Shared Flashcard Set

Details

Anticonvulsants
Exam 1
54
Pharmacology
Graduate
06/11/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Seizure Definition
Definition
Paroxysmal, abnormal neuronal discharge in cerebrum of CNS
-May or May not involve LOC
Term
Convulsion Definition
Definition
Specific seizure type with INVOLUNTARY muscle contractions
Term
Epilepsy Definition
Definition
Medical disorder with recurrent, unprovoked seizure activity
Term
Occurence of First Seizure
Definition
-Peaks in newborns, young kids
-Peaks in patients >65
Term
Predisposing Factors of Seizures
Definition
Genetics
Head Trauma
Stroke
Malignancy
Infection
Substance abuse
Degenerative Disease
Term
Partial/Focal seizure and Variants
Definition
Localized (manifestations represent that area of the brain)
-Simple: Brief, NO LOC
-Complex: widespread, alteration of consciousness
-Secondary Generalized: partial precedes tonic-clonic
Term
Generalized Seizure and Variants
Definition
involves both hemispheres + LOC
-convulsive or non-convulsive
Absence: sudden onset, blank stare
Tonic-Clonic: convulsive
Myoclonic: brief, sudden muscle contraction
Atonic: loss of muscle tone
Term
Two Neuronal Circuit Involved With Seizures
Definition
1. Axonal Conductance (APs along axons)
2. Synaptic transmission
**Both use ion channels
Term
__ & __ depolarize cell membrane
__ repolarizes (inhibitory)
Definition
Na and Ca
K
Term
In ligand-gated channels, NT involved with excitation is ___ and inhibitory is ___.
Definition
Excitation = Glutamate
Inhibitory = GABA
Term
NonPharm Therapy for Seizures
Definition
1) Surgery - refractory focal epilepsy only; high success rate
2) Vagus Nerve Stim - pts >12
3) Ketogenic Diet - hard compliance; high fat low carb and protein... best in kids
Term
When to start Therapy
Definition
-First seizure w/ high risk patients
-->EEG abnormal, trauma, FH, young
-Second seizure
Term
Monotherapy best for what type of seizures?
Definition
Generalized tonic-clonic
Term
When is medication considered ineffective for seizures?
Definition
Unacceptable adverse effects with continued seizures
Term
Major FDA Seizure Med Alert
Definition
Suicidal Behavior/Ideation
Term
Carbamazepine: First line for what? Other uses?
Definition
1st: Partial and General tonic clonic
Other: Bipolar, Neuralgia, Peripheral Neuropathy
Term
Carbamazepine: BB warning, ADEs
Definition
BB: Skin reaction (Stevens-Johnson) or Toxic Epidermal Necrolysis
BB:Aplastic anemia, agranulocytosis (monitor WBCs, platelets)
ADEs:Diplopia, dizzy, drowsy, nausea, hyponatremic with chronic use, rash/blood dyscrasias
Monitor: LFT, CBC, BMP, serum
Term
Carbamazepine: Dosing notes, DIs
Definition
Dosing: Increase 200mg/day weekly
4-6wks for full autoinduction
Therapeutic Serum = 4-12mcg/ml
DI:3A4 INDUCER
CBZ up - Valp Acid, Erythro, Cimetidine, Fluox, INH
CBZ down - phenobarb, phenytoin
CBZ decreases > oral contraceptives, doxy, warfarin, valp acid
Term
Oxcarbazepine: Place in Therapy, Dosing Notes
Definition
Place: adjunctive or first line general tonic clonic
Dosing: Adjust in low CrCl; inactivated by glucuronide conjugation
Term
Oxcarbazepine: DIs, ADEs
Definition
3A4 Inducer
Inc OBZ-perampanel
Dec OBZ-CBZ (goes up), phenytoin, phenobarb, valp acid
Dec levels>Contraceptives, valp, lamotrigin, perampanel
