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DU PA Seizure Pharm

Duke PA Seizure Pharmacology

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