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Pharmacology > Antiepileptic Drugs > Flashcards

Antiepileptic Drugs Flashcards

1
Q

mechanistically what triggers seizures

A

decrease in inhibitory synaptic activity or an increase in excitatory synaptic activity

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2
Q

what are the two main classes of anti epileptic drugs

A
  • drugs that block voltage gated channel: Na and T type Ca

- drugs that affect synaptic transmission: GABA agonist or glutamate antagonist

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3
Q

what are the drugs that block Na voltage gated channels

A

PCOLZ PVT (not so sure about PVT)

  • Phenytoin
  • Carbamazepine
  • Oxcarbazepine
  • Lamotrigine
  • Zonisamide
  • Phenobarbital
  • Valproate
  • Topiramate
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4
Q

drugs that block T type Ca channels

A

Ethosuximide

Valproate

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5
Q

drugs that enhance GABA transmission postsynapticallly and their mechanism

A

Direct action on the GABA receptors

Benzos
Barbiturates
Topiramate

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6
Q

drugs that enhance GABA transmission pre-synaptically and their mechanism

A
  • inhibit reuptake of GABA: Tiagabine

- inhibit degradation of GABA by irreversibly inhibiting GABA aminotransferase: Vigabatrin

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7
Q

drugs that inhibit glutamate neurotransmission pre-synaptically and their mechanism

A
  • decrease glutamate release by blocking pre-synpatic voltage gated Ca channels: Gabapentin and Pregabalin
  • binds to synaptic vesicle glycoprotein 2A (SV2A) : Levetiracetam
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8
Q

drugs that inhibit glutamate neurotransmission post synaptically and their mechanism

A

Phenobarbital and Topiramate: blocks glutamate receptors

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9
Q

drugs used for tonic-clonic seizures (generalized seizure)

A

COLT PV (Coach J)

Carbamazepine
Oxcarbazepine
Lamotrigine
Topiramate

Phenytoin
Valproate

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10
Q

drug of choice for absence seizures (generalized seizures)

A

Ethosuximide

Valproate

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11
Q

drug of choice if tonic-clonic seizures occur or emerge during absence seizures or preferred for atypical absence seizures

A

Valproate

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12
Q

drug of choice for myoclonic seizures (short episode of muscle contractions that may happen for several minutes) and drug used for adjunct therapy

A

Valproate

-Levetiracetam as adjunct therapy

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13
Q

drug of choice for atonic seizure (sudden loss of postural tone)

A

usually all drugs are refractory

Valproate and Lamotrigine may be beneficial

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14
Q

treatment of febrile seizures

A
  • if less than 15 minutes, give supportive therapy

- if greater than 15 minutes, use diazepam IV or as rectal solution

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15
Q

first line treatment for status epilepticus (seizures lasting longer than 30 minutes – life threatening)

A

IV Lorazepam

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16
Q

if seizures in status epilepticus continue after administration of IV lorazepam, what drug should be given

A

IV phenytoin or Fosphenytoin

17
Q

in status epilepticus, if IV lorazepam and phenytoin fail, what should be given

A

Phenobarbital

18
Q

Common complication of phenobarbital especially after giving lorazepam and phenytoin …how should the complication be handled

A

Respiratory depression –> intubation and ventilation should be instituted

19
Q

In status epilepticus, if lorazepam, phenytoin, and phenobarbital are not working, what should be done

A

general anesthesia with
Barbiturates (thiopental or pentobarbital)
Propofol
Midazolam

20
Q

seizures due to drug overdose or poisoning in a non epileptic person should be treated how

A

local anesthesia such as
Diazepam
Lorazepam
Phenobarbital

all IV

21
Q

drug used for breakthrough seizures (seizures in those on anti epileptic regimen)

A

Diazepam rectal gel

22
Q

AE of phenytoin

A

Gingival Hyperplasia

Fetal Hydantoin Syndrome

23
Q

AE of valproate

A

Hepatotoxicity

Spina Bifida

24
Q

AE of lamotrigine and what should be done

A

Steven Johnson’s rash - discontinue at first sign of rash

carries black box warning about rash

25
Q

AE of carbamazepine

A

Aplastic anemia

Agranulocytosis

26
Q

what occurs with overdose of anti epileptics

A

Respiratory Depression

27
Q

AE of phenobarbital

A

Cardiac defects

Oral clefts

28
Q

AE of Topiramate

A

Oral clefts

29
Q

what are some supplements that are given to pregnant women on anti epileptics drugs

A

first off, they should be avoided if possible especially ones like Valproate and Phenytoin

  • supplement folate to prevent spina bifida
  • supplement vitamin K especially in final months of pregnancy and in newborn to prevent Newborn Hemorrhagic Disease
30
Q

first line for essential tremor and also used as an anti epileptic

A

Primidone

31
Q

used for trigeminal and post herpetic neuralgia

A

Trigeminal Neuralgia: Carbamazepine

Post Herpetic Neuralgia: Gabapentin and Pregabalin

32
Q

non pharmacological treatment of seizures

A

Vagus Nerve Stimulation
Surgery
Ketogenic Diet

Pharmacology (79 decks)

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