Anticonvulsants Flashcards
What are the therapeutic objectives of anti-epileptic drugs?
eliminate seizures
avoid adverse side effects
maintain a normal lifestyle
What is the first line of treatment for absence seizures?
What is the first line of treatment for focal seizures?
What is the first line of treatment for generalised tonic-clonic seizures?
What is the first line of treatment for myoclonic seizures?
What is the first line of treatment for tonic or atonic seizures?
What is the target for lamotrigine?
voltage gated sodium channels
How does lamotrigine work?
lamotrigine blocks voltage gated sodium channels preventing Na+ influx which inhibits glutamate excitotoxicity
Why is there a difference in treatment between men (and post-menopausal women) and women of child-bearing potential?
valproate side effects after in utero exposure:
- neural tube defects
- decreased IQ
- autism
What can happen as a result of taking lamotrigine together with combined oral contraceptive pill?
reduced bioavailability of lamotrigine
lamotrigine has no effect on COC conc
- reduced seizure control
- no contraceptive failure
What are the possible explanations of why conc of lamotrigine goes down when taken together with COC?
How should we deal with this effect of the COC on lamotrigine?
Change AED or change contraception.
(Better to stick with AED if it works)
What does levetiravetam target and where (location)? What is the effect?
- target
- SV2A - location
- excitatory presynaptic terminal - reduced glutamate transmission
What does valproate target and where (location)? What is the effect?
- target
- GABA-T - location
- inhibitory presynaptic terminal - effect
- increase GABA availability
What is the key mechanism of action of benzodiazepines?
GABA targeting drug
binds to chloride channel
facilitates GABA
more Cl- influx
more hypopolarizarion and less depolarization
