Pharm S2B3 - Cns - Anticonvulsants

Front 1

What do seizures result from?

Back 1

Imbalance between excitatory & inhibitory systems

Front 2

Describe Partial Seizures

Back 2

1. involve only 1 area of the brain

2. No loss of consciousness

Front 3

What are the 2 types of Partial Seizures?

Back 3

1. Simple Partial (Elementary Symptomatology) = Cortical focal

2. Complex Partial = Psychomotor

Front 4

Describe Generalized Seizures

Back 4

1. Diffuse

2. always involves loss of consciousness

Front 5

List the type of Generalized Seizures

Back 5

1. Absence = Petit Mal = Blank Stare

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

3. Status Epilepticus

Front 6

List the 5 Anticonvulsants that prolong inactivation of Na+ channels & thereby reduce ability of neurons to fire at high frequencies

Back 6

1. Phenytoin
2. Carbamazepine
3. Valproic Acid
4. Lamotrigine
5. Topiramate

PVC-LT

Front 7

What mechanisms of action does Topiramate possess?

Back 7

1. increases Na+ channel inactivation

2. enhances GABA action

3. decreases Glutamatergic activity

Front 8

List the two Anticonvulsants that inhibit T-type Ca+ Channels

Back 8

1. Ethosuximide

2. Valproic Acid

Front 9

What 3 mechanisms of action does Valproic Acid possess?

Back 9

1. increases Na+ channel inactivation

2. enhances GABA

3. inhibits T-type Ca+ channels

Front 10

List the 4 anticonvulsants that enhance GABAergic activity

Back 10

1. Phenobarbital

2. Primidone

3. Diazepam

4. Clonazepam

Front 11

Anticonvulsant that increases the synaptic availability of GABA by inhibiting its reuptake

Back 11

Tiagabine

Front 12

2 Anticonvulsants that enhance depolarization induced GABA release

Back 12

1. Gabapentin

2. Pregabalin

Front 13

What is the DOC for treatment of Status Epilepticus?

Back 13

Diazepam I.V.

Front 14

This is one of the most effective drugs in Infantile Myoclonus, but tolerance is a problem

Back 14

Diazepam

Front 15

What is the downfall when using Benzodiazepines (Diazepam & Clonazepam) for Grand Mal seizures?

Back 15

Only effective for 2-3 weeks due to tolerance = cannot be used for long term seizure treatment

Front 16

What groups of drugs are used to treat Grand Mal, Partial, & Status Epilepticus seizures?

Back 16

1. Benzodiazepines
-Diazepam
-Clonazepam

2. Barbiturates
-Phenobarbital
-Primidone

3. Hydantoins
-Phenytoin

4. Valproic Acid

5. Carbamazepine

6. Add-ons: Lamotrigine, Topiramate, Gabapentin/Pregabalin, Tiagabine

Front 17

Benzodiazepine that may have some efficacy in Petit Mal seizures

Back 17

Clonazepam

Front 18

One of the drugs of choice for Grand Mal seizures but is very sedating, induces microsomal enzymes, & is a possible teratogen

Back 18

Phenobarbital

Front 19

What may happen if abrupt withdrawal from Phenobarbital occurs?

Back 19

precipitated Status Epilepticus

Front 20

Barbiturate that is converted to Phenobarbitol & Phenylethylmalonamide (PEMA) which are both active products

Back 20

Primidone

Front 21

What are the possible side effects of Primidone?

Back 21

1. Ataxia
2. Nausea
3. Vomiting

"the Prima donna is nauseaous & vomits & she can't walk straight"

Front 22

Anticonvulsant that is frequently effective in patients not responding to Phenytoin or Phenobarbital

Back 22

Primidone

Front 23

What is Primidone often given in combination with? What should it never be given in combo with?

Back 23

Phenytoin

Phenobarbital = both are Barbiturates & induce metabolism of each other

Front 24

Arguable is a drug of choice for Grand Mal & Partial seizures & is generally less sedating than Barbiturates

Back 24

Phenytoin

Front 25

What are drug interactions that Phenytoin possesses?

