Anticonvulsants Overview

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Questions and Answers

Which anticonvulsant is known for having life-threatening side effects that have severely restricted its usage?

  • Felbamate (correct)
  • Carbamazepine
  • Vigabatrin
  • Pregabalin

Which of the following is a derivative of carbamazepine that has similar efficacy but is better tolerated?

  • Primidone
  • Valproic acid
  • Eslicarbazepine acetate
  • Oxcarbazepine (correct)

Which group of medications primarily blocks voltage-gated calcium channels in their mechanism of action?

  • Propionates
  • Hydantoins
  • Gabapentinoids (correct)
  • Oxazolidinediones

What is the primary characteristic of the anticonvulsants found in the fatty acids category?

<p>They include valproic acid and related compounds. (C)</p> Signup and view all the answers

Which of the following anticonvulsants has a historical use in treating epilepsy but is primarily used today in veterinary medicine?

<p>Potassium bromide (B)</p> Signup and view all the answers

What is the primary mechanism of action for anticonvulsants?

<p>Alter electrical activity in nerve cells (D)</p> Signup and view all the answers

Which of the following is NOT a common cause of seizures?

<p>Severe dehydration (D)</p> Signup and view all the answers

Which type of seizure is characterized by affecting both sides of the brain?

<p>Generalized onset seizures (D)</p> Signup and view all the answers

Which neurotransmitter's activity is increased by some anticonvulsants?

<p>GABA (C)</p> Signup and view all the answers

What are febrile convulsions primarily associated with?

<p>High fever in children (D)</p> Signup and view all the answers

Which of the following side effects could be considered serious when taking antiepileptic medications?

<p>Aplastic anemia (C)</p> Signup and view all the answers

What can be a consequence of uncontrolled electrical disturbances in the brain?

<p>Changes in behavior and consciousness (C)</p> Signup and view all the answers

Who may be at a higher risk for severe side effects from antiepileptic medications?

<p>Older adults (D)</p> Signup and view all the answers

What primarily causes seizures in epilepsy?

<p>Too little electrical activity between neurons (A)</p> Signup and view all the answers

What is a common psychological complication associated with untreated epilepsy?

<p>Suicidal tendencies (A)</p> Signup and view all the answers

Which of the following is a symptom that may occur before an epileptic seizure?

<p>Euphoria during aura (A)</p> Signup and view all the answers

Which anticonvulsant drug is specifically used to treat absence seizures?

<p>Ethosuximide (D)</p> Signup and view all the answers

What is the term for frequent and recurrent seizures without regaining consciousness?

<p>Status epilepticus (C)</p> Signup and view all the answers

Which of the following is NOT listed as a common symptom of epilepsy?

<p>Chronic headache (A)</p> Signup and view all the answers

What is a potential risk associated with driving for individuals with epilepsy?

<p>Increased risk of accidents (D)</p> Signup and view all the answers

Which medication is classified as an antiseizure agent for focal seizures?

<p>Brivaracetam (D)</p> Signup and view all the answers

Which benzodiazepine is notable for being administered rectally for seizures?

<p>Diazepam (B)</p> Signup and view all the answers

Which of the following benzodiazepines is specifically mentioned for use during menstruation in women with catamenial epilepsy?

<p>Clobazam (A)</p> Signup and view all the answers

What is the main reason phenobarbital is rarely used to treat epilepsy today?

<p>Sedating effects that limit its use (A)</p> Signup and view all the answers

Which anticonvulsant is considered the main drug from 1912 until 1938, but is now used less frequently?

<p>Phenobarbital (C)</p> Signup and view all the answers

Which of the following drugs is rarely used in new patients to treat epilepsy due to the availability of other effective medications?

<p>Phenobarbital (B)</p> Signup and view all the answers

What is the primary route of administration for lorazepam in a hospital setting for status epilepticus?

<p>Intravenous injection (B)</p> Signup and view all the answers

What kind of seizures is Stiripentol indicated for treating?

<p>Dravet syndrome seizures (A)</p> Signup and view all the answers

What common effect do benzodiazepines have due to their action as central nervous system depressants?

<p>Muscle relaxation (C)</p> Signup and view all the answers

Flashcards

What is epilepsy?

A neurological disorder causing repeated seizures or unusual sensations and behaviors.

What causes a seizure?

Sudden bursts of electrical activity in the brain, often caused by too much or too little activity between neurons.

How do epilepsy symptoms vary?

Vary greatly between individuals and depend on the type of seizure. Range from violent shaking to hardly noticeable symptoms.

What are antiseizure agents?

Anti-seizure medications designed to control seizures.

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What is status epilepticus?

A rare but life-threatening complication of epilepsy where seizures occur frequently and repeatedly without regaining consciousness.

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What are anticonvulsant drugs?

Medicines used to treat seizures and convulsions.

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What are benzodiazepines used for in epilepsy?

Can stop a seizure quickly, especially in emergencies.

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What is SUDEP?

A rare complication of epilepsy where there's a sudden unexpected death.

