Anti-epileptics = HARD, lots of pure memory; SHARKS - help with patterning a bit :) Flashcards
Describe: simple partial seizure
no loss of consciousness - SIMPLE partial - singal limb/muscle group invovled (ie can localize in brain) = FOCAL
Describe: complex partial seizure
loss of consciousness = complex motor dysfucntion - chewing, movements, diarrhoea, urination
Describe: partial with secondarily generalized tonic-clonic seizure
partial seizure (focal) evolved to a tonic-clonic seizure with loss of consciousness
~~Describe: generalizes seizure
no evidence of localization convlusive or not **immediate loss of consciousness
Describe: petit mal
aka Absence seizure brief, abrupt, self limiting loss of consciousness patient stares and exhibits rapid eye blinking **3 hz for a few seconds and the stops
MOA fo seizures
decreased in INHIBITORY synpatic activity OR increased in exiciatory activity
concept: Principal of antiepileptic drugs
a) block vt ion channels b) modulate sympatic transmission
What type of ion channels would be beneficial to block?
vg Na channels vg T type Ca++ channels
Please list the drugs that inhibit vg Na+ channels @ principal mechanism SHARK: flashbacks!
PLCZ (places) P: phenytoin (diabetes lecture flash back can cause hyperglycemia with clonidin and CCB) L: lamotrigine C: carbamazepine (flashback: bipolar treatment second option if lithium is no good) Z: zonisamide
Please list the drugs that have blocking vg Na channels as a ‘‘contribution to the effects of’’
phenobarbital valproate topiramate
concept: What role does the T type Ca++ channel have in seizures
governs oscillatory response in thalamic neurons - ie absence seizures that invovled oscillatory neuronal activity betwen thalamus and cortex
Tx for Absence Seizures
Ethosiximide Valproate T type Ca++ inhibtion
List T type Ca++ blockers SHARK: flash back!
Ethosiximide Valproate (also used for bipolar if lithium sucks with carbamezapine)
Pharmacologically, how can you decrease synaptic transmission. times two ways
1) give em a drug that increases GABA 2) give em a durg that decreases glutamate = decreased synaptic transmission
List the drugs that act post synaptically to enhance GABA
a) benzodiazepines b) barbiturates c) topiramate
List the drugs that act pre synaptically to enhance GABA
tiaGAB(a)ine viGABAtrin
MOA Tiagabine
inhibits reuptake of GABA
MOA Vigabatrin
inhibts degradation fo GABA by inhibiting GABA aminotransferase
Postsynaptic reducers of Glutamate and MOA
phenobarbitol topiramate ;) also inhibit Na vg channels ie the glutamate receptor apparently
Presynaptic reducers of glutamate and MOA
gabapentin pregabalin block presynaptic vg Ca AND Levetiracetam - binds synaptic vescile glycoprotein 2A
~*~MOA Levetiracetam
binds to synaptic vesicle glycoprtoein 2a ie SV2A - may alter glutamate and gaba
SHARK: list all the drugs that alter GABA transmission
pre: tiaGAB(a)ine (prevents reuptake), viGABAtrine (inhibits degradation via stopping GABA aminotransferase), levitracetam (inhibits SV2a on vesicles) post: topiramate, barbituates, benzodiazepines WANT TO INCREASE bc seizures are spazzes
SHARK: list all the drugs that alter GLUTAMATE transmssion
pre: ganapentin (inhibits vgCa), pregablin AND levetiracetam (inhibits SV2a) post: phenobarbital, topiramate WANT TO DECREASE bc seizures are spazzes
~*~DOC @ tonic-clonic seizures + SHARK: their MOA
carbamazepine - inhibit vg Na PLCZ oxcarbazepine - inhibit vg Na valproate - inhibit vg Na most likely lamotrigine - inhibit vg Na PLCZ phenytoin - inhibit vg Na PLCZ topiramte - inhibit vg most likely
DOC @ absence seizures + SHARK: MOA
ethosuximide and valproate - inhibit T type Ca @ thalamus to prevent osciltation between it and the cortex
~*~DOC for absence seizures if tonic clonic present
valproate
~*~DOC for atypical absence seizures
valproate
What else is probably effective for absences seizures
lamotrigine PLCZ - inhibit vg Na
~*~ DOC for myoclonic seizures
valproate - inhibit T type Ca at thalamus
Other drugs you can use for myoclonic seizures
topiramate - enhances post synaptic GABA levetiracetam - as adjunct - SV2a vesicle release
~*~DOC for atonic seizures
jk, usually refractory… OR valproate - t type Ca channel AN lamotrigine PLCZ - vg Na channels
~*~ DOC for infantile spasms
corticotropin/glucocorticoids vigabatrin - inhibits GABA aminotransferase ie enhances GABA presynaptic
~*~ DOC febrile convulsions SHARK - flash back!
