Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MD4001 Week 5 > 10. Anti-epileptic drugs > Flashcards

10. Anti-epileptic drugs Flashcards

1
Q

Epilepsy epidemiology?

A

0.5% of population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is epilepsy?

A

Epilepsy is a continuing tendency to have seizures

Seizures are sudden discharges of abnormal electrical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epileptic attack can be confused with…

A

Syncope attack (fainting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Points to consider in the initial diagnosis of epilepsy before examination?

A
  • History is most important, both from patient and witness.
  • ? Aura/warning
  • Abnormal movements
  • Colour
  • Position
  • When?
  • After effects?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigations are used in epilepsy diagnosis?

A

ECG
EEG
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Difference epileptic classificaitons.

A

Partial, simple, complex

Generalised, primary or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of a generalised seizures?

A 
Absence
Myoclonic
Clonic
Tonic
Tonic-clonic
Atonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of simple partial seizure?

A
  • Focal with minimal spread of abnormal discharge

* normal consciousness and awareness are maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of complex partial seizures?

A 
 Local onset, then spreads
 Impaired consciousness
 Clinical manifestations vary with site of origin and degree of spread
– Presence and nature of aura
– Automatisms
– Other motor activity
 Temporal lobe epilepsy
most commonq
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of secondarily generalised seizures?

A

 Begins focally, with or without focal neurological symptoms
 Variable symmetry, intensity, and duration of tonic (stiffening)
and clonic (jerking) phases
 Typical duration up to 1-2 minutes
 Postictal confusion and somnolence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which hemispheres are involved in generalised seizures>

A

Both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Success of epilepsy medications?

A
  • Just under 60% of all people with epilepsy can become seizure free with drug therapy
  • In another 20% the seizures can be drastically reduced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Deciding factors for when choosing an anti-epileptic drug?

**exam **

A 
§ Seizure type
 Epilepsy syndrome
 Pharmacokinetic profile
 Interactions/other medical conditions 
 Efficacy
 Expected adverse effects
 Cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AED?

A

Anti-epileptic durg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the targets for AED?

A
  • Increase inhibitory neurotransmitter system— GABA
  • Decrease excitatory neurotransmitter system—glutamate
  • Block voltage-gated inward positive currents— Na+ or Ca++
  • Increase outward positive current—K+

Many AEDs pleiotropic—act via multiple mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The brain’s major excitatory neurotransmitter, which NT?

A

Glutamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two groups of glutamate receptor?

A

– Ionotropic—fast synaptic transmission • NMDA, AMPA, kainate
• Gated Ca++ and Gated Na+ channels
– Metabotropic—slow synaptic transmission
• Regulation of second messengers (cAMP and Inositol)
• Modulation of synaptic activity

18
Q

Modulators of glutamate receptors by…

A

Glycine, polyamine sites, Zinc, redox site

19
Q

What are the two groups of glutamate receptor?

A
  1. Ionotropic—fast synaptic transmission
    • NMDA, AMPA, kainate
    • Gated Ca++ and Gated Na+ channels
  2. Metabotropic—slow synaptic transmission
    • Regulation of second messengers (cAMP and Inositol)
    • Modulation of synaptic activity
20
Q

Which AEDs act primarily on Na+ channels

A
  1. Phenytoin, carbamazepine: Block voltage-dependent sodium channels at high firing frequences. Use dependent
  2. Oxcarbazepine: Block voltage-dependent sodium channels at high firing frequencies. Also effects K_ channels
  3. Zonisamide: Blocks voltage-dependent Na channels and T-type calcium channel
  4. Lamotrigine
21
Q

What are the currently commonly used anti-epileptic drugs?

A
  • Lamotrigine,
  • Sodium Valproate,
  • Carbamazepine,
  • Oxcarbazepine,
  • Levetiracetam,
  • Topiramate.
22
Q

Lamotrigine:
MoA?
Side effects?

A

MoA:
Na+ inhibiting channels

Side effects:
Hypersensitivity reactions (esp skin rashes)
23
Q

Sodium valproate:
MoA?
side effects?

