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DU PA Seizure Pharm
Duke PA Seizure Pharmacology
| Question | Answer |
|---|---|
| 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 |
Created by:
bwyche
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