ADEs: *Hyponatremia (monitor Na), sedation, N/D, ataxia
Term
Phenytoin (PHT): Place in therapy, Dosing Notes
Definition
-1st for general tonic-clonic, partial, and epilepticus
Dosing: Need loading dose (15-20mg/kg/day in 3 doses, then maintain 300mg/d)
-Albumin levels affect serum
**cpadj = cpmeasured/((.2xalbumin)+.1)
Term
Phenytoin DDIs
Definition
CBZ/Phenobarb - can inc or dec PHT
ValpA - PHT dec then inc (valp goes down)
Inc PHT: amiodarone, disulfiram, etoh, fluconazole, fluoxetine, warfarin
Dec PHT: vigabatrin
PHT decreases>contraceptives, folic acid, thyroid products
Term
Phenytoin ADEs
Definition
Ataxia, HA, nystagmus, cognitive impaired, blurry vision, blood dyscrasia, rash
Chronic: skin thick, folate deficient, gingival hyperplasia, acne, hirsutism, osteomalacia
MONITOR: LFT, CBC, CrCl, serum
Term
Fosphenytoin
Definition
Parenteral phenytoin prodrug; quick loading
Term
Phenobarbital (PB): MOA, place in therapy
Definition
MOA: GABA receptor to block Ca and facilitate Cl channel
*DOC for neonatal seizures or pts who failed other meds
Term
Phenobarbital DDIs, ADEs
Definition
Inc PB: felbamate, PHT, OCZ, ValpA
Decrease> contraceptives, CBZ, lamotrigine, OCZ, valp acid
ADEs: ataxia, HA, hyperactive, rash
Chronic-behavior changes, conn.tissue disorders, intellectual blunting, metabolic bone dz
MONTIOR: LFT, CBC, serum
Term
Primidone metabolized to what?
Definition
Phenobarb (measure these levels when checking serum) and PEMA (phenylethyl)
Term
Primidone: DDIs, ADEs
Definition
Inc Prim-valp acid
Dec Prim-CBZ,PHT
Decreases>TCAs, contracept, valpacid, lamotrigine
ADEs: like phenobarb
MONTIOR: CBC, prim, PB serum
Term
Valproic Acid (VPA): MOA, place in therapy, other uses
Definition
MOA: Increase GABA response
Place: 1st generalized seizures (myoclonic, atonic, absence) and can be useful in mixed disorder
Other uses: Bipolar, MIGRAINE PROPHYLAXIS
Term
Peak Concentrations Order for Valp. Acid
-Where is conc. the highest?
Definition
Syrup -> Capsule -> Ent.Coated Tab
Highest: Fetal Cord Blood (5x)
Term
Valproic Acid: DDIs, ADRs
Definition
Inc VPA: cimetidine, salicylates
Dec VPA: CBZ, PB, PHT, primidone
VPA incre>felbamate, lamtrigine, PB, Primidone
VPA decre>topiramate
ADRS: GI, sedation, tremor, acute hepatic failure and pancreatitis, alopecia
Chronic: wt gain, hperammonemia, irregular menstrual
Monitor: LFT, platelets, serum
Term
Ethosuximide: MOA, place in therapy
Definition
-Inhibit T-type Ca channels
-1st line: absence seizures
Term
Felbamate: MOA, BB warning, ADRs
Definition
-Blocks NMDA synaptic response, potentiates GABA
-BB for aplastic anemia and liver failure
ADRs: Anorexia,n/v/HA,insomnia
Monitor: LFTs, bilirub, CBC
Term
Gabapentin: MOA, other uses, DDIs, ADRs
Definition
MOA: inhibit voltage-gated Ca channels, increases GABA in brain
Other: Neuropathic pain, restless leg syndrome
NO DDIs
ADR: dizzy, fatigue, ataxia, pedal edema
Chronic: Wt gain
Monitor: Renal function
Term
Pregabalin: MOA, other uses, DDIs, ADRs
Definition
MOA: decrease release of excitatory NTs
Other uses: Fibromyalgia, neuropathic pain
NO DDIs
ADRs: dizzy, blurry vision, somnolence, pedal edema, ELEVATED CK
Chronic: Wt gain
Term
Lacosamide: MOA, DDIs, ADRs
Definition
MOA: slow inactivation Na voltage-gated channels
DDIs: decreased by CBZ, PB, PHT
