Psychotherapy: 92b/93b - Epilepsy and Anticonvulsants

Pregabalin

• Mechanism
  

  • Blocks Na+ channels

  • List the 5 types of generalized seizures

    • Atonic

    • Tonic

    • Clonic

    • Tonic-clonic
      

      • Tonic-clonic or myoclonic

    Which AED induces its own metabolism? What is the significance?

    Carbamazepine

    Need to start at low doses and titrate up (will be inefective if the dose isn't increased!)

    What is the mechanism of pregabalin?

    What is it used for?

    What is its major side effect?

    • Mechanism

      • Inhibits voltage-gated Ca2+ channels

      • Also reduces the release of some neurotransmitters

    Which AEDs can be used to treat migraine?

    Valproate

    Topiramate

    Zonisamide

    Which AED is likely to cause prominent hyponatremia?

    Oxcarbazepine

    What is the difference between a focal and generalized seizure?

    Where the seizure starts

    • Focal

      • Seizure starts from one side

      • May progress to affect both...

    Which AEDs can be used to treat bipolar disorder?

    Lamotrigine

    Valproate

    Carbamazepine

    What is the major difference between a focal seizure wtih impairment of consciousness and an abscence seizure?

    No post-ictal confusion with abscence seizure

    What defines epilepsy?

    Recurrent (2+) seizures that are not provoked by systemic or acute neurological insults

    • This excludes seizures due t...

    What is the mechanism of phenytoin?

    What is it used for?

    Inhibits rapid firing of Na+ channels

    Phenytoin is the most widely used AED

    Used extensively to treat status epileptic...

    Which kind of epilepsy is characterized by seizures preceded by aura?

    Temporal lobe epilepsy

    • Aura may involve epigastric sensation, deja vu, emotional feeling, perceptual distorion, autonomic

    Which AED does not have complete absorption >4mg?

    Gabapentin

    Describe the signs of an atonic seizure

    Atonic = generalized

    • Sudden loss of postural tone

      • Severe = fall

      • Mild = head or jaw draw

    Which AED is likely to cause a drop in IQ during therapy, memory deficits, appetite suppression, and weight loss?

    Topiramate

    What is the mechanism of oxcarbazepine?

    What is it used for?

    Blocks Na+ channels

    (its basically better carbamazepine; less risk of toxic metabolite buildup)

    Used for monotherapy in focal (...

    Describe the signs of a tonic-clonic seizure

    Tonic-clonic = generalized

    • Loss of consciousness

    • Post-ictal confusion, lethargy

    • Tonic phase

      • ...

    Describe the signs of an abscence seizure

    Abscence = generalized

    • Sudden onset

    • Eye blinks

    • Brief automatic mouth or hand movments

    • Ch...

    Which AED is associated with aplastic anemia and hepatic failure?

    Felbamate

    Which AED is most likely to cause CNS depression and irritability?

    Levetiracetam

    What is the mechanism of phenobarbital?

    Increases duration of GABAA Cl- channel opening

    Side effect: may cause CNS depression when combined with alcohol or benzos

    What is the mechanism of lamotrigine?

    What is it used for?

    Inhibits Na+ channels and glutamate release

    • Broad spectrum

      • Monotherapy or or adjunctive for generalized and focal seizu...

    Which kind of seizure is associated wtih generalized 3 Hz spike-wave discharges on EEG?

    Abscence

    Describe the seizures commonly associated with temporal lobe epilepsy

    • Preceded by aura

      • Often a weird taste in the mouth

    • Focal seizures with impai...

    Which two "clinically relevant" drugs may exacerbate epileptic seizures?

    Tramadol (an analgesic)

    Venlafaxine (an SNRI antidepressant)

    View all 47 terms

    Related Flashcard Decks

    Psychology

    Cognitive Neuroscience Chapter 2: Methods Part 1

    This flashcard deck covers key concepts from Chapter 2 of Cognitive Neuroscience, focusing on methods used in research, including stimulus onset asynchrony, the Stroop effect, multitasking, and various recording and stimulation techniques.

    14 cards

    View Deck

    Psychology

    CPLEE CA Laws That Guide the Specifics of Clinical Practice: Child Abuse Reporting Part 1

    This deck covers key concepts and legal requirements related to child abuse reporting in California, focusing on the responsibilities of mandated reporters under specific sections of the Penal Code.

    15 cards

    View Deck

    Psychology

    Developmental Psychology - Middle and Late Childhood Part 4

    This flashcard deck covers key concepts in developmental psychology, focusing on moral reasoning, social knowledge, and cognitive abilities during middle and late childhood.

    16 cards

    View Deck

    Psychology

    Sensation and Perception Part 1

    This deck covers key concepts in sensation and perception, including sensory receptors, perception processes, and visual components such as the retina and photoreceptors.

