Antiepileptic drugs
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| Drugs which lower seizure threshold? | Theophylline, Tricyclic antidepressants, Antipsychotics (Pheothiazines--Clopromazine??)
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| Describe Generalized seizures and describe | both hemis involved: CONVULSIVE:Grand Mal, Tonic, Clonic NON-CONVULSIVE-Petit Mal (Absence szrs), Atonic, Myoclonic
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| seizure type? Sudden loss of muscle tone; may fall abruptly | atonic seizure (generalized)
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| Seizure type? 10-30secs LOC,eye/muscle flutters; mostly CHILDHOOD; pt suddenly stops what they're doing and resumes postictus | Absence seizures (Petit Mal)
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| Drugs used for Absence Seizures? ***** | Valproate and Ethosuximide
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| Seizure type? Max neurons of both hemis; begin w/ tonic(rigid) flexion of extremities 15-20 sec.s followed by extension; audible cry; Then clonic jerking phase;LOC | Tonic-Clonic Seizures (grand mal)
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| Seizure type? jerking movements of single/multiple muscle group; no LOC | Myoclonic Seizures
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| Seizure type? Rigid extremity flexion (no clonic phase);mostly during SLEEP; Consciousness not impaired | Tonic Seizures
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| Seizure type? One hemisphere | partial seizure due to injury, trauma, stroke, tumor
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| Name the 2 types of partial seizures, and describe them | Complex partial-LOCSimple partial-NO LOC
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| This seizure type starts with specific motor sensory or psychomotor phenomenon w/o LOC; ofter preceded by aura/specific smell | Simple Partial Seizure
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| Difficult form of childhood epilepsy (mostly nocturnal)2-6yrs old; Characterized by frequent and different seizure types, M.R., & behavioral problems; | Lennox-Gestaut Syndrome--mostly tonic and myoclonic
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| 1-2 min. dissociation w/ surroundings; stagger, mental confusion 1-2 minutes;over originates in temporal lobe-Schizo,depression | Complex Partial Seizures *** Caution must be used cuz Neuroleptic used may decrease threshold for epilepsy
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| seizures one after another (no consciousness in b/t); hours- days; can be fatal; may be due to rapid W/drawal of anticonvulsants | Status epilepticus
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| Status epilepticus...DOC? | Benzodiazepam/Clonazepam
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| Seizures that is triggered by hyperthermia; mostly young kids (3mo-5yrs)---poss. causes--meningitis | 1.)FEBRILE seizures(fever fit); Simple febrile seizure= ~15min& 1episode/24hrs 2.)Complex febrile seizure= LONGER&RECURS; 3.)tonic-clonic
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| highly lipophilic, structure related to IMIPRAMINE (TRICYCLIC),effective for Tonic-Clonic &Partial Seizures | CARBAMAZEPINE-not effective in Myoclonic&petit Mal
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| DOC for partial seizures | Carbamazepine
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| Caution with Carbamazepine...name 2 reasons why: | Autoinduction;**** P-450 inducer(reduces other meds); CARDIAC CONDUCTION DISTURBANCES***
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| Carbamazepine:adverse effects | heart conduction disturbances; dizzy/drowsy/anorexia/nausea/ataxia/diplopia/depression/mental sluggish/rash/short term mem decreases; hyponatremia & H2O retention
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| Carbamazepine increases/decreases metabolism of which drugs?? | Increases:Theophylline,OC's,Doxycycline, Warfarin Decreases: Verapamil, Fluoxetine, Diltiazem, Isoniazid, Erythromycin
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| DOC generalized tonic clonic seizures | Valproate
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| Absence seizure--drug? | Valproate
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| Valproate MOA? | potentiates GABA, Na&Ca blockade (decreases neurotransmission)
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| Valproate--protein or lipo bound? | protein bound---therefore can be easily displaced by others etc.
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| Adverse effects of Valproate? | HEPATOXIC!!!; loss of hair, weight gain, Fine TREMOR (use beta blockers)
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| Avoid Valproate in what type of patients? name 3 | kids<3yrs and those w/ liver dx (hepatotoxic), those taking salicylates (displaces valproate)
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| If Valproate can't be given...give what? | Ethosuxomide
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| Valproate...P450------? | inhibitor!! will increase levels of co-administered AED
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| This AED is contraindicted in pregnancy | Valproate---Teratogenic!!
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| This AED doesn't reduce efficacy of OC | Valproate
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| Phenytoin can be used as anti-epileptic and as what? | ANTI-ARRHYTHMIC!!!!