ADRs: dizzy, HA/N/V, PR INTERVAL INCREASE, liver enzyme elevation
Term
Lamotrigine: MOA, Place in therapy, other uses
Definition
MOA: inhibit volt-gated Na and Ca channels
Therapy: mono or adjunct
Other uses: Bipolar
Term
Lamotrigine Dosing:
1. No CBZ, PHT, Prim, VPA
2. Containing VPA
3. Containing CBZ, PHT, PB, Prim, and NOT VPA
Definition
1. ID = Wk1-2 25mg QD, Wk3-4 50mg QD, Wk 5+ Inc 50mg/d every 1-2wks; Maint: 225-375/d in 2 doses
2. Wk1-2 25mg QOD, Wk3-4 25mg QD, Wk 5+ Inc 25-50/d every 1-2wks; Maint: 100-200 VPA alone or 100-400 if w/other glucuronidation drugs
3. Wk1-2 50 QD, Wk3-4 100/d 2 doses Wk5+ inc by 100 every 1-2wks; Maint: 300-500/d Max 700
Term
Lamotrigine ADRs
Definition
diplopia, dizzy, HA, unsteady, rash (SJS)
Term
Levetiracetam: MOA, ADRs
Definition
MOA: modifies glutamate, GABA
ADR: sedation, behavioral disturbance
Term
Tiagabine: MOA, ADRs
Definition
MOA: inhibit GABA uptake
ADR: dizzy, fatigue, low conc, nervous, blurry vision, tremor, depression, weakness
Term
Topiramate: MOA, other uses
Definition
MOA: inhibit volt-gated Na channels, potentiate GABA, inhibit glutamate
Other: Migraine Prophylaxis
Term
Topiramate: DDIs, ADRs
Definition
Dec Top - most anticonvulsants
Inc Top-HCTZ
Top decreases oral contraceptives
ADR: difficult conc, psychomotor slowing, speech issues, metabolic acidosis, acute angle glaucoma, oligohydrosis
Chronic: kid stones, WT LOSS
Term
Vigabatrin: MOA, BB warning & ADR
Definition
Irreversibly inhibits GABA-trans; increase GABA levels
BB: Vision loss - SHARE program
ADRs: fatigue, wt loss, somnolence, blurry vision, tremor, peripheral neuropathy, anemia
Term
Zonisamide: MOA, Can mix capsules w/?, ADRs
Definition
MOA: inhibit Na Ca Glutamate
Capsules can mix w/ juice,H20
ADRs: sedation, cog impaired, dizzy, oligohydrosis, metabolic acidosis, rash
Chron: Kid stones, wt loss
Term
Perampanel: MOA, ADR, Dosing, ADRs
Definition
AMPA-receptor antagonist
ADR: Hepatic impairment (not recommended in these or renal impaired patients)
**Small dosing (2mg, 4 w/inhibitors)
ADR: dizzy, HA, ataxic, anger aggressive, but usually well tolerated
Term
Evaluation of Seizure Control:
1) No change in seizure frequency
2) Reduction in seizure frequency but still occur
3) Seizures eliminated
Definition
1) FIRST max dose SECOND switch agents - always via taper
2) FIRST max dose SECOND add second agent - if seizures controlled may consider tapering first agent
3) Continue therapy
Term
Status Epilepticus Definition, Tx
Definition
-Any seizure >30 min +/- LOC
-Convulsive or Nonconvulsive
-Recurrent seizures w/ no intervening period of consciousness between
Tx: Supportive (oxygen, preserve cardiorespiratory), Eliminate epileptiform activity (Benzos, PHT/fospho IV push then PO maintenance)
Term
Pregnancy AED: Problems
Definition
Up to 2-fold risk of malformations
-VPA -> spina bifida
Term
AED Withdrawal
Definition
May cause increased seizure freq.
Consider after 2+ seizure free years
Taper one drug at a time, slowly
Term
Issues in Women with AEDs
Definition
-Medroxyprogesterone depot injection, IUD
-Morning after pill - double dose
Term
VPA - Therapeutic Serum
Definition
50-150 mcg/mL
Term
CBZ - Therapeutic Serum
Definition
4-12 mcg/mL
Term
PHT - Therapeutic Serum
Definition
10-20 mcg/mL
Supporting users have an ad free experience!