Anti-Epileptics Flashcards
Name three sodium channel blockers
Carbamazepine Phenytoin Sodium valproate Lamotrigine Topiramate
What is the MoA of sodium channel blockers?
Causes the Na channel to remain inactive in the pre-synaptic neurone after firing.
Therefore prevents neurones from firing repeatedly.
Which three sodium channel blockers are teratogenic?
Carbamazepine
Sodium valproate
Phenytoin
State two side effects of sodium channel blockers
Ataxia Hypotension Bradycardia ‘Thinking through treacle’ Drowsiness
Name two calcium channel blockers
Sodium valproate
Ethosuximide
What is the MoA of calcium channel blockers?
Prevents the ‘spike and wave’ discharge seen in absence seizures
Name two GABA potenitators
Phenobarbital (barbituate)
Midazolam, diazepam, lorazepam (benzodiazepine)
What is the MoA of GABA potenitators?
Increase the effect of GABA to increase the inhibition on excitatory post-synaptic neurones
In what emergency situation is lorazepam used?
Status epilepticus
IV lorazepam
Name a GABA transaminase inhibitor
Vigabatrin
What is the MoA of GABa transaminase inhibitors?
Prevent the breakdown of GABA to increase the inhibition on excitatory post-synaptic neurones
What is the MoA of gabapentin?
Improves the utilisation of glutamate tomake more GABA
What is the MoA of levetiracetam (Keppra)?
Lev-uh-ter-ah-seh-tam
Binds to pre-synaptic vesicles to prevent the release of neurotransmitter
Which five drugs are used in the treatment of partial seizures?
Lamotrigine Topiramate Gabapentin Phenytoin Carbamazepine
Which four drugs are used in the treatment of general seizures?
Phenobarbitol
Sodium valproate
Ethosuximide
Lorazepam
State two reasons why pharmacological treatment can be started in a pt after their first seizure
- 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.
What is the first line treatment of epilepsy?
Sodium valproate
If that’s not tolerated, then use lamotrigine instead
What is the second line treatment of epilepsy?
Add on levetiracetam, topiramate or lamotrigine and sodium valproate
Name two anti-epileptics that are CYP inducers
Carbemazepine
Phenytoin
Name an anti-epileptic that is a CYP inhibitor
Sodium valproate
What advice may need to be given to patients on the COCP?
The oestrogen component may be metabolised quicker, so increase the COCP dose.
Also advise using extra barrier protection.
Name three adverse effects of all anti-epileptics
Dizziness
Fatigue
Ataxia
Diplopia
Name two adverse effects associated with sodium valproate
Weight gain N+V Tremor Hyponatraemia Anaemia Dysmenorrhoea
Name two adverse effects of lamotrigine
Irritability and behaviour changes Tics Insomnia Skin rash Arthralgia
