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55 Cards in this Set
- Front
- Back
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where do seizures usually originate?
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in the cerebral cortex
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What is a partial seizure?
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this starts in a cortical focus and may spread
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What is a simple partial seizure like?
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jerking lasting about 20 sec while preserving consciousness
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What is a complex partial seizure like?
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impairment of conciousness for less than 2 min, has lip smacking or hand tremors.
comes from temporal lobe |
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What are grand mal seizures?
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tonic clonic loss of conciousness, muscle contractions, generalized
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what is a petite mal like?
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staring, cease activity, for less than 30 seconds
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What neurotransmitter changes cause seizures?
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underactivity of GABA neurons or over activity of glutamate ones
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when treating with anticonvulsants, how do you usually initiate therapy?
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with a single drug
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what three antiseizure drugs induce cytochrome P450?
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phenytoin, carbamazepine, phenobarbital
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How does phenytoin (dilantin) work?
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this blocks sustained high frequency firing of neurons by:
Prolonging inactivation of Na+ channel** |
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what types of seizures is phenytoin used against?
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partial seizures and generalized tonic clonic seizures
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is phenytoin affected by plasma protein?
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yes it is 90% bound so it can be extremely variable
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How is phenytoin eliminated?
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elimination is dose dependent, first order at low levels, but zero order at higher ones
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What is the therapeutic range for phenytoin?
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small range 10-20 micrograms per mL
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When you dose phenytoin, how do you know you've reached therapeutic levels?
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the metabolism has become saturated (zero order)
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How does phenytoin react with warfarin?
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phenytoin inhibits warfarins breakdown, so warfarin concentration goes way up**
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What drug increases the metabolism of phenytoin?
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Carbamazepine
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What are the signs of phenytoin toxicity?
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Nystagmus
ataxia double vision |
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What are the funny side effects of phenytoin?
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gingival hyperplasia
hirsuitism (body hair growth) |
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is phenytoin ok for pregnant women?
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NO it is a teratogen
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How does carbamazepine work?
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this works like pheyntoin- by blocking Na+ channels
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What four things is Carbamazepine (Tegretol) used to treat?
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bipolar disorder
partial seizures generalized tonic clonic seizures trigeminal neuralgia |
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What does carbamazepine induce?
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induces hepatic enzymes, CYP3A (much like pheyntoin- kinda the same)
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what is the therapeutic range for carbamazepine (tegretol)
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this is between 6-12 micrograms/mL
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What does carbamazepine (tegretol) increase the metabolism of?
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everything-
phenytoin primidone ethosuximide valproic acid clonazepam |
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What things inhibit carbamazepine (tegretol) metabolism?
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cimetidine (tagament)
fluoxetine (prozac) |
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what are the signs of carbamazepine (tegretol) toxicity?
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GI upset
Blood dyscrasias Rash/stevens johnsons syndrome (HLA-B 1502) |
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is crabamazepine safe for pregnant women?
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no
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How does Vigabatrin (sabril) work?
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this is an Irreversible inhibitor of GABA transaminase (which normally breaks down GABA)
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How does Lamotrigine (Lamictal) work?
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this inactivates voltage depended Na+ channels
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What is Lamotrigine (Lamictal) used to treat?
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partial seizures
absences seizures bipolar disorder |
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What are the side effects of Lamotrigine (lamictal)
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Nausea
somnolence (drowsy) fatal dermatitis |
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How does Gabapentin (neurontin) work?
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this is a GABA analog, but doesnt act as a GABA agonist**
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What is Gabapentin (neurontin) used to treat?
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this treats partial seizures and generalized tonic-clonic seizures**
Neuropathic pain** |
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How long does Gabapentin last for?
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this has a short half life of only a few hours
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What are the common side effects of Gabapentin?
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dizziness, drowsiness, ataxia, headache, tremor, weight gain
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How does Levetiracetam (keppra) work?
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this binds to SV2A and reduces glutamate release while increasing GABA release
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How does Topirmate work?
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this blocks voltage depended Na+ channels, enhances GABA, and limits glutamate receptor activation
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Does topirmate block seizures?
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no, this only inhibits the spread of seizures
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What is Topiramate used to treat?
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this is broad spectrum, used to treat
partial and generalized tonic-clonic seizures migraines |
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What drug interaction does topiramate have?
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this may decrease the effectiveness of birth control pills
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How does Tiagabine (Gabatril) work?
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this inhibits GABA uptake
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What does Tiagabine (Gabatril) treat?
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partial seizures
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What is the first choice drug for absence seizures?
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Ethosuximide (Zarontin)
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How does Ethosuximide (Zarontin) work?
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this reduces low-threshold Ca2+ currents in the thalamus
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What is the only drug interaction of ethosuximide (zarontin)
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valproic acid decreases clearence of zarontin
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what are the signs of toxicity of Ethosuximide (zarontin)
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gastric pain
can cause steven johnsons syndrome |
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What is the drug of choice for absence seizures with generalized tonic/clonic seizures?
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valproic acid (depakene)
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What are the drug interactions of valproic acid?
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this inhibits its own metabolism at low doses.
also inhibits phenytoin and carbamazepine metabolism |
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What are the toxicity signs for valproic acid?
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nausea
vomiting abdominal pain heartburn tremor weight gain |
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is valproic acid ok for pregnant people?
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no
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What type of drug is Clonazepam (klonopin)
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this is a benzodiazepine (binds GABAa- intensifies GABA's action)
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What is clonazepam (klonopin) used to treat?
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this treats absence seizures
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How does clonazepam (klonopin) affect pregnancy?**
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causes deformities in first trimester, do not use
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What type of seizures do Diazepam and Lorazepam treat?
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status epilepticus*
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