Neuro - Carrier - Epilepsy

Front 1

Whats the goal of anti-epileptic drugs?

Back 1

Suppress formation or spread of abnormal electrical discharges in brain

=inhibit Na or Ca influx responsible for neuronal depol

Inc. inhibitory neurotransmission by GABA (=opne Cl- channels)

Inhibit excitatory glutamate neurotransmision

Front 2

What are themolecular targets of GLUTAMATE?

Back 2

AMPA, NMDA, Voltage gated Na channel, Ca2+ channel, and K+ channel

Front 3

What are the molecular targets of GABA?

Back 3

GABA Transaminase

GABA A and B Receptors (A is primary target)

Front 4

T/F: Most anti-epileptic drugs are orally effective

Back 4

TRUE (80-100% into circulation)

Most do not highly bind plasma protein

predominantly distributed into total body water

Plasma clearance slow

Front 5

T/F: The entire class of anti-epileptics is black boxed

Back 5

TRUE

Front 6

How are most Anti-epileptics cleared?

Back 6

Hepatically

Front 7

What drugs work for Partial seizures and general tonic-clonic seizures?

Back 7

"Find Cars Priced Very Low" = Pehnytoin, Carbamasepine, Primadone, Vigabatrin, Lamotrigine

"Find GABA Pre La Leve" = Phenobarbitol, Gabapentrin, Pregabalin, Lacosamide, Levetiracetam

"Zoni Failed To Rufi Ezu Tia" = Zonisamide, Felbamate, Topiramate, Rufinamide, Ezogabine, Tiagabine

Front 8

What drug to do always choose for a seizure in which pt just stares ahead for a little bit where eyes may roll up?

Back 8

This is an absence seizure = use Ethosuximide

Front 9

Alternate drugs for seizures?

Back 9

"Lora Clobbered (x3) Vagus Double Aces" = Lorezepam, Clonazepam, Clorasepate, Clobazam, Vagus n. Stim, Diazepam, Acetazolamide

Front 10

MOA Phenytoin?

Back 10

Alters Na+ = inactive state of Na+ channel - inhibits generation of repetitive APs (=dec. glutamate, inc., GABA)

Front 11

Whats the more soluble form of Phenytoin given orally to be absorbed in GI tract?

Back 11

Fosphenytoin

Front 12

What metabolizes Phenytoin?

Back 12

CYP2C9/2C19

And phenytoin induces 2C9/3A4

Front 13

What are the three drugs that do zero order kinetics

Back 13

Phenytoin, Aspirin, Alcohol

Front 14

Pt presents with Hirsutism, Diplopia and Ataxia, Nyustagmus (and loss of smooth m. eye movement) and Gingival hyperplasia. What drug were they on?

Back 14

Phentytoin

(Pneumonic for SE's = DANG = Diplopia (double vision), Ataxia, Nystagmus (eye movement), Gingival hyperplasia)

Front 15

If infused too fast, what does phenytoin cause?

Back 15

Hypotension and cardiac arrhythmias

Front 16

All of the drugs for Seizures inhibit the Na receptor except which ones?

Back 16

Inhibits GABA-T (GABA Aminotransferase) - Vigabatrin (vision loss)

Inhibit Ca2+ receptor = Bagapenrin, Pregabalin, Ethosuximide

Binds synaptic vessicle protein SV2A = Levetiracetam

Opens K+ Channel = Ezogabine

Front 17

What is the ONLY way Carbamazepine can be given?

Back 17

Orally

Front 18

Carbamazepine toxicity?

Back 18

Diplopia, ataxia, CNS depression, Blood Dyscrasias (leukopenia), Asians more likely to get Steven's Johnson

Front 19

What are the Drugs that can cause Steven's Johnson?

Back 19

Carbamazepine, Lamotrine, Tiagabine

Front 20

Phenobarbital MOA?

Back 20

Enhancement of inhibitory neurotransmission (binds GABA prolonging opening of Cl- channel)

Front 21

MOA of Vigabatrin?

Back 21

Irreversible inhibitor of GABA aminotransferase (GABA-T)

Front 22

PT has vision loss, anemia, somnolence, and suicidal ideation. what drug are they on?

Back 22

Vigabatrin

Front 23

T/F: Via the SHARE program, only specific physicans and pharmacists can prescribe and distribute certain meds

Back 23

TRUE

Front 24

Lamotrigine - Adjunctive or Monotherapy?