Back 25

1. highly bound to plasma proteins = displaces drugs
2. Induces P450 & other enzymes
-increased metabolism of Barbiturates
-Vitamin D deficiency

Front 26

List the side effects of Phenytoin (9)

Back 26

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

Front 27

A DOC for Grand Mal seizuires but is Hepatotoxic, especially in children

Back 27

Valproic Acid

Front 28

What are the drug toxicities of Valproic Acid?

Back 28

1. N/V
2. Teratogen = Neural Tube Defects = Spina Bifida
3. can inhibit metabolism of other drugs = increases their levels

Front 29

This is a drug of choice for Partial Seizures & is relatively safe & nontoxic

Back 29

Carbamazepine

Front 30

What are the side effects of Carbamazepine?

Back 30

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

Front 31

Typically used as an add-on in Partial & possibly Petit Mal seizures

Back 31

Lamotrigine

Front 32

With what drug must Lamotrigine be given in reduced doses due to the drug increasing its half-life?

Back 32

Valproic Acid

Front 33

What are the possible side effects of Lamotrigine?

Back 33

1. Stevens-Johnson syndrome = inflammatory eruption of skin & mucous membranes
2. dizziness
3. Diplopia
4. Nausea
5. Sedation
6. Rashes

"Steve Jones is Lame"

Front 34

Typically used as an add-on for Partial & Generalized Tonic-Clonic seizures & perhaps also Absence seizures

Back 34

Topiramate

Front 35

What are the side effects of Topiramate?

Back 35

1. Teratogenic in animals
2. may decrease the efficacy of Oral Contraceptives

"TOP PIRAte gets his MATE pregnant"

Front 36

Anticonvulsant that is also used for Migraine Prophylaxis

Back 36

Topiramate

Front 37

Anticonvulsants that are effective in Refractory PARTIAL seizures when used in combo with other drugs

Back 37

Gabapentin & Pregabalin = cause increase release of GABA

Front 38

What other drugs are Gabapentin/Pregabalin commonly used with?

Back 38

Carbamazepine or Phenytoin

Front 39

Why are Gabapentin & Pregabalin good drugs?

Back 39

1. Do not affect blood levels of other Anticonvulsant meds
2. well absorbed after oral administration
3. well tolerated

Front 40

Add-on for Partial & Generalized Tonic-Clonic seizures

Side effects include nervousness, tremor, & depression

Back 40

Tiagabine = inhibits GABA uptake

Front 41

DOC for Petit Mal (Absence) Seizures

Back 41

Ethosuximide

Front 42

What are the side effects of Ethosuximide?

Back 42

1. GI upset

2. Lethargy = "sux" the energy out of you

Front 43

What is Ethosuximide often co-administered with? Why?

Back 43

Primidone or Phenytoin

May precipitate Grand Mal seizures

Front 44

What drug can exacerbate Petit Mal (Absence) seizures & should not be used alone in patients with Petit Mal?

Back 44

Phenytoin

Front 45

Anticonvulsant that is effective for both Petit Mal & Grand Mal; unlike Ethosuximide, it may be used alone to treat Petit Mal

Back 45

Valproic Acid

Front 46

What are the side effects of Valproic Acid?

Back 46

1. Hepatotoxicity, esp. in children
2. N/V
3. Teratogenic

Front 47

Anticonvulsant useful in Petit Mal, but tolerance develops in a few weeks

Minimal side effects other than sedation

Back 47

Clonazepam

Front 48

What 3 anticonvulsants can also be used for Bipolar Disorder as a mood stabilizer?

Back 48

1. Carbamazepine
2. Valproic Acid
3. Lamotrigine

"Valerie is Bipolar so she eats Lame Carbs"

Front 49

What anticonvulsants are also used for Peripheral Neuropathic pain?

Back 49

Gabapentin & Pregabalin