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Pharm > Anti- Epileptics > Flashcards

Anti- Epileptics Flashcards

1
Q

Define epilepsy

A

Episodic discharge or abnormal high frequency electrical activity in the brain leading to seizure

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2
Q

Describe the 2 types of focal seizures (only a certain focal area is affected)

A

Simple - remain conscious

Complex - impaired consciousness

Symptoms reflect area affected

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3
Q

Describe the 2 types of generalised seizures

A

Tonic clonic - unconscious, stiffening of the limbs, jerking of the limbs

Absence - as if daydreaming but can’t respond

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4
Q

What are some of the signs of partial seizures?

A

Unusual feeling, unusual taste, unusual smell, tingling, twitching, smacking lips, random noises, picking at clothes

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5
Q

Describe some signs of generalised seizures

A

Vacant stare (absence)

Incontinence, cyanosis, tongue biting

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6
Q

What is status epilepticus?

A

Seizure lasting over 30 mins/multiple back to back (>5 mins an emergency)

Risk of hypoxia due to changes in breathing and heart rhythm, brain damage and SUDEP

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7
Q

What are the 2 classes of anti epileptics?

A

Voltage gated Na blockers

Enhancing GABA inhibition

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8
Q

How do Na channel blockers work?

A

They bind to the channel once it has been inactivated and keep it in this state meaning Na can not enter the cell to cause depolarisation thus reduces the probability of an action potential. It dissociates once the membrane potential is back to normal

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9
Q

How do GABA agonists work?

A

GABA is an inhibitory neurotransmitter that reduces excitability. GABA agonists bind with the GABAA receptor (ligand gated ion channel) which increases Cl conductance causing hyperpolarisation.

Reuptake of GABA can also be targeted

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10
Q

Name 3 Na channel blockers

A

Carbamazepine

Phenytoin

Lamotragine

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11
Q

Name the 2 GABA agonists

A

Benzodiazepines e.g. Diazepam, lorazepam

Valproate

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12
Q

Describe the pharmacokinetics of carbamazepine

A

Protein bound

Half life of 30 hours but induces own metabolism with CYP450 so reduces half life to 15 hours

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13
Q

What are the main ADRs associated with Na blockers?

A

Dizziness, ataxia

Carbamazepine - numbness, vomiting, hyponatraemic rash

Lamotrigine - nausea, hyponatraemic rash

Phenytoin - Steven Johnson syndrome, gingervival hyperplasia

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14
Q

What are the major DDIs with carbamezipine?

A

CYP450 inducers - warfarin, oral contraceptive, corticosteroids

Antidepressants

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15
Q

Describe the pharmacokinetics for phenytoin

A

Protein bound, non linear, variable half life, requires monitoring

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16
Q

What are the main DDIs for phenytoin?

A

Induces CYP450 - contraceptive pill

Protein binding by valproate and salicylate exacerbates non linear kinetics

Cimetidine increases

17
Q

Describe the pharmacokinetics of lamotrigine

A

Linear, half life of 24 hours protein bound

18
Q

What are the main DDIs for lamotrigine?

A

Is not a CYP450 inducer

Contraceptive pill reduces levels

Valproate increases levels

19
Q

Describe the pharmacokinetics of benzodiazepines

A

Linear, half life varies, protein bound

20
Q

What are the main ADRs of benzodiazepines?

A

Sedation, confusion, impaired coordination, CNS depression, respiratory depression, tolerance, dependence

21
Q

What are the main ADRs for valproate?

A

Ataxia, tremor, sedation, liver failure (requires monitoring)

22
Q

What are the main DDIs for valproate?

A

Protein binding affects other AED concentrations

Antipsychotics/antidepressants antagonise so lower threshold

Aspirin increases action

23
Q

Which AEDs reduce efficacy of the contraceptive pill?

A

Carbamazepine, phenytoin

24
Q

Which AED is especially teratogenic?

A

Valproate (neural the defect)

25
Q

Which AED is the safest in pregnancy?

A

Lamotrigine

26
Q

Which AED is first line in pregnant women?

A

Lamotrigine

27
Q

Which AED is first line for partial seizures?

A

Carbamazepine

28
Q

Which AED is first line for generalised seizures?

A

Valproate

29
Q

How would you manage status epilepticus?

A

Benzodiazepines/phenytoin

ITU - sedation, paralysis, ventilation

Exclude hypoglycaemia

Pharm (18 decks)

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