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| MOA of Phenytoin? | Blocks Na&Ca channels and Ca+mediated neurotransmission/electrical activity
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| Phenytoin effective for what types of seizures? | Generalized and Partial epilepsy---NOT effective against absence seizure
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| Adverse effects of Phenytoin? | gingival hyperplasia; FETAL HYDANTOIN SYNDROME; hirsuitism; involuntary movements (dyskinesias); Ataxia, diplopia, nystagmus,
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| Deficiency of what? is ass'd with Phenytoin use? | Folic acid (don't give prophylactic)
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| Phenytoin= P450....? | inducer, therefoere increases metabolism of theophylline, OC's, carbamazepine, and valproate
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| Phenytoin can be displaced by what other AED? | Valproate
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| Phenytoin + Valproate=?? | Valproate displaces Phenytoin--> increased free fraction of Phenytoin-->higher adverse effects of Phenytoin
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| MOA Ethosuximide? | Blocks Ca channels in Thalamus
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| Adverse effects Ethosuximide? | Blood dyscrasias, sedation, nausea, anorexia, headache
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| MOA Phenobarbital & Primidone? | prolongs Cl-channel opening @GABA receptor
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| Drugs for CHRONIC tx of epilepsy? partial and generalized seizures | Phenobarbital<Primidone
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| Adverse effects of Phenobarbital and Primidone? | Osteomalacia; Paradoxical effects (hyperactivity&insomnia); P450 inducers
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| Adverse effect Primidone? | impotence
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| Primidone is a prodrug converted to | Phenobarbital&Phenylethylmalonamide
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| Diazepam and Clonazepam-classification? | Benzodiazepines for tx. of epilepsy
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| Tx of termination of status epilepticus**** and febrile seizures; adverse effects? | Benzodiazepines; Excess salivation, wt. gain, anterograde amnesia
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| strucural analog of GABA that enhances its release; used for partial seizrures, tonic clonic, neuropathic pain, mood stabilizers | GABApentin
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| Blocks release of excitatory Amino acids(glutamate); increases GABA levels; used for partial seizures | Topiramate
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| Blocks Na channels and inhibits excitatory AA's; uses-partial&generalized szrs; short 1/2 life | Lamotrigine
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| This med inhibits metabolism of Latorigine | Valproate
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| Analog of GABA; increases levels; uses:partial and focal seizures | Vigabatrin
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| Side effect of Vigabatrin | can exacerbate absence/myoclonic seizures
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| monotherapy for epilepsy; TOURETTEs and anxiety | Levitriacetam
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| MOA of Levitiracetam | binds synaptic vesicle protein SV2A to impede nerve conduction across synapses
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| Slide 32?? | k;
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| P450 AED inhibitors? | Valproate
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| P450 AED inducer? | Phenytoin, Carbamazepine, Phenobarbital
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| Antiepilectic drugs that are mood stabilizers?**** | Valproate, Gabapentin, Carbamazepine
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| To assess tx failures, non-compliance/malabsorption, guide dose adjustments, evaluate drug related adverse effects...do what? | check blood levels
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| This AED causes neural tube defects in fetus | Valproate
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| This AED causes craniofacial abnormalities, growth retardation (fetal hydantoin syndrome) | Phenytoin
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| Safest AED in Pregnancy for Grand Mal and Partial epilepsy? | Carbamezepine
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| Clotting should be monitored and Vit K is given (deficient) by IM to baby immediately after birth (1mg) if what meds were taken by mom? | Phenobarb, Phenytoin, Primidone
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| Baby of mom taking AED is lethargic...why? | AED's are lipophilic (go to brain) therefore get passed through milk
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| Phenytoin, Phenobarbital, and Carbamezepine are all drugs effective for what type of seizures? | Grand mal
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| it's antiseizure activity is due to its metabolism to Phenobarbital and Phenylethylmalonide | Primidone
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| alcohol is P450 inducer therefore it ___'s phentoin | decreases
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| Phenytoin can ____OC efficacy | decrease (phenytoin is an inducer)
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| Valproate can cause Phenobarbital to ___ | increase
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| Gabapentin and Lamotrigine effective in ___ seizures | complex partial
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| Type of seizure? lasts 20-60 seconds...NO LOC | simple partial
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| hirsuitism...ass'd w/ chronic administration of what drug? | Phenytoin
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| anti epileptic used for chronic neuropathic pain? | GABAPENTIN, caramazepine, phenytoin
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| bipolar pt. w/ non drug induced tonic clonic seizures. Appropriate drug? | Valproate
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| 6wk preggers lady with seizure disorders...she takes phenytoin? please advise... | Stop phenytoin and change to Carbamazepine
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