Pharmacology Exam 3: Anti-epileptic Drugs

Define Epilepsy
Chronic medical condition produced by sudden changes in the electrical function of the brain

What kind of seizure is when the electrical discharge is confined to the motor area?
Simple partial (Jacksonian)

Define the seizure when the electrical discharge is confined in certain parts of the temporal lobe concerned with mood as well as muscle.
Complex partial (psychomotor)

When a patient falls in convulsions and may bite his tongue and lose bladder and bowel control, he/she is having what kind of seizure?
Tonic-clonic

After dropping unconscious and the patient only experiences the tonic OR clonic phase of a seizure, he/she is having what kind of seizure?
Tonic

This type of seizure starts at ages 2-5. The legs simply give out.
Atonic (akinetic)

This type of seizure is a sudden, brief shock like contraction which may involve the entire body or be confined to the face, trunk or extremities.
Myoclonic

This type of seizure is most common in children (4-12 years). It’s a loss of consciousness without involving the motor area.
Absence

This is a continuous seizure without intervening return of consciousness.
Status epilepticus (re-occurring seizure)

What are 5 triggers for seizures?
Fatigue, Stress, Sleep Deprivation, Poor Nutrition, Alcohol.

Name 2 anticonvulsants that are given for generalized seizures.
Phenobarbital, Zonisamide

Name 2 anticonvulsants that are given for Absence seizures.
Clonazepam, Ethosuximide

Name 2 anticonvulsants that are given for Partial seizures.
Oxcarbazepine, Tiagabine

Should anti-convulsants be stopped pre-operatively?
NO!!! Maintain regimen and continue ASAP postoperatively.

Which volatile anesthetic may be epileptogenic?
Sevoflurane! (Des, Iso, and N2O are acceptable)

Anesthetic Management of epileptic patients, you should avoid _______ and ______. Instead, use ________ and _________.
ketamine, methohexital
propofol, benzodiazepines

If a patient is on chronic anticonvulsant therapy, they will be resistant to ________.
Non-depolarizing neuro muscular blockers (NDNMB’s). Rocuronium, vecuronium, and pancuronium.

Because of Hoffman elimination, these 2 muscle relaxers can be given with standard dosing to patients with chronic anticonvulsant therapy.
Atracurium, Cisatracurium

If you must treat an active seizure in your case, and dilantin is given, what should you anticipate?
Dilantin (phenytoin) prolongues NDNMB’s

Name 4 primary side effects of anticonvulsant therapy.
*Stevens-Johnson syndrome*
Sedation
Hepatitis
Pancreatitis

In MOA of anti-convulsants, they increase activity of ________ and decrease activity of _________.
GABA (inhibitory)
Glutamate (excitatory)

(Also note that altering Na, K, & Ca currents is part of MOA as well).

What anti-convulsant is a calcium channel blocker?
Ethosuximide

What kind of seizure is ethosuximide given for?
Absence seizures

Which 2 anti-convulsants MOA is to increase levels of GABA?
Phenobarbitol and Benzodiazepines

Are drugs in this class highly or lowly protein bound?
Highly protein bound!

Where does metabolization of anti-convulsants take place?
hepatic metabolism

Name 3 enzyme inducers
Phenobarbital
Phenytoin
Carbamazepine (most potent)

What are enzyme inducers?
Increase hepatic metabolism which increases metabolization of the drug. If you give an enzyme inducer, you need to give MORE of the drug.

What is the therapeutic plasma concentration of phenytoin?
10-20 mcg/ml (very narrow therapeutic range)

Because of saturation kinetics in regards to phenytoin, the ________ you are on the drug, the _______ the half life.
longer,
longer

What is the MOA of phenytoin?
blocking Na & Ca influx into the neuronal axon.

or inhibits the release of excitatory amino acids via inhibition of Ca influx

What can you give phenytoin for?
Seizures (Partial and generalized tonic clonic). NOT effective for absence seizures.

also can be used for *v-fib

In addition to seizures, Carbamazepine can give given for _______ and _________.
Mania,
Trigeminal neuralgia

Carbamazepine can lead to failure of other drugs such as what?
Birth control*, warfarin

What are unique side effects with Carbamazepine?
Congenital malformation (craniofacial anomalies & neural tube defects)

Hyponatremia & water intoxication

MOA of phenobarbital?
Increases GABA which prolongs the opening of Cl- channels. This will hyper polarize the cell.

Valproic acid inhibits metabolism of several drugs such as what? (list 4)
Carbamazepine, phenytoin, topiramate, phenobarbital.

Unique side effect of Valproic Acid
neural tube defect – contraindicated in pregnancy

Valproic Acid is very effective for what type of seizures?
Absence, myoclonic seizures

Lamotrigine resembles phenytoin in its pharmacological effects however it does not induce or inhibit __________.
P-450

(it’s metabolism is inhibited by valproate

What is the MOA of Gabapentin?
May increase the activity of GABA or inhibit its re-uptake.

Is Gabapentin highly or lowly protein bound?
Trick question: It is NOT bound to proteins

(it also does not induce or inhibit hepatic enzymes) -similar to Lamotrigine

What can you assume if you see this drug listed as home medication if given without other antiepileptics?
This drug is rarely given alone as an antiepileptic. If you see someone is on this drug alone, you should ask if they are on it for chronic pain therapy or trigeminal neuralgia.

This anti-epileptic drug has no effect on microsomal enzymes and is minimally protein bound.
Topiramate

This is one of the safest antiepileptics which can be used alone for partial and generalized tonic-clonic, and absence seizures.
Topiramate

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What is epilepsy? Group of disorders characterized by excessive excitability of neurons in the CNS. This abnormal neuronal activity can produce a variety of symptoms ranging from brief periods of unconsciousness to violent convulsions. Convulsion applies to abnormal movement (jerking …

9.1 Which one of the following statements is correct regarding benzodiazepines? A. Benzodiazepines directly open chloride channels. B. Benzodiazepines show analgesic actions. C. Clinical improvement of anxiety requires 2 to 4 weeks of treatment with benzodiazepines. D. All benzodiazepines have …

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Hydantoins – phenytoin (Dilantin), fosphenytoin (Cerebyx) Notes Narrow therapeutic index (10-20μg/ml), dosing is highly individualized Half life increases with dosage Hydantoins – phenytoin (Dilantin), fosphenytoin (Cerebyx) Indications Partial and generalized tonic-clonic (grand mal) seizures WE WILL WRITE A CUSTOM ESSAY …

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