if lasts more than 15 mins - diazepan IV or rectal solution (benzopine; long acting) diazepam also used for alcohol withdrawl with the benzo that starts wtih an o AND for status epilepticus with the benzo that starts wtih an L
Treatment regimine for status epilepticus
IV lorazepam (intermediate benzo) –> IV phenytoin (vg Na channel blocker) –> IV phenobarbitaol (partially vg Na channel blocker) –> general anesthetia with IV midazolam, propofol or barbiturates
Treatment for drug induced seizures in nonepileptic patients
a) diazepam b) lorazepam c) phenobarbital
Treatment for breakthrough seizures
diazepam rectal gel ;) breakthrough haha. its late.
~*~SHARK: what seizures can you treat with valproate
absent seizures wtih tonic clonic atypical absent seizures absent seizures (with ethosiximide) myoclonic atonic VALPROATE = ABSENT ANYTHINGS nad muscle-y
~*~SHARK: what seizures can you treat with diazepam
febrile convulsions drug induced seizures breakthrough seizures IE caused by external stuff, not just hte brain being a spazz
~*~SHARK: what seizures respond to vg Na inhibitors
tonic clonics
SHARK: what seizures respond to corticosteroids/glucocorticoids
infantile spams –> then vigabatrin (GABA aminotransferase inhibitor)
A/se mania + MOA of each: inducers of P450 VRS inhibtors of P450
inducers - phenytoin, phenobarbital, carbamazepine = vg Na inhibitors inhibitors - valproate - T type Ca channel inhibotr
A/se mania + MOA of each: valproate
highest teratogenecity - fetal malformations hepatotoxicity a) inhibits P450 b) inhibits its own metabolism c) inhibits metabolsim of other drugs = drugs building up everywhere, liver cnat handle it - toxivity inhibits T type Ca channcels
A/se mania + MOA pheytoin ~*~*~*~
vg Na inhibitor * induces P450 * diplopia * ataxia ~** GINGIVAL HYPERPLASIA * coarsening of facial features * hirsutism ZERO ORDER KINETICS (pea from first aid)
A/se + MOA carbamazepine
vg Na channel inhibitor P450 inducer aplastic anemia leukopenia rash
a/se + MOA vigabatin
inhibits GABA aminotrasnferase - presynatpic enhancement vision loss (v for vigabatin and vision loss)
SHARK: antiepileptics that can be used to treat neuropathic pain
carbamazepine (causes blood s/e) gabapentin (inhibit presynaptic vg Ca) pregbalin (same zees)
SHARK: antiepileptics that can be used to treat bipolar disorder when Lithium sucks out
carbamazepine (Causes blod s/e and rahs, and induces P450) lamotrigine (vg Na inhibitor - tx tonic clonics) valproate (absent seizures, myoclonic and atonic seizure treatment + fetal abnormalities, hepatotoxicity = P450 inhibition, inhibits its own and other drug metabolsim)
SHARK: migraine
topiramoate (post synaptic Glutamate receptor/Na inhibitor) valproate (hepatotoxicity, P450 inhibit, self and other durg inhibi)
