Duke PA Seizure Pharmacology
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| two types of partia seizure | simple, complex
🗑
|
||||
| types of generalized seizure | tonic-clonic, absence, myoclonic, infantile spasm, status epilepticus
🗑
|
||||
| these seizures are caused by a group of hyperactive neurons exhibiting abnormal electrical activity, which are confined to a single locus in teh brain. the electrical discharge dies not spread, and the patient does not lose consciousness | simple partial seizure
🗑
|
||||
| theses seizures exhibit complex sensory hallucinations, mental distortion, and loss of consciousness. Motor dysfunction may involve chewing movements, diarrhea, and or urination. Consciousness is altered | complex partial seizure
🗑
|
||||
| result in loss of consciousness, followed by continuous contraction, and rapid contraction relaxation phases. period of confusion and exhaustion may follow due to depletion of glucose and energy stores | tonic-clonic seizure
🗑
|
||||
| brief, abrupt, and self limiting loss of consciousness. Patient stares and exhibits rapid eye blinking. Very distinct three per second spike on EEG. onset is from 3-5 years and last till puberty or beyond | abscence seizure
🗑
|
||||
| seizures that consist of short episodes of muscle contractions that may reoccur for several minutes. generally occur after wakening and exhibit as brief jerks of the limbs. | myoclonic
🗑
|
||||
| seen in young children with fever. generalized tonic-clonic convulsions of short duration and do not necessarily lead to diagnosis of epilepsy | febrile seizures
🗑
|
||||
| two or more seizures occuring without recovery of full consciousness between them. life threatening and requires emergency treatment | status epilepticus
🗑
|
||||
| second generation antiepileptics | gabapentin, lamotrigine, topiramate, levetiracetam, oxcarbazepine, zonisamide
🗑
|
||||
| older antiepileptics | phenobarbitol, phenytoin, carbamazepine, ethosuximide, divalproex, valproic acid
🗑
|
||||
| bind to GABA inhibitory receptors to reduce firing rate | benzodiazepines
🗑
|
||||
| examples of benzodiazepines | diazepam, lorazepam
🗑
|
||||
| reduces the propagation of abnormal impulses in the brain by blocking sodium channels, thereby inhibiting the generation of repetitive action potentials in the epileptic focus and preventing their spread | carbamazepine
🗑
|
||||
| carbamazepine is effective for treatment of __ | partial seizures, secondarily generalized tonic-clonic seizures, trigeminal neuralgia, bipolar disease
🗑
|
||||
| __ may be seen in some patients taking carbamazepine (especially in the elderly) | hyponatremia
🗑
|
||||
| carbamazepine should not be prescribed for patients with __ b/c it may cause an increase in seizure | absence
🗑
|
||||
| is a combination of sodium valproate and valproic acid and is reduced to valproate when it reaches teh GI tract | Divalproex
🗑
|
||||
| was designed to improve GI tolerance of valproic acid | Divalproex
🗑
|
||||
| Divalproex is effective in the treatment of | partial and primary generalized epilepsies
🗑
|
||||
| __ is bound to albumin which can cause significant interaction with other highly protein bound drugs | valproate
🗑
|
||||
| __ should be monitored frequently in patients on Divalproex | hepatic enzymes
🗑
|
||||
| teratogenicity is of great concern with | Divalproex
🗑
|
||||
| reduces propagation of abnormal electrical activity in the brain, most likely by inhibiting T-type calcium channels | Ethosuximide
🗑
|
||||
| Ethosuximide is effective only in treating __ which limits its clinical use | primary generalized absence seizures
🗑
|
||||
| __ has a broad spectrum of anticonvulsant action | Felbamate
🗑
|
||||
| Felbamate is reserved for use in refractory epilepsies because of the risk of __ | aplastic anemia and hepatic failure
🗑
|
||||
