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Pharmacology > Anti-epileptics = HARD, lots of pure memory; SHARKS - help with patterning a bit :) > Flashcards

Anti-epileptics = HARD, lots of pure memory; SHARKS - help with patterning a bit :) Flashcards

1
Q

Describe: simple partial seizure

A

no loss of consciousness - SIMPLE partial - singal limb/muscle group invovled (ie can localize in brain) = FOCAL

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2
Q

Describe: complex partial seizure

A

loss of consciousness = complex motor dysfucntion - chewing, movements, diarrhoea, urination

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3
Q

Describe: partial with secondarily generalized tonic-clonic seizure

A

partial seizure (focal) evolved to a tonic-clonic seizure with loss of consciousness

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4
Q

~~Describe: generalizes seizure

A

no evidence of localization convlusive or not **immediate loss of consciousness

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5
Q

Describe: petit mal

A

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

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6
Q

MOA fo seizures

A

decreased in INHIBITORY synpatic activity OR increased in exiciatory activity

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7
Q

concept: Principal of antiepileptic drugs

A

a) block vt ion channels b) modulate sympatic transmission

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8
Q

What type of ion channels would be beneficial to block?

A

vg Na channels vg T type Ca++ channels

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9
Q

Please list the drugs that inhibit vg Na+ channels @ principal mechanism SHARK: flashbacks!

A

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

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10
Q

Please list the drugs that have blocking vg Na channels as a ‘‘contribution to the effects of’’

A

phenobarbital valproate topiramate

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11
Q

concept: What role does the T type Ca++ channel have in seizures

A

governs oscillatory response in thalamic neurons - ie absence seizures that invovled oscillatory neuronal activity betwen thalamus and cortex

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12
Q

Tx for Absence Seizures

A

Ethosiximide Valproate T type Ca++ inhibtion

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13
Q

List T type Ca++ blockers SHARK: flash back!

A

Ethosiximide Valproate (also used for bipolar if lithium sucks with carbamezapine)

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14
Q

Pharmacologically, how can you decrease synaptic transmission. times two ways

A

1) give em a drug that increases GABA 2) give em a durg that decreases glutamate = decreased synaptic transmission

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15
Q

List the drugs that act post synaptically to enhance GABA

A

a) benzodiazepines b) barbiturates c) topiramate

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16
Q

List the drugs that act pre synaptically to enhance GABA

A

tiaGAB(a)ine viGABAtrin

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17
Q

MOA Tiagabine

A

inhibits reuptake of GABA

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18
Q

MOA Vigabatrin

A

inhibts degradation fo GABA by inhibiting GABA aminotransferase

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19
Q

Postsynaptic reducers of Glutamate and MOA

A

phenobarbitol topiramate ;) also inhibit Na vg channels ie the glutamate receptor apparently

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20
Q

Presynaptic reducers of glutamate and MOA

A

gabapentin pregabalin block presynaptic vg Ca AND Levetiracetam - binds synaptic vescile glycoprotein 2A

21
Q

~*~MOA Levetiracetam

A

binds to synaptic vesicle glycoprtoein 2a ie SV2A - may alter glutamate and gaba

22
Q

SHARK: list all the drugs that alter GABA transmission

A

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

23
Q

SHARK: list all the drugs that alter GLUTAMATE transmssion

A

pre: ganapentin (inhibits vgCa), pregablin AND levetiracetam (inhibits SV2a) post: phenobarbital, topiramate WANT TO DECREASE bc seizures are spazzes

24
Q

~*~DOC @ tonic-clonic seizures + SHARK: their MOA

A

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

25
Q

DOC @ absence seizures + SHARK: MOA

A

ethosuximide and valproate - inhibit T type Ca @ thalamus to prevent osciltation between it and the cortex

26
Q

~*~DOC for absence seizures if tonic clonic present

A

valproate

27
Q

~*~DOC for atypical absence seizures

A

valproate

28
Q

What else is probably effective for absences seizures

A

lamotrigine PLCZ - inhibit vg Na

29
Q

~*~ DOC for myoclonic seizures

A

valproate - inhibit T type Ca at thalamus

30
Q

Other drugs you can use for myoclonic seizures

A

topiramate - enhances post synaptic GABA levetiracetam - as adjunct - SV2a vesicle release

31
Q

~*~DOC for atonic seizures

A

jk, usually refractory… OR valproate - t type Ca channel AN lamotrigine PLCZ - vg Na channels

32
Q

~*~ DOC for infantile spasms

A

corticotropin/glucocorticoids vigabatrin - inhibits GABA aminotransferase ie enhances GABA presynaptic

33
Q

~*~ DOC febrile convulsions SHARK - flash back!

A

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

34
Q

Treatment regimine for status epilepticus

A

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

35
Q

Treatment for drug induced seizures in nonepileptic patients

A

a) diazepam b) lorazepam c) phenobarbital

36
Q

Treatment for breakthrough seizures

A

diazepam rectal gel ;) breakthrough haha. its late.

37
Q

~*~SHARK: what seizures can you treat with valproate

A

absent seizures wtih tonic clonic atypical absent seizures absent seizures (with ethosiximide) myoclonic atonic VALPROATE = ABSENT ANYTHINGS nad muscle-y

38
Q

~*~SHARK: what seizures can you treat with diazepam

A

febrile convulsions drug induced seizures breakthrough seizures IE caused by external stuff, not just hte brain being a spazz

39
Q

~*~SHARK: what seizures respond to vg Na inhibitors

A

tonic clonics

40
Q

SHARK: what seizures respond to corticosteroids/glucocorticoids

A

infantile spams –> then vigabatrin (GABA aminotransferase inhibitor)

41
Q

A/se mania + MOA of each: inducers of P450 VRS inhibtors of P450

A

inducers - phenytoin, phenobarbital, carbamazepine = vg Na inhibitors inhibitors - valproate - T type Ca channel inhibotr

42
Q

A/se mania + MOA of each: valproate

A

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

43
Q

A/se mania + MOA pheytoin ~*~*~*~

A

vg Na inhibitor * induces P450 * diplopia * ataxia ~** GINGIVAL HYPERPLASIA * coarsening of facial features * hirsutism ZERO ORDER KINETICS (pea from first aid)

44
Q

A/se + MOA carbamazepine

A

vg Na channel inhibitor P450 inducer aplastic anemia leukopenia rash

45
Q

a/se + MOA vigabatin

A

inhibits GABA aminotrasnferase - presynatpic enhancement vision loss (v for vigabatin and vision loss)

46
Q

SHARK: antiepileptics that can be used to treat neuropathic pain

A

carbamazepine (causes blood s/e) gabapentin (inhibit presynaptic vg Ca) pregbalin (same zees)

47
Q

SHARK: antiepileptics that can be used to treat bipolar disorder when Lithium sucks out

A

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)

48
Q

SHARK: migraine

A

topiramoate (post synaptic Glutamate receptor/Na inhibitor) valproate (hepatotoxicity, P450 inhibit, self and other durg inhibi)

Pharmacology (70 decks)

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