Anti-Seizure Drugs Flashcards
Dr. Kaul
Key hepatic enzyme inhibiting Anti-seizure drug
Valproate
Ethosuximide Adverse efects
GI distress
Representative Drugs for Absence seizures (T-type inhibitors)
- Ethosuximide (Zarontin)
Phenytoin Mechanism of Action
Sodium Block
Given Valproic Acid and Lamatrogine’s Mechanism of action, what are its indications?
All kinds of seizures
Valproic acid has a Triple mechanism of Action, where it’ll inhibit Na+, but it will also inhibit ______ channels and promote _____ neurotransmitter production
- Calcium
- GABA
Indications for Carbamazepine and Phenytoin?
The 4 Easy Uses of Anti-seizure drugs
Which drug is a modified Carbazepine, which has less adverse side effects, but more likely to cause hyponatremia?
Oxcarbazepine
Long-term use of anti-seizure drugs puts patients at risk for ______
Osteoporosis
Ethosuximide MOA
T-Type Calcium Block
Valproate is huge in Neural Tube Defects, but 2 also distinguishing effects:
- Alopecia
2. Weight Gain
Valproic acid has a Triple mechanism of Action, where it’ll inhibit Na+, but it will also inhibit ______ channels and promote _____ neurotransmitter production
- Calcium
- GABA
Tiagabine MOA
Inhibit GABA (GAT-1) (Reuptake blocker)
Given Valproic Acid’s Mechanism of action, what are its indications?
All kinds of seizures
Representative Drugs for Partial seizures
Phenytoin, Carbamazepine
Hirsutism and Gingival hyperplasia are two distinguishing side effects of which anti-seizure drug?
Phenytoin
Phenobarbital MOA
Target GABA-A receptor
- Prolongs Cl- channel opening
Phenobarb indications
4 easy seizures
Lamotrigine has two funny drug interactions:
- Valproate will cause _____ lamotrigine.
- Phenytoin or Carbamazpine will cause _____ lamotrigine.
- More (because Valproate is super needy and displaces)
- Less (because Cyps go on super metabo mode with Pheny and Carba)
Phenobarb is used for _____ but not for _____
- Children
- Adults
3 Contra-indications of Phenytoin
- Myoclonic
- Absence
- Lennox-Gastaut
(The Twitch/Muscle-based diseases don’t want sodium to be blocked)
Carbamzepine is just like Phenytoin, except it also can auto-induce its own metabolism and will present with 3 different, key adverse effects. _____, ______, _______.
- Hyponatremia
- Leukopenia
- Terrible Rash
Aside from weight gain, Vigabatrin distinguishing side effect
Retinal Toxicity & pieripheral vision loss
Tiagabine is only really good to treat ______ seizures
Focal
Do not use Gabapentin or Pregabalin for ____ & _____ seizures, or ____ _____ ______ seizures
- Myoclonic
- Absence
- Generalized Tonic Clonic
Gabapentin and Pregabalin MOA
Inhibit Calcium channels (with a2d1)
Tiagabine, Vigabatrin, and Gabapentin/Pregabalin are all cleared by the ______
Kidneys
Less Drug-drug interactions
What is significant of phenytoin’s PK curve?
Starts off linear, becomes exponential at higher doses
Benzos should only be used for the special kind of seizures. Name 5
- Status Epilepticus
- Lennox
- Myoclonic
- Atonic
- Absence Seizures
Benzo MOA
Target GABA-A receptor
- Prolongs Cl- channel opening
Perampanel Adverse Effects
- Black Box warning: Suicidal Thoughts
Phenobarb adverse scary effect
Respiratory depressions
What are the 4 easy uses of Anti-seizure drugs?
- Simple Partial
- Complex Partial
- Secondarily Generalized
- Primary Generalized Tonic-Clonic
Vigabatrin MOA
Inhibit GABA breakdown
- Target GABA Transaminase
- less breakdown means more drug
Tiagabines distinguishing side effects
GI probs
2 Key Pharmacokinetic facts of the needy Valproate?
- HIGH albumin binding, so high drug displacement
2. Hepatic Enzyme inhibitions
The Brand-new Perampanel MOA
- Non Comp
- Bind AMPA to Antag Glutamate
Representative Drugs for Status Epilepticus Initial vs Long-term
Initial: Benzodiazapines(1st line), Lorazepam, Diazepam, or Clonazepam
Long-term: Phenytoin, Phenobarbital
What’s the awesomest thing about Lamotrigine’s (Lamictal) pharmacokinetics?
Does NOT induce or inhibit CYPs
Lamotrigine has a similar Mech as Valproic acid with Na and Calcium inhibition but differs in that _______ neurotransmitter is inhibited
Glutamate
2 Key Hepatic enzyme inducing Seizure drugs?
- Pheny
2. Carba
Valproate is the most deadly to the ______
Fetus
3 Contra-indications of Phenytoin
- Myoclonic
- Absence
- Lennox-Gastaut
(The Twitch/Muscle-based diseases don’t want sodium to be blocked)
Indications for Carbamazepine and Phenytoin?
The 4 Easy Uses of Anti-seizure drugs
Carba more selective for partial though
The unique target of Levetiracetam (Keppra); thought to decrease neurotransmitter release
Synaptic Vesicle Protein 2A (SVP2A)
