Anti-Epileptic Drugs Flashcards

1
Q

Seizures are excessive synchronous neural activity usually occuring in the _______. They are complex and incompletely understood

A

Cerebral Cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Seizure causes:

A

1) Intracranial lesion (symptomatic)
2) Extracranial insult (reactive)
3) Primary disorder (idiopathic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 7 traits of the ideal anti-epileptic drug (AED)

A

1) effective –> broad spectrum
2) Safe –> risk vs benefit
3) limited drug-drug interactions
4) Long half life (SID or BID dosing)
5) Anti-epileptogenic effects
6) enteral and parenteral formulations
7) affordable/sustainable for long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two “Old AEDs”

A

1) Phenobarbital

2) Bromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Phenobarb

  • ROA
  • Class
  • MoA
A

Oral and IV

  • Most common first line AED for chronic therapy
  • Class: Barbiturate (long acting) - drug class IV
  • MoA: classic barbiturate mechanism: GABA-A agonist/potentiator; potentiates the inhibitory effects of GABA by binding and prolonging opening of Cl- channels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Phenobarbital Pharmacokinetics

A
  • Crosses BBB
  • Good oral bioavailability (~90%), wide distribution
  • Extensively plasma protein (albumin) bound
  • Metabolized by liver –> potent inducer of hepatic microsomal enzymes, and is metabolized through that system (P450).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is tolerance more likely to develop in bromide or phenobarbital?

A

phenobarbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Precautions/Adverse Effects of Phenobarb

A

PU/PD/PP

  • Sedation (transient)
  • Elevated liver enzymes (induced alkaline phosphatase- ALP)
  • Less commonly: paradoxical hyperexcitability, hepatoxicity, pancytopenia (reversible)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bromide

  • RoA
  • Use
  • Class
A
  • Oral Only
  • 1’ add on anticonvulsant for dogs NOT CATS
  • Class: anticonvulsant: Salt/Chemical powder - alters chloride transport across neuronal cell membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bromide pharmacokinetics

A
  • Good oral absorption, excreted unchanged by kidneys
  • changes in serum chloride ion concentration can significantly interfere with bromide levels –> keep salt intake from diet stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bromide Precautions/Adverse Effects

A
  • Interferes with chloride on serum chemistry -> reads falsely high (bromide recognized as Cl-)
  • GI upset (vomiting), sedation (can be severe during loading)
  • 25-50% of cat may show asthma-like pulmonary changes (CONTRAINDICATED)
  • Toxicity with overdose is termed “bromism- severe sedation and neurological signs (tx with.9% NaCl to promote bromine excretion)
  • Pancreatitis is also possible -> range of GI signs from vomit, regurg, GI ulcers, abdominal pain, inappetence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name the 3 New AEDs

A

1) Levetiracetam (Kepra)
2) Zonisamide
3) Imeption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly