrease the efficacy of Oral Contraceptives

"TOP PIRAte gets his MATE pregnant"
Anticonvulsant that is also used for Migraine Prophylaxis
Topiramate
Anticonvulsants that are effective in Refractory PARTIAL seizures when used in combo with other drugs
Gabapentin & Pregabalin = cause increase release of GABA
What other drugs are Gabapentin/Pregabalin commonly used with?
Carbamazepine or Phenytoin
Why are Gabapentin & Pregabalin good drugs?
1. Do not affect blood levels of other Anticonvulsant meds
2. well absorbed after oral administration
3. well tolerated
Add-on for Partial & Generalized Tonic-Clonic seizures

Side effects include nervousness, tremor, & depression
Tiagabine = inhibits GABA uptake
DOC for Petit Mal (Absence) Seizures
Ethosuximide
What are the side effects of Ethosuximide?
1. GI upset

2. Lethargy = "sux" the energy out of you
What is Ethosuximide often co-administered with? Why?
Primidone or Phenytoin

May precipitate Grand Mal seizures
What drug can exacerbate Petit Mal (Absence) seizures & should not be used alone in patients with Petit Mal?
Phenytoin
Anticonvulsant that is effective for both Petit Mal & Grand Mal; unlike Ethosuximide, it may be used alone to treat Petit Mal
Valproic Acid
What are the side effects of Valproic Acid?
1. Hepatotoxicity, esp. in children
2. N/V
3. Teratogenic
Anticonvulsant useful in Petit Mal, but tolerance develops in a few weeks

Minimal side effects other than sedation
Clonazepam
What 3 anticonvulsants can also be used for Bipolar Disorder as a mood stabilizer?
1. Carbamazepine
2. Valproic Acid
3. Lamotrigine

"Valerie is Bipolar so she eats Lame Carbs"
What anticonvulsants are also used for Peripheral Neuropathic pain?
Gabapentin & Pregabalin