| Felbamate is reserved for use in refractory epilepsies, primarily __ | Lennox-Gastaut syndrome
🗑
|
||||
| __ is an analog of GABA | Gabapentin
🗑
|
||||
| even though it is a GABA analog it does not act on GABA receptors nor enhance GABA action, nor is it converted to GABA | Gabapentin
🗑
|
||||
| Gabapentine is approved for adjunct therapy for __, as well as treatment for post herpetic neuralgia | partial seizures
🗑
|
||||
| for gabapentin reduced dosing is required for | renal disease
🗑
|
||||
| Gabapentin has been shown to be well tolerated in the __ population with partial seizures due to relatively mild side effects | elderly
🗑
|
||||
| __ has limited or no reported pharmacokinetic drug interactions | Gabapentin
🗑
|
||||
| __ blocks sodium channels as well as high voltage-dependant calcium channels | Lamotrigine
🗑
|
||||
| Lamotrigine is effective in treating __ | a wide variety of seizure disorders including, parital, generalized, typical absence, Lennox-Gastaut syndrome, and bipolar disorder
🗑
|
||||
| lamotrigine doses should be reduced when adding valproate to therapy unless __ | valproate is being added in small amounts to boost the lamotrigine serum concentration
🗑
|
||||
| rapid titration of Lamotrigine has been reported to cause a potentially life threatening __ | rash
🗑
|
||||
| Lamotrigine has been shown to be well tolerated by the __ population with partial seizures due to the relatively minor adverse effects when titrated slowly | elderly
🗑
|
||||
| levetiracetam is approved for adjunct therapy of __ | partial seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children
🗑
|
||||
| side effects of levetiracetam most often reported include __ | dizziness, sleep disturbances, headache, and weakness
🗑
|
||||
| __ is well absorbed orally and excretion is urinary, with most of the drug being unchanged | Levetiracetam
🗑
|
||||
| __ is a prodrug that is rapidly metabolized to MHD which is responsible for its anticonvulsant quality | Oxcarbazepine
🗑
|
||||
| Oxcarbazepine is approved for use in __ | adults and children with partial onset seizures
🗑
|
||||
| Oxcarbazepine AE's | nausea, vomiting, headache, and visual disturbances
🗑
|
||||
| primary mechanism of action of __ is the enhancement of inhibitory effects of GABA-mediated neurons | Phenobarbital
🗑
|
||||
| the primary use for phenobarbital in epilepsy is treatment of __ | status epilepticus
🗑
|
||||
| Phenobarbital should only be considered for chronic therapy once a patient is found to be refractory to many other drugs because of __ | adverse effects of sedation, cognitive impairment, potential for osteoporosis and its role as an inducer of the P450 enzymes
🗑
|
||||
| __ selectively blocks voltage-gated sodium channels by selectively binding to the channel in the inactive state and slowing its rate of recovery | Phenytoin
🗑
|
||||
| Phenytoin is effective for the treatment of __ | partial seizures, generalized tonic-clonic seizures, and in the treatment of status epilepticus
🗑
|
||||
| with Phenytoin __ causing nystagmus and ataxia | depression of the CNS occurs particularly in the cerebellum and vestibular system
🗑
|
||||
| Phenytoin may cause __ | gingival hyperplasia
🗑
|
||||
| long term use of Phenytoin may lead to development of __ | peripheral neuropathies and osteoporosis
🗑
|
||||
| __ is a prodrug that is rapidly converted to phenytoin in the blood providing high levels of phenytoin within minutes | Fosphenytoin
🗑
|
||||
| unlike phenytoin sodium fosphenytoin can be given | IM
🗑
|
||||
| __ inhibits excitatory neurotransmitter release | Pregabalin
🗑
|
||||
| Pregabalin has proven effects on __ | partial onset seizures, neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and fibromyalgia
🗑
|
||||
| __ have been reported with Pregabalin | drowsiness, blurred vision, wieght gain, and peripheral edema
🗑
|
||||
| __ has two active metabolites phenobarbitol and phenylethylmalonamide | Primidone