    30 cards

    View Deck

    Psychology

    AP Psychology: Unit 1 Part 3

    This deck covers key concepts and figures in psychology, including foundational theories, research methods, and statistical techniques.

    29 cards

    View Deck

    Psychology

    Intro to Psychology (PSYC101): Module 8: Sleep and Dreams

    This deck covers key concepts related to sleep and dreams, including definitions and characteristics of various sleep stages and disorders.

    15 cards

    View Deck

    Psychology

    Mors 200 Arts Final - Klicker Chapter 22

    Financial conditions affect how families plan funerals.

    28 cards

    View Deck

    Psychology

    Animal Behaviour - Abnormal and Repetitive Behaviours

    The majority of behaviour complaints in animals are not truly abnormal, but rather normal species-specific behaviours that are undesirable to owners, such as urine spraying or aggression. However, abnormal behaviours can occur—these are repetitive, lack clear function, and are not part of the normal behavioural repertoire.

    29 cards

    View Deck

    Psychology

    CPLEE CA Laws on Psychotherapist Sexual Exploitation

    This deck covers the California laws guiding clinical practice concerning psychotherapist sexual exploitation, including legal obligations, penalties, and procedures.

    11 cards

    View Deck

    Psychotherapy: 92b/93b - Epilepsy and Anticonvulsants

    Term	Definition
    Which 1st generation AEDs are enzyme inducers?	Phenobarbital Phenytoin Carbamazepine
    Which AED is the drug of choice for abscence seizures?	Ethosuximide
    What is the mechanism of the benzodiazepines? Which seizures do they treat?	Increased frequency of Cl- channel opening Effective for myoclonic seizures Rescue medication for status epilepticus
    Describe the general mechanisms of seizure generation	Too much excitation Ionic: too much inward Na+, Ca2+ NeuroT: Too much glutamate, aspartate Too little inhibition Ionic: too little inward Cl-, outward K+ NeuroT: Not enough GABA
    What is the mechanism of ethosuximide? What is it used for?	Blocks T-type Ca2+ currents in the thalamus Drug of choice for abscence seizures
    What is the most concerning possible side effect of lamotrigine?	Steven-Johnson syndrome But broadly, lamotrigine is a good broad-spectrum AED that is safe in pregnancy
    Which AED can also be used for migraine prophylaxis and neuropathic pain?	Topiramate
    Describe the signs of a myoclonic seizure	Myoclonic = generalized Myoclonus Brief, shock-like jerk of a muscle or group of muscles Bilateral, synchronous vs. clonus which is repeated rhythmic jerking If several myoclonic jerks occur in rhythmic succession, it is a clonic seizure Consciousness NOT impaired
    Which AEDs are safe in pregnancy?	Lamotrigine But need frequent adjustment in dose b/c serum levels fall in the 3rd trimester
    Describe the signs of a tonic seizure	Tonic = generalized Symmetric, tonic muscle contraction of extremities Tonic flexion of waist and neck Lasts 2-20 seconds EEG Sudden attenuation, generalized polyspike waves (similar to atonic)
    Which kind of epilepsy is characterized by focal seizures with impaired consciousness with automatisms?	Temporal lobe epilepsy Automatisms = lip smacking, swallowing, fumbling, picking at clothes
    What is the mechanism of Levetiracetam? What is it used for? What is its notable side effect?	Mechanism Binds to synaptic vescicle protein SV2A to regulate neurotransmitter release Also reduces activity through high-voltage Ca2+ channels Use Broad spectrum - used as monotherapy or adjunctive Side effect CNS depression and irritability
    What EEG changes are associated with abscence seizures?	3 Hz spike-wave discharges in every channel Lasts for 3-10 seconds Abscence seizures are generalized Sudden onset, sudden resolution No post-ictal confusion
    What is the mechanism of carbamazepine? What is it used for?	Inhibits Na+ channels Tricyclic Used to treat epilepsy w/predominantly focal seizures Will worsen abscence seizures
    Which kind of epilepsy is characterized by seizures that originate in the hippocampus and/or amygdala?	Mesial temporal lobe epilepsy Focal seizures evolve into a bilateral, convulsive seizure early on
    In which populations should valproate be avoided?	Pregnant women High risk of neural tube defects Neonates Hepatic toxicity due to elevated liver enzymes
    Which AEDs can be used for neuropathic pain?	Gabapentin Carbamazepine Pregabalin
    Which 1st generation AED is an enzyme inhibitor?	Valproate
    What is the mechanism of zonisamide? What is it used for?	Blocks Na+ and T-type Ca2+ channels Blocks carbonic anhydrase (-> side effect = kidney stones) Used as add-on therapy for partial and generalized seizures
    What is the mechanism of gabapentin? What is it used for?	Interferes with GABA uptake Add-on therapy for focal seizures Lacks potency for seizure - used off-label for neuropathic pain