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Anticonvulsants (AEDs)

Drugs/agents used to treat epileptic seizures, characterized by excessive rapid firing of neurons.

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Seizure

Sudden, uncontrolled electrical disturbance in the brain causing changes in behavior, movements, feelings, and consciousness.

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Convulsion (Febrile Convulsion)

Involuntary muscle contractions caused by disturbances in brain activity, often associated with epilepsy, toxins, or fever.

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Generalized Onset Seizures

Seizures affecting both sides of the brain, causing widespread brain disruption.

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Focal Onset Seizures (formerly Partial Seizures)

Seizures affecting only one area or side of the brain, with limited impact.

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Unknown Onset Seizures

Seizures where the starting point is unknown, making accurate diagnosis difficult.

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How do anticonvulsants work?

Anticonvulsants work by either blocking or stimulating ion channels involved in nerve cell signaling, or by enhancing the activity of neurotransmitters like GABA.

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Common side effects of anticonvulsants

Common side effects of anticonvulsant medication include dizziness, tiredness, upset stomach, blurry vision, memory problems, and trouble concentrating.

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GABA Analogues

A class of anticonvulsants that act on the GABA receptor, crucial for mediating neuronal inhibition in the brain.

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Anticonvulsants

A broad category of anticonvulsant medications with a diverse range of actions, affecting various aspects of neuronal function.

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Hydantoins

A family of anticonvulsants that have been used for decades, including the well-known medication phenytoin (Dilantin).

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Gabapentinoids

A class of anticonvulsants that act by blocking voltage-gated calcium channels, primarily the N-Type and P/Q-Type.

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Carbamates

These drugs work by blocking the release of excitatory neurotransmitters, leading to a decrease in nerve cell activity.

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Barbiturates

A type of anticonvulsant that acts as a central nervous system (CNS) depressant, leading to effects ranging from mild sedation to anesthesia.

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Phenobarbital

The most commonly used barbiturate for seizures, but rarely used for new patients due to its sedative effects. It was the main anticonvulsant until 1938.

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Benzodiazepine

A class of drugs with hypnotic, anxiolytic, anticonvulsive, amnestic and muscle relaxant properties. They act as a CNS depressant.

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Benzodiazepines for Seizures

Benzodiazepines used specifically for seizures: Diazepam, Lorazepam, Clonazepam, and Clobazam.

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Diazepam (Valium)

A benzodiazepine used in emergency situations to quickly stop seizures. It can be given rectally by trained care-givers.

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Clobazam

A benzodiazepine used for seizures, particularly in women with catamenial epilepsy (where seizures worsen during specific menstrual phases).

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Status Epilepticus

A condition where seizures occur repeatedly without regaining consciousness. It is a rare but life-threatening emergency.

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Study Notes

Anticonvulsants (Antiepileptic Drugs (AEDs)/Anti-seizure Medications (ASM))

  • Used in treating epileptic seizures, bipolar disorder, borderline personality disorder, mood stabilizers, and neuropathic pain
  • MOA: Alter electrical activity in nerve cells (neurons) by either blocking or stimulating ion channels (e.g. sodium, calcium, or potassium) or influencing neurotransmitter activity (e.g. GABA)
  • Seizures are sudden, uncontrolled electrical disturbances in the brain, affecting behaviour, movement, feeling, and consciousness
  • Three major types of seizures: generalized (both brain sides), focal (one brain area/side), and unknown onset
  • Common causes of seizures include sleep deprivation, drug use (amphetamines, cocaine), certain medications (pain relievers, antidepressants, smoking cessation therapies), lack of oxygen during birth, and stress.
  • Common side effects are often mild and short-lived, including dizziness, tiredness, upset stomach, or blurry vision.
  • More significant side effects (though less common): low white blood cell or platelet counts, rashes, pancreas problems, aplastic anaemia (life-threatening bone marrow disorder), and liver damage.
  • Epilepsy (epileptic fits/seizures) is a neurological disorder that causes recurrent seizures or unusual behaviors. Symptoms vary, ranging from mild shaking to severe symptoms.

Antiseizure Agents

  • Different types of antiseizure agents are categorized by the type of seizures they target (focal, generalized, and absence).
  • Medications like carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), topiramate (Topamax), and others are listed.
  • Some agents (like benzodiazepines) can stop seizures quickly, particularly in emergencies
  • Important note on some medication use with specific seizure types (e.g certain benzodiazepines useful for status epilepticus)
  • Other groups include aldehydes (like paraldehyde), aromatic and allylic alcohols, barbiturates, benzodiazepines, bromides, carbamates, and others. Specific examples within each group are detailed. Note particular usage of these groups (e.g. phenobarbital as a main form of treatment in certain periods, and now less common given other treatments that have less severe side effects)

Complications of Untreated Seizures

  • Prolonged untreated seizures can lead to complications such as injuries (falls, drowning), increased risk of accidents (driving), psychological issues (depression, anxiety, suicidal tendencies), and status epilepticus (frequent/recurrent seizures without regaining consciousness), along with potentially life-threatening conditions like SUDEP (sudden unexplained death in epilepsy).

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