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Pharmacology Year 2 > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

What is an epileptic seizure?

A

Manifestation of an abnormal or excessive synchronised discharge of a set of cerebral neurones

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2
Q

What is epilepsy?

A

A tendency to recurrent, unprovoked seizures

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3
Q

Diagnosis of epilepsy?

A

Brain activity can be measured using:

  • Electroencephalography (EEG)
  • Magnetic resonance imaging (MRI)
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4
Q

What are the two main types of epilepsy?

A

Partial/Focal seizures– the excess discharge is localised to one area of the brain (and may spread out)
Generalised seizures – the synchronised discharge affects both hemispheres of brain

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5
Q

List the five types of general seizures

A 
Tonic-clonic seizures
Absence seizures
Tonic/atonic seizures
Myoclonic seizures
Status epilepticus
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6
Q

State the symptoms associated with each the five types of general seizure

A

Tonic-clonic seizures: loss of consciousness => muscle stiffening => jerking/twitching => deep sleep => wakes up

Absence seizures: brief staring episodes with behavioural arrest

Tonic/atonic seizures: sudden muscle stiffening/sudden loss of muscle control

Myoclonic seizures: sudden, brief muscle contractions

Status epilepticus: > 5 min of continuous seizure activity

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7
Q

State and describe the two different types of partial/focal seizures

A

Simple: retained awareness/consciousness
Complex: impaired awareness/consciousness

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8
Q

Briefly describe the neurotransmission at the glutamatergic synapse

A
  1. Voltage-gated Na+ channel (VGSC) opens => membrane depolarisation
  2. Voltage-gated K+ channel (VGKC) opens => membrane repolarisation
  3. Ca2+ influx through voltage-gated calcium channels (VGCCs) => vesicle exocytosis; Synaptic vesicle associated (SV2A) protein allows vesicle attachment/docking to presynaptic membrane
  4. Glutamate activates excitatory post-synaptic receptors (e.g. NMDA, AMPA & kainate receptors)
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9
Q

State two Voltage-gated Na+ channel blockers

A

Carbamazepine

Lamotrigine

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10
Q

State any important details on the pharmacodynamics and pharmacokinetics of carbamazepine

A

Pharmacodynamics:
- Stabilises inactive state of Na+ channel, reducing neuronal activity

Pharmacokinetics:

  • Enzyme inducer
  • Onset of activity within 1 hour
  • 16-30 hour half-life
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11
Q

Potential severe side-effects in using carbamazepine in individuals with what?

A

potential severe side-effects (SJS & TEN) in individuals with HLA-B*1502 allele

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12
Q

State any important details on the pharmacodynamics and pharmacokinetics of Lamotrigine

A

Pharmacodynamics:
- Inactivates Na+ channels, reducing glutamate neuronal activity

Pharmacokinetics

  • Onset of activity within 1 hour
  • 24-34 hour half-life
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13
Q

Name a Voltage-gated Ca2+ channel blocker

A

Ethosuximide

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14
Q

State any important details on the pharmacodynamics and pharmacokinetics of Ethosuximide

A

Pharmacodynamics
- T-type Ca2+ channel antagonist; reduces activity in relay thalamic neurones

Pharmacokinetics
- Long half-life (50 hours)

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15
Q

State two drugs which interfere with glutamate exocytosis and/or receptors

A

Levetiracetam

Topiramate

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16
Q

State any important details on the pharmacodynamics and pharmacokinetics of Levetiracetam

A

Pharmacodynamics:
- Binds to and inhibits synaptic vesicle associated protein (SV2A), preventing glutamate release

Pharmacokinetics
- Fast-onset (1 hour); half-life (10 hours)

17
Q

State any important details on the pharmacodynamics and pharmacokinetics of Topiramate

A

Pharmacodynamics:

  • Inhibits NMDA & kainate receptors
  • Also affects VGSCs & GABA receptors

Pharmacokinetics:
- Fast-onset (1 hour); long half-life (20 hours)

18
Q

How may GABA be released? What kind of post-synaptic receptors do they activate?

A

GABA can be released tonically & also following neuronal stimulation.
GABA activates inhibitory post-synaptic GABA-A receptors (Cl-channels)

19
Q

How does Diazepam work? Recall any important pharmacokinetic details?

A

GABA receptor, PAM => increases GABA-mediated inhibition

Pharmacokinetics:
Rectal gel
Fast-onset (within 15 min)
Half-life (2 hours)

20
Q

How does Sodium Valproate work? Recall any important pharmacokinetic details?

A

Inhibits GABA transaminase => increases GABA-mediated inhibition

Pharmacokinetics:
Fast onset (1h); half-life (12h)
21
Q

Tonic-clonic seizures - which drugs are indicated?

A

Carbamazepine
Lamotrigine
Valproate

22
Q

Absence seizures - which drugs are indicated?

A

Ethosuximide
Lamotrigine
Valproate

23
Q

Tonic/atonic seizures - which drug is indicated?

A

Valproate

24
Q

Myoclonic seizures - which drugs are indicated?

A

Levetiracetam Topiramate

Valproate

25
Q

Status epilepticus - which drug is indicated?

A

Diazepam

26
Q

Simple partial and complex partial seizures - which drugs are indicated?

A

Carbamazepine (partial) Levetiracetam
Lamotrigine
Valproate

Pharmacology Year 2 (32 decks)

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