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Pharm OTL > Anti-Epileptics > Flashcards

Anti-Epileptics Flashcards

1
Q

Name three sodium channel blockers

A 
Carbamazepine
Phenytoin
Sodium valproate
Lamotrigine
Topiramate
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2
Q

What is the MoA of sodium channel blockers?

A

Causes the Na channel to remain inactive in the pre-synaptic neurone after firing.
Therefore prevents neurones from firing repeatedly.

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3
Q

Which three sodium channel blockers are teratogenic?

A

Carbamazepine
Sodium valproate
Phenytoin

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4
Q

State two side effects of sodium channel blockers

A 
Ataxia
Hypotension
Bradycardia
‘Thinking through treacle’
Drowsiness
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5
Q

Name two calcium channel blockers

A

Sodium valproate

Ethosuximide

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6
Q

What is the MoA of calcium channel blockers?

A

Prevents the ‘spike and wave’ discharge seen in absence seizures

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7
Q

Name two GABA potenitators

A

Phenobarbital (barbituate)

Midazolam, diazepam, lorazepam (benzodiazepine)

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8
Q

What is the MoA of GABA potenitators?

A

Increase the effect of GABA to increase the inhibition on excitatory post-synaptic neurones

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9
Q

In what emergency situation is lorazepam used?

A

Status epilepticus

IV lorazepam

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10
Q

Name a GABA transaminase inhibitor

A

Vigabatrin

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11
Q

What is the MoA of GABa transaminase inhibitors?

A

Prevent the breakdown of GABA to increase the inhibition on excitatory post-synaptic neurones

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12
Q

What is the MoA of gabapentin?

A

Improves the utilisation of glutamate tomake more GABA

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13
Q

What is the MoA of levetiracetam (Keppra)?

Lev-uh-ter-ah-seh-tam

A

Binds to pre-synaptic vesicles to prevent the release of neurotransmitter

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14
Q

Which five drugs are used in the treatment of partial seizures?

A 
Lamotrigine
Topiramate
Gabapentin
Phenytoin
Carbamazepine
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15
Q

Which four drugs are used in the treatment of general seizures?

A

Phenobarbitol
Sodium valproate
Ethosuximide
Lorazepam

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16
Q

State two reasons why pharmacological treatment can be started in a pt after their first seizure

A
  • Neurological deficit.
  • EEG shows major epileptic activity.
  • Risk of a further seizure is unacceptable (from the pts PoV).
  • Imaging reveals a structural abnormality which suggests a second seizure is inevitable.
17
Q

What is the first line treatment of epilepsy?

A

Sodium valproate

If that’s not tolerated, then use lamotrigine instead

18
Q

What is the second line treatment of epilepsy?

A

Add on levetiracetam, topiramate or lamotrigine and sodium valproate

19
Q

Name two anti-epileptics that are CYP inducers

A

Carbemazepine

Phenytoin

20
Q

Name an anti-epileptic that is a CYP inhibitor

A

Sodium valproate

21
Q

What advice may need to be given to patients on the COCP?

A

The oestrogen component may be metabolised quicker, so increase the COCP dose.
Also advise using extra barrier protection.

22
Q

Name three adverse effects of all anti-epileptics

A

Dizziness
Fatigue
Ataxia
Diplopia

23
Q

Name two adverse effects associated with sodium valproate

A 
Weight gain
N+V
Tremor
Hyponatraemia
Anaemia
Dysmenorrhoea
24
Q

Name two adverse effects of lamotrigine

A 
Irritability and behaviour changes
Tics
Insomnia
Skin rash
Arthralgia
25
Q

How do you change anti-epileptics?

A

Start the new drug, gradulally titrating up the dose.

When the new drug is at its max dose, slowly withdraw the old drug

26
Q

If a pt has been seizure free then they may be taken off of their meds. 60% of these pts will be fine. State two risk factors for having another seizure after being taken off of meds

A
  • Epilepsy since childhood
  • On more than one drug
  • Myoclonic or tonic-clonic seizures
  • Abnormal EEG in the last year
  • Know underlying brain damage
27
Q

How do you take pts off of anti-epileptics?

A

Withdraw the drug slowly to avoid withdrawl Sx.

If pt is on more than one drug, withdraw one at a time with one month inbetween/

28
Q

What are the effects on baby from sodium valproate?

A
  • Neural tube defects
  • Craniofacial and skeletal abnormalities
  • Developmental disorders after birth
29
Q

What are the effects on baby from phenytoin?

A
  • Cleft lip and palate

- Septal defects in the heart

Pharm OTL (18 decks)

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