Antiepileptics

Question 1

Lamotirigine

• Class
• MoA
• Indications
• Side effects
• Pregnancy

Answer 1

Class:
Anticonvulsant

MoA:
Blocks Na+ channels on glutamatergic neurons inhibiting depolarisation

Indications:
First line for focal seizures.
In women first line for generalised tonic clonic and atonic seizures

Side effects:
Rash, drowsiness, SJS syndrome, suicidal thoughts

Pregnancy rules:
Safe for pregnancy and breastfeeding

Question 2

Sodium Valproate

• Class
• MoA
• Indications
• Side effects
• Pregnancy
• Monitoring
• Extra info

Answer 2

Class:
Anticonvulsant

MoA:
Inhibition of GABA transaminase

Indications:
For males first line generalised tonic clonic, atonic or myoclonic seizures

Side effects:
GI effects - nausea, increased appetite/weight gain, pancreatitis (particularly in children), hepatotoxicity, hyperammonemic encephalopathy
Neuro - Ataxia, confusion, tremor
Haem - haemorrhage, anemia, hyponatremia, thrombocytopenia
Other - hair loss

Pregnancy rules:
Not safe for pregnancy but safe for breastfeeding

Monitoring:
LFT and FBC before treatment, LFTs periodically

Extra information:
CYP450 enzyme inhibitor

Question 3

-zepams drugs

• Class
• MoA
• Indications
• Side effects
• Extra info

Answer 3

Class:
Benzodiazepine

MoA:
Increases the chloride ion channel frequency and so potentiates GABA action

Indications:
Termination of seizure, sedation, muscle relaxant

Side effects:
Drowsiness,** respiratory depression**, confusion, lack of coordination

Extra information:
Not used long-term (more than 2-4 weeks) due to acquired tolerance. Reduce by 1/8 every fortnight. Antidote is flumazenil.

Question 4

Levetiracetam

• Class
• MoA
• Indications
• Side effects
• Preganancy rules

Answer 4

Class:
Anticonvulsant

MoA:
Inhibition of SV2A prevents glutamate exocytosis

Indications:
First line for focal seizures, in females first line for generalised tonic clonic seizures and myoclonic seizures

Side effects:
Dizziness, fatigue, headache

Pregnancy rules:
Safe for pregnancy and breastfeeding

Question 5

Carbamazepine

• Class
• MoA
• Side effects
• CYP450 status

Answer 5

Class:
Anticonvulsant

MoA:
Binds to sodium channels increases their refractory period

Side effects:
Dizziness and ataxia, drowsiness, headache, visual disturbances (especially diplopia), Steven-Johnson syndrome,** leucopenia and agranulocytosis, hyponatraemia secondary to syndrome of inappropriate ADH secretion**

CYP450 status:
Inducer