Anti-Convulsants Pharm V

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Anti-Convulsants Pharm V
2011-05-01 22:57:09
Anti Convulsants Pharm

Anti-convulsants Pharm V
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  1. What is the definition of epilepsy?
    a chronic neurological disorder characterized by recurrent and unpredictable seizures
  2. How are epilepsies characterized?
    type of seizure and EEG
  3. What are always common presentations diagnostically for epileptic seizures
    excessive EEG discharges with SYNCHRONIZED activity of a group of neurons
  4. What is primary epilepsy? How are they treated
    no specific anatomic cause (70% of seizures arize from this type) treated with chronic antiepileptic drugs
  5. What is secondary epilepsy?
    epilepsy caused by some definable source such as brain tumors, stroke, infection, or injury
  6. How is secondary epilepsy treated?
    drugs are given until the primary cause of the seizures is corrected
  7. What is the goal of antiepileptic drug therapy?
    use the simplest drug regimen (usually only monotherapies are used sometimes two drugs but usually no more than this)
  8. How are antiepileptic drugs selected?
    they are selected based on seizure type
  9. What is partial epilepsy and what are its subtypes?
    • - Originated from a small group of neorons that constitute the seizure focus, may become generalized
    • - Simple and Complex
  10. What are the signs and symptoms associated with Simple partial epilepsy?
    focal motor, sensory, autoniomic or psychic disturbances, does not spread, no impairment of consciousness
  11. What are the signs and symptoms of complex partial epilepsy?
    IMPAIRED CONSCIOUSNESS, dreamy states with or without automatisms, may spread
  12. What are the subtypes of generalized seizures? what are the general symptoms for generalized seizures?
    tonic clonic, absence, myoclonic, febrile, status epilepticus

    symptoms: immediate loss of consciousness, convulsive or non-convulsive, both hemispheres involved
  13. What are tonic clonic seizures?
    most common and dramatic form. tonic phase(<1min) sudden loss of consciousness and rigidity loss of respiration. Clonic(2-3 min) rhythmic contractions. followed by confusion and exhaustion
  14. What are absence seizures?
    brief loss of consciousness, happens in kids mostly associated with rapid eye blinking for several secs
  15. What are myoclonic seizures?
    occurs at any age, short epidsodes of muscle contractions
  16. What are febrile seizures?
    associated with young kids and fevers generalized tonic clonic with short duration do not ususally cause damage
  17. What is status epilepticus?
    Repeated seizures without recovery between them. Last around 30 min can lead to cardio collapse and brain damage. MED EMERGNECY
  18. What does an EEG of generalized seizures look like?
    Highly synchronized involves pretty much all of the lines
  19. What do antiepileptic drugs do?
    • -block the origin of the seizure inducing activity
    • - block the spread of the seizure inducing activity
    • - reduce of slow the synchronization of neuronal activity
  20. How do antiepileptic drugs work?
    • alter ion conductances:
    • - inhibit voltage activated NA ion changels thus reducing firing and increasing refractory period
    • - inhibit voltage CA channels and decrease rhythmic activity
    • enhance inhibitory GABAergic neurotransmission
  21. Which drugs inhibit NA channels?
    carbameazepine phenytoin lamotrigine and valproic acid
  22. Which drugs inhibit voltage gated Ca channels?
    ehtosuxumide and valproic acid
  23. Which drugs enhance inhibitory GABA transmission?
    barbiturates, benzodiazepines, valproic acid and gababpentin
  24. What dare some nonpharmacological means of treating epilepsy?
    lobotomy and vagal nerve stimulation through implanted pulse generators
  25. What does phenytoin do?
    • Oral administrtaion for chronic tx IV for emergencies
    • - plasma bound
    • enhances metabolism of other drugs.
    • metabolism enhanced by CARBAMEZEPINE
    • metabolism inhibited by Chloramphenicol and sulfonamide
    • -Fosphenytoin is prodrug used IV and IM
    • blocks NA and Ca channels
    • used for partial simple and complex and tonic clonic also IV for status epilepticus
  26. What is cabamazepine used for?
    • partial simple and complex and tonic clonic
    • NA blockade, suppresses firing and propagation of abnormal APs
  27. Carbamazepine pharmacokinetics
    • Orally absorbed
    • - induces hepatic enzymes to metabolize it therefore need to increase dose over time
  28. What does Valproic acid do?
    • -choice of drug for myoclonic seizures
    • -very hepatotoxic
    • -reduces propagation of abnormal brain discharge (Na, Ca, and GABA)
  29. What are the pharmacokinetics of Valproic acid
    • -orally effective rapidly absorbed
    • -high protein binding
    • -metabolized by liver
  30. What is divalproex?
    • valproic acid+Na valproate
    • - improves GI tolerance
  31. What is Ethosuximide? What is its mechanism of action
    • drug of choice for absence seizures
    • - blocks T-type Ca channels supressing rhythmic activity
  32. Ethosuximide pharmokinetics?
    • Oral
    • - NOT Bound to proteins
    • hepatic metabolism
  33. What do the barbiturates (phenobarbital and primidone) treat and how do they work?
    • treat simple partial, tonic clonic, and febrile
    • -faciliate activation of GABA
  34. Pharmokinetics of barbiturates
    • oral
    • hepatic metabolism
    • freely penetrates brain
  35. What benzodiazepines used for and how do they work?
    • used to tx acute status epilepticus IV
    • -and myoclonic and absence seizures: clonazepam
    • potentiate GABA actions
  36. What is Lamotrigine
    • inhibits release of glutamate blocks NA channels
    • -metabolized by the liver
    • use for simple and complex partial and tonic clonic
  37. What is Gabapentin?
    • enhances GABA transmission
    • - not metabolized by liver-
    • not bound
    • - elimination through kidneys
    • -tx of simple or complex partial and tonic clonic
  38. What is pregabalin
    • blocks ca and release of glutamate
    • used for simple and complex partial seizures
  39. What is topiramate?
    • blocks na and increase activity of GABA receptors POST SYNPATICALLY
    • - simple and complex partial and tonic clonic
  40. What is zonisamide?
    • blocks na and t-type Ca
    • -used for treating simple and complex partial and tonic clonic
  41. What are some common side effects of anti-epileptic drugs?
    • drowsiness and seation
    • - atatxia
    • - nausea
    • -skin rash
    • -weight gain and loss
  42. What causes gingival hyperplasia?
  43. What causes heptotoxicity
    valproic acid and carbamazepine
  44. What are the preferred drugs to treat simple partial seizures, complex, and tonic clonic seizures?
    • phenytoin
    • -carbamazepine
    • -loratigine
  45. What are the preferred drugs to treat absence seizures?
  46. What are the preferred drugs to treat myoclonic seizures?
    Clonazepam and Valproic acid
  47. What drug is used to treat febrile seizures?
  48. What drugs are used to treat status epilepticus?
    Diazepam and phenytoin