AEM's and Triptans

Question 1

carbamazepine

Answer 1

enhanced fast inactivation of Na channel
broad spectrum
CYP450 inducer, auto-induction (self metabolism)
Toxicities:
- Hematoogical penias
- hypocalcemia/vit. D. def/ osteoporisis
-hepatotoxicity
-hyponatremia

Question 2

oxcarbazepine

Answer 2

enhanced fast inactivation of Na channel
fewer CNS/ hematological side effects
less potent CYP450 inducer compared to carbamazepine
Renal clearance instead of hepatic

Question 3

eslicarbazepine

Answer 3

enhanced fast inactivation of Na channel

Question 4

lamotrigine

Answer 4

enhanced fast inactivation of Na channel

Question 5

phenytoin

Answer 5

enhanced fast inactivation of Na channel
broad spectrum
Zero order pharmkinetics (Saturable)
inducer of CYP450
Toxicities:
- gingival hyperplasia 
- hypothyroidism
- hypocalcemia/Vit.D def/osteoporosis

Question 6

topiramate

Answer 6

enhanced fast inactivation of Na channel
AMPA receptor antagonist 
GABA agonist 
broad spectrum 
renal clearance

Question 7

valproic acid

Answer 7

enhanced fast inactivation of Na channel
inhibition GABA metabolism by GABA-T or SSD
promotes GABA production via glutamic acid decarboxylase
T-type Ca channel antagonist for absence seizure
broad spectrum

Question 8

zonisamide

Answer 8

enhanced fast inactivation of Na channel

T-type Ca channel antagonist for absence seizure

Question 9

lacosamide

Answer 9

enhanced fast and slow inactivation of Na channel

Question 10

perampanel

Answer 10

AMPA receptor antagonist

Question 11

Felbamate

Answer 11

NMDA receptor antagonist at glycine site

Question 12

Tiagabine

Answer 12

GABA reuptake inhibitor of GAT-1

Question 13

Vigabatrin

Answer 13

inhibitor of GABA met. by GABA-T
Ocular toxicity w/ central retinal damage
renal clearance

Question 14

barbiturates

Answer 14

phenobarbital (broad spectrum) and primidone(for tonic/clonic)
GABA independent
increase duration of Cl- channel opening

Question 15

benzodiazapines

Answer 15

lorazepam, diazepam, clonaxepam (for myoclonic), clorazepate
potentiates GABA binding to receptor, allosteric change
increases chloride conductance
GABA dependent

Question 16

ethosuximide

Answer 16

T-type Ca channel antagonist

used for Absence seizures only

Question 17

Levetiracetam

Answer 17

Synaptic vesicle protein

renal clearance

Question 18

Brivaracetam

Answer 18

synaptic vesicle protein

Question 19

Gabapentin

Answer 19

alpha-2-delta Ca channel

renal clearance

Question 20

pregabalin

Answer 20

alpha-2-delta Ca channel

renal clearance

Question 21

Status epilepticus drugs

Answer 21

lorazepam, diazepam, phenobarbital, phenytoin, valproic acid, levetiracetam

Question 22

phenobarbital

Answer 22

C-IV agent
CYP450 inducer
CNS depressant
hypocalcemia/Vit.D def./ osteoporosis

Question 23

CYP450 inducer interactions

Answer 23

carbamazepine, phenytoin, phenobarbital, valproate

• increase clearance of contraceptives
• increased clearance of warfarin
• increased clearance of antivirals

Question 24

Inhibitors of glucruonosyltransferases (UGT)

Answer 24

valproic acid and lamotrigine

causes accumulation of parent drug

Question 25

inducers of UGT

Answer 25

phenytoin, carbamazepine, phenobarbital | cause reduction of parent drug

Question 26

Other triptans

Answer 26

``` almotriptan naratriptan zolmitriptan rizatriptan eletriptan frovatriptan ```

Question 27

Naratriptan

Answer 27

70% bioavailability, half-life 6 hrs

Question 28

Zolmitriptan

Answer 28

5HT1d agonist on synaptic terminal | fast onset nasal spay

Question 29

frovatriptan

Answer 29

half-life 24 hrs

Question 30

sumatriptan

Answer 30

fastest onset with SC or nasal spray | half-life 1-2 hrs

Question 31

MOA inhibitors

Answer 31

sumatriptan, rizatriptan and zolmitriptan contraindicated

Question 32

dihydroergotamine (DHE)

Answer 32

interact with alpha, dopamine and 5HT receptors longer lasting effects but don't work as fast as triptans side effects include: - emetic action and severe vasoconstriction

Question 33

Treatment during pregnancy

Answer 33

all trimesters = acetaminophen + codeine 1 and 2 trimester = aspirin or ibuprofen Triptans used cautiously never use DHE

Question 34

migrane prevention

Answer 34

propranolol, timolol (decreases cortical spreading depression, CSD) Tricyclic antidepressants: - amitriptyline, imipramine Anticonvulsants: - topirimate, valproate Ca channel blocker: - verapamil (First choice for prevention)