🗑
|
||||
| due to adverse effects associated with phenobarbitol __ should only be considered for use in those patients with refractory epilepsy | Primidone
🗑
|
||||
| __ blocks GABA uptake into presynaptic neurons, permitting more GABA to be available for receptor binding, thus there is thought to be enhanced inhibitory activity | Tiagabine
🗑
|
||||
| Tiagabine is effective in | decreasing the number of seizures in patients with partial onset epilepsy
🗑
|
||||
| Tiagabine adverse effects include __ | tiredness, dizziness, and GI upset
🗑
|
||||
| Topiramate is effective and approved for treatment of | migraine, and has broad spectrum anti seizure activity
🗑
|
||||
| Topiramate adverse effects include | somnolence, weight loss, paresthesias, renal stones, glaucoma, oligohidrosis, and hyperthermia
🗑
|
||||
| __ is a sulfonamide derivative that has a broad spectrum of action. Cross reaction with other sulfonamides should be monitored. | Zonisamide
🗑
|
||||
| Zonisamide is approved for use in patients with | partial epilepsy
🗑
|
||||
| Zonisamide may cause | kidney stones, oligohidrosis
🗑
|
||||
| Drugs that may cause drug toxicity seizures | hig-dose antibiotics, cocaine, antipsychotics
🗑
|
||||
| first choice drugs for partial seizures | carbamazepine, oxcarbazepine, phynytoin
🗑
|
||||
| first choice drugs for primarily generalized tonic-clonic seizures | phenytoin, valproic acid
🗑
|
||||
| first choice drugs for absence seizures | ethosuximide, valproic acid
🗑
|
||||
| proper titration of most anticonvulsant agents (except phenytoin and phenobarbital) | initiate with 1/3-1/4 of anticipated maintenane dose and increase over 3-4 weeks
🗑
|
||||
| <20% of patients have improved control with | polytherapy
🗑
|
||||
| the IV form of phenytoin | fosphenytoin
🗑
|
||||
| commonly used for prophylaxis following trauma or neurosurgery | phenytoin,fosphenytoin
🗑
|
||||
| used for patients with seizures secondary to brain mets | phenyoin, fosphehnytoin
🗑
|
||||
| if you double the dose of phenytoin, the effect is __ | more than doubled
🗑
|
||||
| phenytoin is bound to __ about 90% | albumin
🗑
|
||||
| disease states that decrease blood albumin will increase __ , in a patient on phenytoin | free phenytoin
🗑
|
||||
| indications for use of carbamazepine (tegretol) | simple and complex partial seizures, generalized tonic-clonic (grand mal)
🗑
|
||||
| sulfonamide based anticonvulsant | Zonisamide (Zonegran)
🗑
|
||||
| gabapentin serious adverse events | none
🗑
|
||||
| gabapentin nonserious adverse events | weight gain, peripheral edema, bahavioral changes
🗑
|
||||
| lamotrigine adverse events | rash (Stevens Johnson and toxic epidermal necrolysis), hypersensitivity reactions, DIC, arthritis, tics, insomnia
🗑
|
||||
| levetiracetam serious adverse effects | none
🗑
|
||||
| oxcarbazepine serious adverse effects | hyponatremia(more common in elderly), rash
🗑
|
||||
| topiramate adverse effects | nephrolithiasis, open angle glaucoma, hypohidrosis (in children)
🗑
|
||||
| zonisamide adverse effects | rash, ranal calculi, hypohidrosis (in children)
🗑
|
||||
| IV medications used for treatment of status epilepticus | Diazepam (valium), lorazepam (Ativan)
🗑
|
||||
| phenytoin, carbamazepine and valproic acid are category __ for pregnancy | D
🗑
|
||||
| __ appears to carry the greatest risk of teratogenicity and should be avoided during pregnancy and in women of childbearing age | Valproic acid
🗑
|
||||
| Newer agents are categorie __ in pregnancy | C
🗑
|
||||
| when appropriate gradually withdraw anticonvulsants over a period of __ | 6 months
🗑
|
||||
| when is it appropriate to discontinue anticonvulsants | seizure free period 2-4 years, complete seizure control within 1 year, onset after age 2 but before 35, normal EEG
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
bwyche
Popular Medical sets