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Pharm personal > Anticonvulsants and anti-epileptic drugs > Flashcards

Anticonvulsants and anti-epileptic drugs Flashcards

1
Q

Define epilepsy

A

Tendency for recurrent, unprovoked seizures

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2
Q

Define seizure

A

sudden changes in behaviors characterised by electrical hyperchronisation of neuronal networks in the cerebral cortex

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3
Q

Types of seizures

A

Generalised

Partial/Focal

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4
Q

Define generlaised seizure

A

a seizure manifesting itself in both hemispheres

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5
Q

Define partial/focal seizure

A

a seizure originating from a discrete brain area in one hemisphere, has the potential to spread and develop into a global seizure

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6
Q

State the types of global seizures and what they’re charcterised by

A

Tonic-clonic = loss of consciousness -> muscle stiffening -> rapid jerky/twitching movements -> deep sleep -> awakes (with no recollection)
Absence = brief staring episodes and behavioural arrest
Tonic/atonic = sudden muscle rigidity/relaxation
Myoclonic = sudden brief muscle contractions
Status epilepticus = state of CONTINUOUS seizure activity for >5 mins

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7
Q

State the types of partial seizures and what they’re charcterised by

A 
Simple = no impairment in awareness/consciousness
Complex = impaired awareness/consciousness
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8
Q

2 most common types of central neurotransmission

A 
Gluatminergic = excitatory
GABA = inhibitory
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9
Q

Describe normal glutaminergic transmission

A

Depolarisation of presynaptic neurone
opening of VGSC, Na+ inlfux
opening of VGKC, K+ efflux
Opening of VGCC at synapse, Ca2+ influx
Stimulation of exocytosis of gluamate-containing vesicles
Docking at presynaptic membrane by SV2A docking protein
Glutamate binds to excitatiry NMDAR and Kainate-R on postsynaptic membrane
Depolarisation of postsynaptic neurone

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10
Q

Describe normal GABAergic transmission

A

GABA synthesised from GLU
Exocytosis and binding to inhibitory GABAAR
Cl- influx and hyperpolarisation
Reuptaken by GAT (GABA transporter) by presynaptic
Reuptaken by support cells and broken down to GLU by GABA-T (?GABA transaminase)

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11
Q

Examples of VGSC blockers

A

Carbamazepine, Lamotrigine

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12
Q

Carbamazepine MOA, PK

A

Stabilises inactive state of VGSC, reducing depol
ENZYME INDUCER
fast onset <1hr
long t1/2

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13
Q

Lamotrigine MOA, PK

A

Inactivates VGSC, reduced glutaminergic transmission
fast onset <1hr
long t1/2

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14
Q

Principles of anticonvulsant therapy

A

Inhibit excitatory central Glutaminergic transmission

Stimulate inhibitoy central GABAergic transmission

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15
Q

Types of anticonvulsant drug groups

A 
Inhibit excitatory central Glutaminergic transmission:
VGSC blockers
VGCC blockers
docking protein inhiitors
Glutamate receptor inhibitors

Stimulate inhibitoy central GABAergic transmission
GABAAR agonists
GABA-T inhibitors

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16
Q

Example of VGCC blocker

A

Ethosuximide

17
Q

Ethosuximide MOA, PK

A

T-type CC antagonist, reducing exocytosis of glu in relay thala mic neurones
long t1/2 50hrs

18
Q

Example of docking protein inhibitor

A

Levetiracetam

19
Q

Levetiracetam MOA, PK

A

binds to SV2A docking protein preventing exocytosis

fast onset <1hr, t1/2 shorter 10hrs

20
Q

Example of glutamate receptor blockers

A

Topiramate

21
Q

Topiramate MOA, PK

A

NMDA-R + Kainate-R antagonist (also affects VGSC + GABAAR)

fast onset <1hr, long t1/2

22
Q

Example of GABAAR agonist

A

Diazepam

23
Q

Diazepam MOA, PK

A 
GABAAR PAM (positive allosteric mediator as binds to BDZ receptor), increases frequency of Cl- channel opening and reciprocal potentiation of GABA
PR gel, fast onset 15mins, short t1/2 2hrs
24
Q

Example of GABA-T inhibitor

A

(sodium) Valproate

25
Q

Valproate MOA, PK

A

Inhibits GABA-T, increases synaptic [GABA]
fast onset <1hr, long t1/2
USED IN ALL TYPES OF EPILEPSY

26
Q

Anticonvulsants used in tonic-clonic seizures

A

Carbamzepine
Lamotrigine
Valproate

27
Q

Anticonvulsants used in absence seizures

A

Ethosuximide
Lamotrigine
Valproate

28
Q

Anticonvulsants used in tonic/atonic seizures

A

Valproate

29
Q

Anticonvulsants used in myoclonic seizures

A

Levetiracetam
Topiramate
Valproate

30
Q

Anticonvulsants used in status epilepticus

A

Diazepam (due to fast onset)

31
Q

Anticonvulsants used in simple/complex partial seizures

A

Carbamazepine
Levetiracetam
Lamotrigine
Valproate

32
Q

Why are anticonvulsants very convenient for epilepsy patients?

A

Can be taken orally
Fast absorption in all (<1hr)
Long t1/2 therefore can be taken once a day

33
Q

Factors affecting anticonvulsant prescription

A

Risk vs benefit
Specific anticonvulsant to match seizure type
usually keep on 1
Careful with drug interactions (eg carbamezapine is ENZYME INDUCER)
Previous effectiveness
Pharmacodynamic/pharmacokinetic factors

Pharm personal (5 decks)

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