Back 24

Either...mostly Adjuctive

Front 25

SE's Lamotrigine?

Back 25

Skin rash, dizzy, H, Diplopia, N, somnolence

Life-threatening dermatitis in 1-2% of pediatric pts...ie Steven's Johnson or toxic epidermal necrosis

(3 that cause Steven's Johnson = Carbamazepine, Lamotrine, Tiagabine)

Front 26

MOA of Gabapentin and Pregabalin (and Ethosuximide)?

Back 26

Block voltage-gated Ca2+ channels = modify release of GABA

Front 27

Whats the MOA of Lacosamide?

Back 27

Enhanced slow inactivation of Na+ Channel --> blocks actions of neurotropic factors of axonal and dendritic growth

Front 28

Whats the BEST Use for Lacosamide?

Back 28

It doesn't have ANY effect on CYP450s and drug interactions are negligible so use in pts who are on a lot of other drugs

Front 29

MOA levetiracetam?

Back 29

Binds to synaptic SV2A = may modify release of glutamate and GABA

Front 30

SEs of Tigabine?

Back 30

Steven's Johnson (=Carbamazepine, Lamotrine, Tiagabine) or toxic epidermal necrolysis

CNS depression, suicidal ideation

Front 31

What are some things we can use Topiramate for other than seizures?

Back 31

Lennox-Gustaut syndrome, West's syndrome, Absence seizures, migraine H

Front 32

SE's Topiramate?

Back 32

Urolithiasis = ONLY ONE that causes kidney stones

myopia, glaucoma, metabolic acidosis

Front 33

What are the drugs that can cause Metabolic acidosis?

Back 33

Zonisamide, Topiramate

Front 34

MOA Felbamate?

Back 34

Use-dependant block of NMDA receptors

Front 35

SE's Felbamate?

Back 35

Aplastic Anemia, Severe Hepatitis

Front 36

SE's Rufinamide?

Back 36

Short QT, V, Somnolence

Front 37

MOA Ezogabine?

Back 37

Opens K+ Channel (NOTE - ONLY ONE THAT DOES THIS!!!)

= suppressing epileptic activity

Front 38

MOA Ethosuzimide, used for Absence Seizures?

Back 38

Inhibits Ca2+ channels (others that do this too are Bagapenrin and Pregabalin)

Front 39

What type of Seizure can Valproic Acid and Sodium Valproate treat?

Back 39

Every

Front 40

SE's for valproic acid and sodium valproate?

Back 40

Hepatotoxicity, Pancreatitis, Inc. risk Spina Bifida in offspring of preggos taking it

Front 41

What are the Benzodiazepines we talked about?

Back 41

Diazepam and Lorazepam, Clonazepam, Clorazepate, and Clobazam

Front 42

MOA of Acetazolamide?

Back 42

Inhibits Carbonic Anhydraseq

Front 43

What does Vagus nerve stimualation work best for?

Back 43

Pts with refractory partial seizures

or when seizure meds are poorly tolerated

Front 44

Define Vagus nerve stimulation

Back 44

Wire into chest, wrapped around vagus n., regularly sends electrical pulses to vagus to try and prevent seizures.

Front 45

Define Status Epilepticus

Back 45

recurrent episodes of tonic-clonic seizures = remain unconscious without normal muscle movements between episodes

= requires IMMEDIATE CV, respiratory and metabolic management

Front 46

Pt is seizing on floor of Wal-Mart - they're unconscious, don;t have movement between seizures. Tx?

Back 46

1st = IV Diazepam or Lorazepam
2nd = IV Phenytoin, BUT More likely we'll use Fosphenytoin
3rd - IF no response to Fosphenytoin (phenytoin) try Phenobarbital

Front 47

Women on what seizure meds need to use a non-hormonal BC?

Back 47

Phenytoin, Phenobarbital, Carbamazepine, Topiramate, Oxcarbazepine, Felbamate

Front 48

What Seizure meds are teratogenic?

Back 48

Phenytoin, Valproate and Topiramate = don't use in preggos

Front 49

A pt with epilepsy hasn't had a seizure for 3 years and wants to go off drugs. What do you tell them?

Back 49

OK - Withdrawal can cause inc. frequency and severity of seizures

Benzodiazepines and Barbiturates are difficult to doscontinue - may take weeks to months

Front 50

T/F: Generic anti-epileptic drugs are not as good as brand drugs

Back 50

TRUE