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Pharm II
AED's
34
Pharmacology
Graduate
03/07/2014

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Cards

Term
Seizure Disorders
Epileptic seizures
Definition
-synchronous activation of many neurons
-self-limiting
Term
Seizure Disorder
Epileptic disorder or epilepsy
Definition
-recurrent epileptic seizures
- most common neuro problem
Term
Types of Epilepsy
Idiopathic
Definition
No ID cause
Genetic and Age dependent
Therapy for life
Term
Types of Epilepsy
Symptomatic
Definition
Intracranial (brain tumors, encephalitis)
Extracranial (toxins, metabolic disorders)
Term
Management of Epilepsy
Definition
May require:
-no tx, if freq is low (<1/mth)
-one drug
-multiple drugs
Term
Objectives of drug therapy
Definition
-reduction in freq and intensity while avoiding side effects
-reduce freq by at least 50%
Term
Ideal Characteristics of AED
Definition
-non-sedating
-safe and effective
-high bioavailability
-long half life
Term
Question from him: Which among the following would you consider least ideal characteristic for an AED?
Definition
Short half-life
Term
Question from him: Which of the following is a common objective for the long-term tx of idiopathic epilepsy in dogs?
Definition
Reduction in freq of seizures by 50% or more
Term
Principle of Antiepileptic Therpay
Definition
-therapeutic range
-elimination T(1/2)
-owner compliance
-side effects
-drug interactions
-avoid seizure prone drugs
Term
Phenobarbitol Factoids
Definition
-CHRONIC TX
-Acts on GABA
-Decreases release of neurotransmitters by decreasing influx of Ca
-Stabilizes post-synaptic neurons
Term
Phenobarb PK
Definition
-oral absorption slow
-long half-life
-Peak [plasma] 4-8 hrs post tx
-wide distribution
-HEPATIC METABOLIZATION
-ss in 2-3 weeks
Term
Phenobarb Side EFfects
Definition
Sedation/Polyphagia (at first)
Hepatotoxicity, hypothyroid, blood dyscrasias
Term
Phenobarb TDM
Definition
-Phenobarb induces its own metabolism (adjust dose after a while)
-trough (to make sure its still at therapeutic levels)
-peak (if toxicity suspected) 4-6 hrs after given
Term
Question by him: Which of the following is true about phenobarb?
Definition
It is better for chronic than for acute treatment
Term
KBr Factoids
Definition
-Add-on of choice in dogs
-Stabilizes neuronal cells by hyperpolarization (accumulation of Bromide)
-CONTRAINDICATED in renal failure
-Br and Cl compete for renal reabsorption
Term
KBr PK
Definition
-well-absorbed (peak 1.5 hrs)
-KIDNEY ELIMINATION
-1/2 life is 24 days (Dogs)
-1/2 life is 1-2 wks (Cats)
-when SS is reached, phenobarb dose can be reduced or elim
Term
KBR (his question)
What is the most common side effect assoc with KBr use?
Definition
Sedation
Term
KBr (his question)
What is the most appropriate way to deliver a loading dose of KBr
Definition
Divided into several daily doses (3-5)
Term
Diazepam (Valium) Factoids
Definition
-increases the action of GABA on nerve cells
-First choice in status epilepticus (acute)
-SECOND CHOICE for CHRONIC (cats)
Term
Diazepam (Routes of Admin)
Definition
-IV (emergency)
-CRI
-Intranasal
-per rectum (at home)
Term
Diazepam (PK)
Definition
-low oral availability in dogs
-variable elim
-NOT APPROPRIATE for LONG term use in dogs
Term
Levetiracetam Factoids
Definition
- add-on
- well tolerated in dogs/cats
- oral bioavailability in dogs is 100%
- serum 1/2 life is 3-4 hrs
- elimination in urine
- high margin of safety
- FIRST CHOICE as add on for CATS
- Binds to synaptic vesicle protein in brain to prevent neurotransmitter release
Term
PRIMIDONE (FYI)
Definition
-metabolized to phenobarb
-$$$
Term
Felbamate Factoids
Definition
-low tox potential
-DOES NOT CAUSE SEDATION
-liver dysfxn potential side effects
Term
Felbamate Uses
Definition
-focal and generalized seizures
-adjunct or monotherapy
-little experience in CATS
Term
2nd generation AEDS
MOA: Sodium Channels
Definition
-initiate action potential in neurons
-inactive during refractory period
-drugs stabilize the inactive config preventing neuronal firing
Term
2nd generation AEDs
MOA: Low voltage Ca channels
Definition
-"pacemakers" of normal rhythmic brain activity
-generalized seizures
-drugs lock these channels inhibiting slow depolarizing currents
Term
2nd generation AEDs
MOA: GABA-A receptors
Definition
-GABA increases intracellular Cl
-hyperpolarization (no action potential)
Term
2nd generation AEDs
MOA: Glutamate receptors
Definition
-Na and Ca influx
-K efflux
Term
Gabapentin Factoids
Definition
-MOA not well known
-increases of concentration of GABA in neurons
-inhibit neuronal Na and Ca channels
-eliminated in urine
-eliminated in hepatic metabolism
- 1/2 life 3-4 hrs
Term
Zonisamide
Definition
-focal and generalized seizures in people
-mainly eliminated by liver
-BID as monotherapy
-much higher drug clearance in dogs receiving PB
Term
Zonisamide
Efficacy in dogs with refractory epilepsy
Definition
-seizure freq decreased by 93%
-side effects: transient sedation, ataxia, vomiting
Term
Cluster Seizures & Status Epilepticus
Definition
-Diazepam IV first choice
-Pento/Phenobarb (15-20 min onset)
-Propofol (rapidly acting and quickly metabolized/ admin slowly to avoid apnea)
-Etomidate
-Levetiracetam IV
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