Case 1 DRUGS

Question 1

Sodium valproate/ Valproic acid/ Semisodium Valproate/ Depakote.

What is it & what is it used for?
Mechanism of action?
Side effects?

Answer 1

Anticonvulsant (epilepsy) - reduces seizures.
Mood stabiliser.
Used for Bipolar Disorder (mania*)

MOA:
Weak inhibitor of enzymes that deactivate GABA such as GABA transaminase - or block the re-uptake of GABA into glial cells or pre-synaptic neurones.
May also stimulate the synthesis of GABA.

Side effects:
Folate antagonist
Teratogenic
Can cause specific facial characteristics to develop when children are exposed to in utero.

Question 2

What does Teratogenic mean?

Answer 2

An agent or factor that causes malformation of an embryo.

Question 3

Lithium.

What is it & what is it used for?
Mechanism of action?

Answer 3

Anticonvulsant (epilepsy) - reduces seizures.
Mood stabiliser.
Used for Bipolar Disorder (mania & depression*)

MOA:
NMDA antagonist - blocks NMDA receptors. Reduces the Ca2+ inflow to the post-synaptic neurone, thus reducing the excitatory effects on Glutamate.

Question 4

TCA’s, SSRI’s, SNRI’s.

What do they stand for?
What is it & what is it used for?
Mechanism of action?

Answer 4

Tricyclic antidepressants (TCA’s)/ Selective Seretonin Re-uptake Inhibitors (SSRI’s)/ Selective Noradrenaline Re-uptake Inhibitors (SNRI’s).

Antidepressants - used to treat depression (Bipolar disorder/ MDD/ Generalised Anxiety Disorder GAD).

MOA:
Block re-uptake of synaptic amines (serotonin, noradrenaline, dopamine), therefore increasing their concentration in the synaptic cleft.

Question 5

Folic acid (folinic acid + THF)

What is it used for?
How much should be taken initially, and then to avoid re-occurance?
When should it be taken?
What does it do generally?
Is it better to take folic acid or natural folates after conception?

Answer 5

Preventing first occurrence of NTD - 400mg of folic acid daily before conception (while trying to conceive).

Preventing re-occurance of NTD - 4-5mg per day.

Folate is necessary for the production and maintenance of new cells, for DNA synthesis and RNA synthesis, and for preventing changes to DNA.

Plays a crucial role in the closure of the anterior and posterior neuropores.

Better to take supplements that combine naturally occurring floats such as folinic acid and THF after conception, as taking folic acid during CNS developmental stages can cause more harm.