Exam 1 Chapter 18 drugs used for seizure disorders

Term Definition
Generalized seizures— affect both brain hemispheres
Partial seizures —begin in one hemisphere
Generalized convulsive seizures tonic clonic, atonic, and myoclonic seizures
Tonic-clonic (grand mal) first phase – pt suddenly develops intense muscular contractions that causes them to fall to the ground, lose consciousness, and lie rigid.
Second phase- bilaterally symmetric jerks alternating w/ the relaxation of the extremities.
postictal state flaccid paralysis and sleep that lasts 2-3 hours
o Status epilepticus is a rapidly recurring generalized seizure that does not allow the individual to regain normal function between seizure. Needs prompt medical attention
Myoclonic seizures – lightening like repetitive contractions of the voluntary muscles of the face, trunk and extremities. They may be isolated or rapidly repetitive. Usually lose balance and fall to the floor. No loss of consciousness, mostly occur at night.
o Absence (petit mal) epilepsy Occur in children; pt may develop a second type of seizure activity after puberty. lasts 5-20 sec. Appear to be staring into space may have a movement of the eyes or head, lip smacking, mumbling, chewing, or swallowing movement. nonconvlsive, no memory
o Partial (localized) seizure localized convulsions of voluntary muscles. A single body part such as a finger may start jerking (turning head, smacking lips, mouth movements, drooling, abnormal numbness, tingling., etc.) may end spontaneously or may spread over whole body.
Partial Complex seizures o vast array of possible symptoms. May be in a confused dreamlike state. May occur several times daily and last several minutes. Commonly end during sleep or with a clouded sensorium, usually has no recollection.
• Selection of drug depends on type of seizure, age and gender of patient, and potential adverse effects
*important • Anticonvulsants increase seizure threshold
NONDRUG THERAPY FOR SEIZURES • Surgical intervention can treat refractory seizures • Implantable vagus nerve stimulator • Ketogenic diet (restricts carbohydrates and protein)
Benzodiazepines “pam” Thought to enhance inhibitory effects of GABA in postsynaptic clefts between nerve cells
Benzodiazepines “pam” effects include Sedation, drowsiness, dizziness, fatigue, lethargy; blurred vision
Benzodiazepines “pam” effects include Behavioral disturbances, blood dyscrasias, hepatotoxicity
Diazepam Benzodiazepines “pam" prototype.
Used for all forms of epilepsy in conjunction with other agents.
hydantoids “toin” Anticonvulsants to control tonic-clonicseizures
hydantoids “toin” effects include Nausea, vomiting, indigestion; sedation, drowsiness, dizziness, fatigue, lethargy; blurred vision; gingival hyperplasia
hydantoids “toin” effects include Hyperglycemia; blood dyscrasias; hepatotoxicity; dermatologic reactions
Phenytoin hydantoids prototype (Dilantin) used for generalized tonic-clonic seizures psychomotor seizures.
Succinimides Control absence (petit mal) seizures
Succinimides effects include Nausea, vomiting, indigestion; sedation, drowsiness, dizziness, fatigue, lethargy
gabapentin (Neurontin) Mechanism of action unknown; does not appear to enhance GABA
gabapentin (Neurontin) used In combination with other anticonvulsants to control partial seizures, treat postherpetic neuralgia
gabapentin (Neurontin) common adverse effects effects include Sedation, drowsiness, dizziness; blurred vision
gabapentin (Neurontin) and levetiracetam (Keppra) serious adverse effects effects Neurologic changes
lamotrigine (Lamictal) Thought to block voltage-sensitive sodium and calcium channels in neuronal membranes
lamotrigine (Lamictal) used In combination with other anticonvulsants to control partial seizures; bipolar disorder
lamotrigine (Lamictal) effects include Nausea, vomiting, indigestion; sedation, drowsiness, dizziness; blurred vision
lamotrigine (Lamictal) effects include Neurologic changes, Aseptic meningitis (headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light), 10% of patients develop skin rash and urticaria, could become more serious
levetiracetam (Keppra) Classified as pyrrolidine derivative; unrelated to other antiepileptic drugs • Mechanism of action unknown
levetiracetam (Keppra) used In combination with other anticonvulsants to treat adult partial-onset seizures
phenobarbital (Luminal) Long-acting barbiturate; elevates the seizure threshold, prevents spread of seizure
phenobarbital (Luminal) used Primarily as alternative when single anticonvulsants are unsuccessful • Treat partial and generalized tonic-clonic seizures and generalized myoclonic seizures • In combination with other anticonvulsants
topiramate (Topamax) Mechanism of action unknown; appears to prolong blockade of sodium channels, enhance activity of GABA, antagonize certain receptors for the neurotransmitter
topiramate (Topamax) used In combination with other anticonvulsants to control tonic-clonic seizures • Prevention of migraine headaches
topiramate (Topamax) effects include Neurologic changes • Cleft palate in newborns • Decreased sweating and overheating, especially in children • Enhanced sedation with CNS depressants
valproic acid (Depakene) • Appears to support GABA activity as an inhibitory neurotransmitter
valproic acid (Depakene) Control tonic-clonic seizures • Only single-drug therapy to treat combination of generalized tonic-clonic, absence, or myoclonic seizures • Treat acute mania of bipolar disorder
valproic acid (Depakene) effects include Nausea, vomiting, indigestion; sedation, drowsiness, dizziness; blurred vision
valproic acid (Depakene) effects include Blood dyscrasias • Birth defects: neural tube defects, craniofacial defects, cardiovascular malformation • Hepatotoxicity • Pancreatitis
valproic acid (Depakene) If you know someone who is diabetic and you test the urine and find ketones in the urine, this drug has the tendency to have ketones in the urine so it is not uncommon