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3922 > 18 - Epilepsy treatment > Flashcards

18 - Epilepsy treatment Flashcards

1
Q

What is the criteria to be diagnosed with epilepsy

A

Occurrence of at least one unprovoked seizure

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2
Q

What are the two types of seizures

A

Focal

Generalised

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3
Q

What is a focal seizure

A

Activation of neurons in a relatively small, discrete region

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4
Q

What is a complex partial seizure

A

Impairment of consciousness

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5
Q

What are the types of generalised seizures

A 
Tonic
Atonic
Clonic
Tonic-clonic
Generalised absence seizures
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6
Q

What are tonic seizures

A

Extension of the extremities

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7
Q

What are atonic seizures

A

Sudden loss of muscle tone

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8
Q

What are clonic seizures

A

Repetitive muscle twitching

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9
Q

What are generalised absence seizures (petit-mal)

A

Brief lapse of consciousness

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10
Q

What are 6 mechanisms of anticonvulsants

A

1) Enhance Na channel inactivation
2) Inhibit excitatory AA release (block Ca channels)
3) Block excitatory AA action
4) Enhance GABA action
5) Inhibit GABA breakdown
6) Inhibit GABA uptake

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11
Q

What are Na channels critical for

A

Initiation and propagation of action potentials

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12
Q

How do Na+ channel blockers work

A
  • Enhance voltage-gated Na channel inactivation
  • Use dependent
  • Reduction of sustained high-frequency firing of action potentials
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13
Q

What are some Na channel blockers

A

Phenytoin
Carbazepine
Lamotrigine

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14
Q

What are some side effect of Na channel blockers

A

Dizziness
Upset stomach
Headache
Unsteadiness

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15
Q

MOA of ethosuximide (Zarontin)

A

T-type Ca channel blocker

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16
Q

What is ethosuximide used for

A

Treatment of generalised absence seizures

17
Q

What two drugs are Ca channel blockers

A

Levetiracetam

Ethosuximide

18
Q

What does levetiracetam bound to

A

Neuronal synaptic vesicle glycoprotein 2A which coordinates synaptic vesicle exocytosis
Inhibits presynaptic CaV channels

19
Q

What are some side effects of levetiracetam

A

Sleepiness
Loss of energy
Dizziness
Anxiety

20
Q

How do barbiturates work

A

1) Increase affinity for GABA
2) Increase Cl conductance
3) Prolongs the open time of the channel

21
Q

What are the unwanted sedative side effects of barbiturates

A

1) Tiredness, forgetfulness
2) Confusion, dizziness
3) Anaemia
4) Folic acid deficiency
5) Decreased libido, erection problems

22
Q

What is the MOA for benzodiazepines

A

Enhance the actions of GABA

Increases frequency of channel opening

23
Q

Which GABAA receptor subunits do benzodiazepines act at

A

a1, a2, a3, a5, y

24
Q

Where do benzodiazepines bind at

A

Interface between a and y

25
Q

What are some issues of benzodiazepines

A

1) Rapid tolerance
2) Sleepiness
3) Fatigue
4) Poor concentration

26
Q

How does vigabatrin work (Sabril)

A

Inhibit GABA breakdown
Structural analogue of GABA
Specific inhibitor of GABA transaminase

27
Q

What are some side effects of vigabatrin

A

Fatigue
Dizziness
Loss of peripheral vision

28
Q

What is the mechanism of tiagabine

A

Inhibition of GABA reuptake
GAT1 inhibitor
Increase extracellular GABA levels

29
Q

What are some side effects of tiagabine (Gabitril)

A

Sleepiness
Tremor
Dizziness
Anxiety

30
Q

What is the MOA of sodium valproate

A

Enhance Na channel inactivation
Block Ca channel
Maybe: Inhibit GABA breakdown

31
Q

What are some side effects of sodium valproate

A 
Dizziness
Upset stomach
Headache
Tremor
Weight gain
Hair loss
32
Q

What is the MOA of topiramate

A

Enhance Na channel inactivation
Block excitatory AA action (AMPA/Kainate receptor antagonist)
Enhance GABA action

33
Q

What are some side-effects of topiramate

A 
Dizziness
Confusion
Problems with word retrieval
Tremor
Weight loss
Hair loss
34
Q

What is the MOA of felbamate

A

Enhance Na channel inactivation
Block excitatory AA action (NMDA receptor antagonist)
Enhance GABA action

35
Q

What are the MOAs of gabapentin and pregabalin

A

Unknown but increase total GABA concentrations
Synthesised as GABA analogues
Bind to a2d subunit of voltage-gated Ca channels

36
Q

What are the side effects of gabapentin and pregabalin

A

Sleepiness, weight gain and dizziness

37
Q

What is the GABRG2 mutation

A

Lysine 289 to methionine mutation in y2 subunit of GABAA receptor
Decrease in GABAA receptor amplitude

38
Q

What is SCN1A mutation

A

Nav1.1 channel arginine 1916 to glycine mutation

Renders Nav1.1 non-functional

3922 (19 decks)

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