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Anti-Seizure Drugs

USMLE Step 1

DrugMOA & ADRs
Primary Epilepsy no anatomic cause
Secondary Epilepsy occurs as a result of tumors,head injury,AVMs in the brain,stroke,hypoglycemia,meningitis,or rapid EtOH w/drawl in an EtOHic
Simple partial epilepsy grp of hyperactive neurons confined to a single locus (temporal or hippocampal) discharge, theres no spread, doesnt lose consciousness
Complex partial epilepsy loss of consciousness along w/ motor dysfx, diarrhea & urination, arise from single brain region like the temporal lobe and MAY SPREAD causing secondary general tonic-clonic seizure
Phenytoin MOA stabilizes neuron membranes 2 depolarization by decrease Na influx in resting state or during depolarization also reduces influx of Ca during depolarization & - repetitive firing,used 4 either type partial focal seizures,grand mal,status epilepticus
Carbamazepine MOA reduces propagation by - Na channels = - repetitive APs,DOC 4 either type of partial focal seizure,also 4 grand mal
Phenobarbital MOA maybe via - effects of GABA cause limit spread of seizure discharge & elevation of seizure threshold,used in grand mal,DOC 4 ongoing or recurrent febrile seizures,used occasionally for insomnia,anxiety & 4 tonic-clonic seizures
Ethosuximide MOA:unknown,but reduces propagation of abnml electrical activity in the brain,DOC in absence seizures
Clonazepam MOA:BZD that binds to GABA receptor to trigger Cl influx,NOT for chronic tx, but maybe used to limit myoclonic seizure spread
Diazepam DOC in status epilepticus
Grand mal tonic-clonic seizure, most common and most dramatic form,marked by loss of consciousness followed by the tonic-clonic phase
Petit mal absence seizure,marked by brief,abrupt,self-limited LOC,occurs b/t ages 3-5 & recurrs until puberty,tend to stare during attack w/ rapid eye blinking lasting 3-5 secs
Myoclonic seizure marked by short episodes of muscle contraction that recur for several mins,rare @ any age,often a result of permanent neurologic damage due to hypoxia,uremia,encephalitis or drug poisoning
Febrile seizure most commonly occur in 3-5 mons old,dont cause any lasting damage,occur in assoc w/ illnesses cause high febrile states & consist of generalized tonic-clonic convulsions of short duration;*Note if resolved then use fever reducers & tx underlying cause*
Valproic acid MOA:enhances GABA action action @ inhibitory synapses,DOC for myoclonic seizures
Status epilepticus rapidly recurrent unrelenting seizures
Phenytoin ADRs lrgly bound 2 albumin in body,depresses CNS,nystagmus & ataxia,n/v,gingival hyperplasia,megaloblastic anemia,- ADH release,hyperglycemia,glucosuria,teratogen due to potent P450 +
Phenobarbital ADRs use cautiously b/c decrease cognitive performance in kids
Carbamazepine ADRs chronic use cause stupor,coma,respiratory depression,drowsiness,vertigo,ataxia,blurred vision,n/v,aplastic anemia,agranulocytosis,thrombocytopenia & possible liver toxicity
Created by: jerrica_08
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