A

MoA:
Increase in GABA content of the brain
Weak inhibition of GABA transaminase

Side effects:
Hair loss
Teratogenicity (embryo malaborption causative factor)
Foetal syndrome
Liver damage
24
Q 
Carbamazepine:
relation to anti-depressants?
Therapeutic use?
Strong enzyme inducting agent, leads to... 
Side effects?
A

Relation to anti-depressants?
Tricyclic derivative

Therapeutic use?
Partial seizures
Trigeminal neuralgia

Strong enzyme inducting agent, leads to… drug interactions e.g. Contraceptive pill

Side effects?
Sedation
Ataxia
Mental disturbances
Water retention
25
Oxcarbazepine - Use? - MoA? - Side effects?
Use: Monotherapy Add-on therapy in partial seizures MoA: - Augments K+ channels - P450 induction Side effects: Sedations Note: Related to carbamazepine but less P450 induction and less toxic
26
Name 4 newer AEDs?
Levetiracetam Topiramate Tiagabine Zonisamide
27
Action of levetiracetam? Use? Side effects?
Newer AED MoA: Inhibit precsynaptic Ca+ channels Use: 1. Analogue of piracetam, a drug used to improve cognitive function 2. Used in partial and generalised seizures 3. 2nd line in children Psychiatric side effects
28
Action of topiramate? | Side effects?
Newer AED, unknown MoA Side effects: - Risk of teratogenesis - Needs slow titration to avoid cognitive side effects (dizziness and confusion)
29
Which 3 older AED's should be made aware of as they are still in use?
Phenytoin: Na+ blocker, requires close monitoring as 1st order kinetics, lots of drug interactions and side effects Ethosuximide: Treated absence seizures in chidlren but may exacerbate other forms Phenobarbitone: Side effect os osteoporosis
30
What is the NMDA receptor?
The NMDA receptor is very important for controlling synaptic plasticity and memory function. The NMDAR is a specific type of ionotropic GLUTAMATE receptor. NMDA receptor: "N-methyl-D-aspartate (NMDA)" binds selectively to it, and not to other glutamate receptors.
31
What is the role of benzodiapepines in epilepsy treatment?
E.g. Lorazapam and Diazepam • Benzodiazepines used as first-line treatment for status epilepticus (delivered IV – fast acting) • Sedating
32
Why is felbamate rarely used to treat epilepsy?
Risk of severe hypersensitivity reactions and aplastic anaemia
33
Why is vagabatrin rarely used to treat epilepsy?
Inhibiting GABA transaminase | Side effects: Drowsiness, behavioural/mood changes, retinal loss
34
Role of Gabapentin and Pregabalin (2nd generation derivative of gabapentin) as AEDs: Act specifically....... Use? Bonus?
Act specifically on calcium channel subunits called a2d1. Use: Add-on therapy for partial seizures and tonic-clonic seizures. *Neuropathic pain* Bonus: Less sedating
35
Role of Gabapentin and Pregabalin (2nd generation derivative of gabapentin) as AEDs: Act specifically....... Use? Bonus?
Act specifically on calcium channel subunits called a2d1. Use: Add-on therapy for partial seizures and tonic-clonic seizures. *Neuropathic pain* Bonus: Less sedating
36
1st and 2nd line treatment for Simple, Complex and Seconary generalised partial seizures?
1st line: Carbamazepine, Lamotrigine oxcarbazepine, Sodium valproate, levetiracetam 2nd line: Valproic acid, lamotrigine, topiramate, (levetiracetam, zonisamide)
37
1st line treatment for primary generalised seizures (tonic-clonic, tonic, myoclonic, atonic)?
Valproic acid, lamotrigine, topiramate, (levetiracetam, zonisamide)
38
treatment for absence seizures (primary generalised)?
Ethosuximide
39
AEDs in children?
Little RCT evidence VALPROATE still first line, consider foetal abnormalities • Lamotrigine, Levetiracetam increasingly being used • Ethosuxamide for Primary generalised
40
What is status epilepticus?
More than 30 minutes of continuous seizure activity Two or more sequential seizures spanning this period without full recovery between seizures * Is a medical emergency*
41
Treatment of status epilepticus?
– Diazepam, lorazapam IV (fast, short acting) | – Followed by phenytoin, fosphenytoin, or phenobarbital (longer acting) when control is established
42
``` Baclofen: MoA? Administration? Use? Side effects? Epilepsy? ```
MoA: Selective agonist on GABA-receptors Administration: Oral Use: Spasticity associated with MS or spinal injury Side effects: Drowsiness, motor inco-ordination, nausea Epilepsy: NOT USED IN TREATMENT

MD4001 Week 5 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions