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Pharmacology > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

How do anticonvulsants work

A

Reducing high frequency neuronal firing by modifying activity of neurotransmitters
1. Increasing GABA activity (main inhibitory neurotransmitter)
2. Decreasing excitatory glutamate
Modifying activity of ion channels
1. Voltage gated sodium channels
2. Calcium channels

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2
Q

How do anticonvulsants work

A

Reducing high frequency neuronal firing by modifying activity of neurotransmitters
1. Increasing GABA activity (main inhibitory neurotransmitter)
2. Decreasing excitatory glutamate
Modifying activity of ion channels
1. Voltage gated sodium channels
2. Calcium channels

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3
Q

Adverse effects of phenobarbital

A

Hypersensitivity in children
Agitation and confusion in elderly
Systemic hypersensitivity reaction
Sedation (decreases over time)

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4
Q

Indications of phenobarbital

A

All epilepsy except ABSENCE and MYOCLONIC seizures

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5
Q

MOA of phenobarbital

A

GABA receptor mediated

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6
Q

Drug interactions of phenobarbital

A

Strong inducer of drug metabolising enzymes and transporters

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7
Q

Adverse effects of phenytoin

A

Systemic hypersensitivity reaction
Cardiac arrhythmia
Cerebella signs (nystagmus, ataxia)
Gum hypertrophy
Hirsutism and acne

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8
Q

MOA of phenytoin

A

Prolongs inactivation of voltage sensitive Na channel

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9
Q

Which anticonvulsants increases drug concentration exponentially in plasma

A

Phenytoin

-non linear kinetics, zero order
=toxicity

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10
Q

Dose of phenytoin in our institution

A

300mg/day (yields 10mcg/ml), if seizures continues add 25-30 mg

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11
Q

MOA of Carbamezapine

A

Prolongs inactivation of volatage gated sensitive Na channel
Potentials postsynaptic actions of GABA

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12
Q

Adverse reactions of Carbamezapine

A

Aplastic anaemia (haematological toxicity)
Systemic hypersensitivity reaction
Drowsiness
Vertigo
Ataxia
Diplopia
Blurred vision

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13
Q

MOA of sodium valproate

A

Prolongs inactivation of voltage-sensitive Na channels
Increases GABA synthesis

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14
Q

Adverse effects of NaValproate

A

Teratogenic
Idosynthetic Hepatotoxicity
PCOS and menstrual irregularities
Alopecia
Ataxia
Sedation
Bone marrow suppression

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15
Q

Which anticonvulsants can be used in absence seizures

A

Valproate

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16
Q

Drug interaction of valproate

A

Inhibits glucuronidation (potent inhibitor)

17
Q

What to consider before starting ACD in a patient with first time seizure

A

Risk of recurrence
Benefit expected from immediate anticonvulsant drug therapy on the risk of recurrent seizure
Side effect profile of various ACD based on individuals age and comorbidities
Patient values and preference

18
Q

Risk of seizure recurrence after first unprovoked seizure in epilepsy

A

21-45% in the first 2 years
ACD reduces risk of recurrence but lowers quality of life

19
Q

Risk of seizure recurrence after first unprovoked seizure in epilepsy

A

21-45% in the first 2 years

20
Q

RF for recurrence of seizures

A

Structural brain lesions
Abnormal Neuro exam
Presenting with status epilepticus
Strong family history
Epileptiform abnormalities on EEG (EEG is specific for epilepsy)

21
Q

Factors to consider when choosing ACD

A

Type of seizure
Drug-drug potential interactions
Comorbidities conditions
Pregnancy risk
Cost of drug

(Commence at low dose and gradually build to therapeutic dose)

22
Q

What do you do if there is failure to control on initial management

A

Confirm adherence
Is drug concentration therapeutic
If so then taper off slowly and slowly introduce alternative drug
Combination therapy should be a last resort by a specialist

23
Q

Which anticonvulsants are safe in childbearing

A

Carbamezapine

Folate supplementation needed before conception
Pregnancy reduces concentration in 2nd and 3rd trimester, adjust dose according to concentration results

24
Q

Potential drug-drug interaction of ACDs

A

Strong inducers and oral contraceptives
Strong inducers and many ARVs
Valproate inhibits glucoronidation of lamotrigine

25
Q

When to discontinue anticonvulsant

A

Pt that have been seizure free for >2years

26
Q

What is status epilepticus

A

Seizure lasting more than 30min with no intervening periods of recovering consciousness

27
Q

Indications of lamotrigine

A

Partial and generalised
Focal
Juvenile myoclonic epilepsy (JME)
Lennox Gastaut

28
Q

Definition of epilepsy

A

Atleast 2 unprovoked seizures occurring more than 24hours apart

1 unprovoked seizure and a >60% probability of further seizures occurring over the next 10years

Pharmacology (6 decks)

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