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B&B 2 (MM) > 3.20.14 37 AEDs (anti-epileptics) > Flashcards

3.20.14 37 AEDs (anti-epileptics) Flashcards

1
Q

What are the 6 mechanisms of AEDs?

A
  1. Prevention of repetitive propagation (Na channel inactivity stabilizer)
  2. Increased GABA inhibition
  3. Reduced presynaptic release of excitatory NTs
  4. Activate inhibitory K channels
  5. Block AMPA glutamate receptors
  6. Slow rhythmic firing reducers (T-type Ca2+ channel blocker)
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2
Q

Name all of the repetitive propagation inhibitors.

A 
Phenytoin (and fosphenytoin)
Carbamazepine
Oxcarbazepine
Valproic acid
Lamotrigine
Topiramate
Zonisamide
Phenobarbital
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3
Q

Name the GABA inhibition promoters.

A 
Clonazepam (benzodiazepines)
Phenobarbitol*
Topiramate
Gabapentin*
Valproic acid*
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4
Q

Name the NT release inhibitors

A

Gabapentin (Ca2+ blocker)
Pregabalin (Ca2+ blocker)
Levatiracetam (SV2A protein binder; blocks vesicles)

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5
Q

Name the K channel activator

A

Ezogabine (SMURFS)

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6
Q

Name the AMPA glutamate receptor blocker

A

Perampanel

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7
Q

Name the slow rhythmic firing reducers (T-type Ca channel blockers)

A

Ethosuximide
Valproic acid
Zonisamide
Lamotrigine

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8
Q

Define status epilepticus

A

+5 min of continuous seizing or without recovery of consciousness

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9
Q

Treatment for status epilepticus

A

Stabilize (ABCs)
IV Benzodiazepines
IV Fosphenytoin
Anesthetics if necessary

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10
Q

What 6 (or 2x3) drugs are good for partial and GTC?

A

Phenytoin
Phenobarbitol

Gabapentin
Pregabalin

Carbamazepine
Oxcarbazepine

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11
Q

What 1 drug is good for myoclonic seizure?

A

Levetiracetam

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12
Q

What 2 drugs are most often used for absence?

A 
Ethosuximide (absence sux)
Valproic acid (if GTC as well)
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13
Q

What 5 drugs are good for virtually all types of seizure?

A 
"VirTuaLLZ every seizure"
Valproic
Topiramate
Lamotrigine
Levetiracetam
Zonisamide
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14
Q

What non-AED purpose does carbamazepine have?

A

Trigem neuralgia
Anxiety
Neuropathic pain

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15
Q

What non-AED purpose does valproic acid have?

A

Headaches

Bipolar disorder

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16
Q

What non-AED purpose does topiramate have?

A

Headache

17
Q

What is the first line for focal sz with secondary generalization?

A

Carbamazepine
Phenytoin
Lamotrigine

18
Q

What is the second line for focal sz with seconary generalization?

A

Valproic acid
Oxcarbazepine
Topiramate

19
Q

What is the treatment for primary generalized seizures?

A

Valproic acid
Lamotrigine
Topiramate
Levetiracetam

20
Q

What two drugs have serious teratogenic risk?

A

Valproic acid and carbamazepine

21
Q

What are the 3 unique pharmacokinetic features of phenytoin?

A
  1. Limited water solubility (IV –> fosphenytoin)
  2. High protein binding
  3. Saturation of P450 changes to zero order metabolism
22
Q

What are the major adverse effects of repetitive action potential blockers?

A

Diplopia and nystagmus
Lethargy, cognitive slowing
Ataxia, vertigo

23
Q

What AED is similar to tricyclic antidepressants?

A

Carbamazepine

24
Q

What are the adverse effects of carbamazepine?

A

Aplastic anemia
Rash
Hyponatremia
Low WBCs (dose)

25
Q

What are the adverse effects of pheyntoin?

A

Gingival hyperplasia

Osteopenia

26
Q

What drug induces P450s?

A

Carbamazepine

27
Q

What drug inhibits hepatic metabolism of other drugs?

A

Valproic acid

28
Q

What are the various MOAs of valproic acid?

A

Na+ inactivity stabilizer
GABA enhancement
T-type Ca2+ blocker

29
Q

What are the key adverse effects of valproic acid?

A 
Fat, shaky, bald, yellow
-Weight gain
-Tremor
-Hair loss
-Jaundice
TERATOGENESIS
30
Q

What is the unique pharmacokinetic feature of lamotrigine?

A

Long half-life

31
Q

What is the unique adverse effect of lamotrigine?

A

Stevens-Johnson

32
Q

What is the MOA of phenobarbitol? What are the key adverse effects?

A

GABAa enhancement
Paradoxical hyperactivity in kids
Sedation, cognitive slowing, dizziness

33
Q

What is the major adverse effect of topiramate?

A

Renal stones

Excreted via kidneys

34
Q

What drug inhibits Ca2+ channels via the a2d subunit?

A

Gabapentin

Pregabalin

35
Q

What drug binds to SV2A, blocking release of vesicles?

A

Levetiracetam

36
Q

What drug causes smurf skin? What is its MOA?

A

Ezogabine

Activates potassium channels (hyperpolarization and inhibition)

37
Q

What drug is used exclusively for absence seizures?

A

Ethozuximide (absence sux)

38
Q

What drug changes from first order elimination to zero order elimination by saturating P450s?

A

Phenytoin

39
Q

What drug binds to proteins very strongly? What drug binds more strongly, displacing the first drug?

A

Phenytoin

Valproic acid

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