    Which AED is first line for generalized epilepsies? What is its mechanism?	Valproate Broad spectrum Mechanisms: Enhances GABA activity Inhibits Na+ current Activates K+, T-type Ca2+ channels
    Which AED causes significant appetite increase and weight gain?	Pregabalin
    What is the mechanism of topiramate? What is it used for? What are the major side effects?	Mechanism Blocks Na+ channels Increases frequency of GABAA opening Interferes with glutamate binding Uses Broad specturm (monotherapy or adjunctive for focal or general) Also used for migraine prophylaxis, neuropathic pain, tremor Side effects Memory and cognitive impairment Appetitie suppression and weight loss
    List the 5 types of generalized seizures	Atonic Tonic Clonic Tonic-clonic Tonic-clonic or myoclonic Abscence
    Which AED induces its own metabolism? What is the significance?	Carbamazepine Need to start at low doses and titrate up (will be inefective if the dose isn't increased!)
    What is the mechanism of pregabalin? What is it used for? What is its major side effect?	Mechanism Inhibits voltage-gated Ca2+ channels Also reduces the release of some neurotransmitters Uses Neuropathic pain Peripheral neuropathy Fibromyalgia Anxiety Side effect Appetite increase and weight gain
    Which AEDs can be used to treat migraine?	Valproate Topiramate Zonisamide
    Which AED is likely to cause prominent hyponatremia?	Oxcarbazepine
    What is the difference between a focal and generalized seizure?	Where the seizure starts Focal Seizure starts from one side May progress to affect both sides of the brain, resulting in motor activity on both sides of the body (a secondarily generalized seizure) Generalized Seizure start from both sides
    Which AEDs can be used to treat bipolar disorder?	Lamotrigine Valproate Carbamazepine
    What is the major difference between a focal seizure wtih impairment of consciousness and an abscence seizure?	No post-ictal confusion with abscence seizure
    What defines epilepsy?	Recurrent (2+) seizures that are not provoked by systemic or acute neurological insults This excludes seizures due to metabolic disorders or alcohol or sedative drug withdrawal or
    What is the mechanism of phenytoin? What is it used for?	Inhibits rapid firing of Na+ channels Phenytoin is the most widely used AED Used extensively to treat status epilepticus
    Which kind of epilepsy is characterized by seizures preceded by aura?	Temporal lobe epilepsy Aura may involve epigastric sensation, deja vu, emotional feeling, perceptual distorion, autonomic
    Which AED does not have complete absorption >4mg?	Gabapentin
    Describe the signs of an atonic seizure	Atonic = generalized Sudden loss of postural tone Severe = fall Mild = head or jaw draw Consciousness usually impaired EEG Sudden diffuse atenuation, generalized polyspike waves Similar to tonic
    Which AED is likely to cause a drop in IQ during therapy, memory deficits, appetite suppression, and weight loss?	Topiramate
    What is the mechanism of oxcarbazepine? What is it used for?	Blocks Na+ channels (its basically better carbamazepine; less risk of toxic metabolite buildup) Used for monotherapy in focal (aka partial) seizures Note: tends to cause prominent hyponatremia
    Describe the signs of a tonic-clonic seizure	Tonic-clonic = generalized Loss of consciousness Post-ictal confusion, lethargy Tonic phase Stiffening + fall Ictal cry Clonic phase Rhythmic extremity jerking Drooling, foaming at the mouth, biting tongue Bladder and bowel incontinence Agitation
    Describe the signs of an abscence seizure	Abscence = generalized Sudden onset Eye blinks Brief automatic mouth or hand movments Changes in muscle tone No post-ictal confusion
    Which AED is associated with aplastic anemia and hepatic failure?	Felbamate
    Which AED is most likely to cause CNS depression and irritability?	Levetiracetam
    What is the mechanism of phenobarbital?	Increases duration of GABAA Cl- channel opening Side effect: may cause CNS depression when combined with alcohol or benzos
    What is the mechanism of lamotrigine? What is it used for?	Inhibits Na+ channels and glutamate release Broad spectrum Monotherapy or or adjunctive for generalized and focal seizures Safe in pregnancy!! But serum levels fall in 3rd trimester, needs adjustment Feared side effect = Steven-Johnson syndrome
    Which kind of seizure is associated wtih generalized 3 Hz spike-wave discharges on EEG?	Abscence
    Describe the seizures commonly associated with temporal lobe epilepsy	Preceded by aura Often a weird taste in the mouth Focal seizures with impaired consciousness with automatisms Lip smacking, swallowing, fumbling, picking at clothes Often cannot be medically controlled; opt for anteromesial temporal lobectomy
    Which two "clinically relevant" drugs may exacerbate epileptic seizures?	Tramadol (an analgesic) Venlafaxine (an SNRI antidepressant)