epilepsy pharm

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Author:
cwhusker
ID:
171029
Filename:
epilepsy pharm
Updated:
2012-11-14 16:53:50
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epilepsy pharm
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epilepsy pharm
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  1. carbamazepine
    • 1st gen, NS
    • MOA: enhances GABA receptors - enhances Cl flow and hyperpolarizes the membrane, stabalizes the inactivaiton gate of Na channels
    • USES: partial and generalized tonic-clonic seizures, bipolar disorder, trigeminal neuralgia, neuropathic pain - DOC, acute mania
    • AE: drowsiness, vertigo, ataxia, blurred vision
    • best risk ratio in pregnancy, increased metabolism of OC
  2. phenytoin
    • 1st gen, NS
    • MOA: Na channel blocker, slows recovery of Na channels from inactivaiton
    • USES: effective against partial seizures
    • AE: facial hair, skin problems, gingival hyperplasia, osteoporosis, megaloblastic anemia, teratogenic
    • valporate competes for protein binding and can greatly increase free phenytoin plasma levels
    • enzyme inducer - enhances the metabolism of OCs or inhibits warfarin
  3. phenobarbital
    • 1st gen, NS
    • MOA: increases GABA A receptors, enhances Cl flow and hyperpolarizes the membrane
    • USES: effective in generalized tonic clonic and partial seizures
    • AE: sedation, nystagmus, ataxia, agitation, and confusion
    • significant birth defects and cognitive impairment
  4. ethosuximide
    • 1st gen, NS
    • MOA: reduces the low threshold of Ca currents
    • USES: Absence seizures
    • AE: divided doses needed to avoid nausea, PD-like symptoms, photophobia
  5. valproic acid
    • 1st gen, BS
    • MOA: inhibits sustained repetative firing by depolarization, prolongs recovery of Na channels
    • USES: partial, myoclonic, tonic-clonic and absence seizures
    • AE: anorexia, sedation, weight gain, rare fatal hepatic disease seen in pts <2
    • teratogen, highly bound to albumin - displaces phenytoin
  6. clonazepam
    • 1st gen, BS, 
    • MOA: increase the freq of GABA A activated Cl channels, increasing Ca, decreases the ability to produce an action potential
    • USES: long acting BZ, absence seizures, lennox-gastaut syndrome
    • AE: amnesia when used as a sedative, drowsiness, lethargy, cognitive effects
    • used in emergency situations
  7. oxcarbazepine
    • 2nd gen, NS
    • MOA: prodrug of carbamazepine, less potent enzyme inducer (doesn't interfere with anticoagulant effects)
    • USES: best efficacy in idiopathic partial epilepsies
    • AE: increase risk for polycystic ovaries
  8. gabapentin
    • 2nd gen, NS
    • MOA: possibly act at the Ca channel - may lead to increase GABA transport, inhibit excitation of muscles
    • USES: partial seizures, some generalized seizures, neuropathic pain
    • AE: weight gain
    • non-enzyme inducer
  9. pregabalin
    • 2nd gen, NS
    • MOA: possibly act at the Ca channel - may lead to increase GABA transport
    • USES: partial seizures, some generalized seizures, neuropathic pain
    • AE: weight gain
  10. lamotrigine
    • 2nd gen, BS
    • MOA: blocks sustained repetative firing and delays recovery from inactivation of Na channels
    • USES: partial or secondary generalized seizures, lennox-gastaut syndrome
    • AE: typical AE occur when titrated too fast, can get rash better side effects than valproic acid
    • non-enzyme inducer
  11. levetiracetam
    • 2nd gen, BS
    • MOA: unknown
    • USES: partial, generalized, tonic-clonic myoclonic seizures
    • AE: well tolerated, some somnolence, may cause mood changes
  12. felbamate
    • 2nd gen, BS
    • MOA: inhibits NMDA responses and potentiates GABA evoked repsonses (inhibits glutamate receptors)
    • USES: useful in partial and generalized seizures, used in refractory pts
    • AE: toxicity issues when given in combo with other large doses of other anticonvulsants
  13. topiramate
    • 2nd gen, BS
    • MOA: enhances GABA
    • USES: partial and generalized seizures, migrane prevention, approved for weight loss
    • AE: somnolence, fatigue, weight loss (can't be used in pregnancy)
    • reduces OC plasma levels
  14. zonisamide
    • 2nd gen, BS
    • MOA: inhibits T type Ca channels, prolongs inactivation state of Na channels
    • USES: partial and generalized tonic-clonic seizures, includes absence seizures
    • AE: somnolence, anorexia and dizziness

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