Drugs for Epilepsy Flashcards
1
Q
Lamotrigine
A
- voltage gated sodium channel blocker
- only work when channel is in open or fast-inactivated state
- neurons in epileptic state are more often in open state, and bind sodium channel blockers better
- decreases excitation
2
Q
carbamazepine
A
- voltage gated sodium channel blocker
- only work when channel is in open or fast-inactivated state
- neurons in epileptic state are more often in open state, and bind sodium channel blockers better
- decreases excitation
3
Q
phenytoin
A
- voltage gated sodium channel blocker
- only work when channel is in open or fast-inactivated state
- neurons in epileptic state are more often in open state, and bind sodium channel blockers better
- zero order kinetics, risk of toxicity!
- CYP450 inducer, and gingival hyperplasia
- decreases excitation
4
Q
topiramate
A
- voltage gated sodium channel blocker AND AMPA receptor blocker AND GABA-A receptor agonist
- only work when channel is in open or fast-inactivated state
- neurons in epileptic state are more often in open state, and bind sodium channel blockers better
- decreases excitation
5
Q
valproic acid
A
- voltage gated sodium channel blocker
- AND enhances Glutamic Acid Decarboxylase to produce more GABA
- AND inhibits SSD from metabolizing GABA
- only work when channel is in open or fast-inactivated state
- neurons in epileptic state are more often in open state, and bind sodium channel blockers better
- decreases excitation AND increases inhibition
6
Q
lacosamide (zonisamide/rufinamide)
A
- voltage gated sodium channel blocker
- works during both the fast inactivated and slow inactivated
- (zonisamide is also a T-type Ca blocker)
- decreases excitation
7
Q
perampanel
A
- AMPA receptor blocker on post-synaptic cell
- decreases excitation
8
Q
felbamate
A
- NMDA receptor blocker on post-synaptic cell
- decreases excitation
9
Q
ethosuxamide
A
- T-type Ca channel blocker
- only used for absence/petit mal seizures
- decreases excitation
10
Q
levetiracetam
A
- inhibit SV2A vesicle protein
- prevents release of glutamate by preventing fusion of the vesicle
- decreases excitation
11
Q
brivaracetam
A
- inhibit SV2A vesicle protein
- prevents release of glutamate by preventing fusion of the vesicle
- decreases excitation
12
Q
gabapentin
A
- blocks α2δ subunit of the T-type Ca channel
- AND enhances Glutamic Acid Decarboxylase to produce more GABA
- decreases excitation AND increases inhibition
13
Q
pregabalin
A
- blocks α2δ subunit of the T-type Ca channel
- AND enhances Glutamic Acid Decarboxylase to produce more GABA
- decreases excitation AND increases inhibition
14
Q
ezogabine
A
- OPENS K+ channel on both pre and post synaptic neurons
- makes K+ leave cells, polarizing them
- at high doses, it can also act as a post-synaptic GABA receptor agonist
- decreases excitation
15
Q
tiagabine
A
- blocks GAT1 on pre-synaptic GABAergic neurons
- prevents reuptake of GABA
- increases inhibition by GABA
16
Q
vigabatrin
A
- inhibits GABA-T enzyme in pre-synaptic neurons
- prevents the breakdown of GABA
- risk of bilateral concentric vision loss, D/C after 3 months. must complete training course to Rx
- increases inhibition by GABA
17
Q
lorazepam
diazepam
clobazam
clonazepam
A
- bind to allosteric site on Cl- channel WITH GABA to potentiate effect
- increases inhibition
18
Q
barbiturates
A
- GABA independent
- bind to allosteric site on Cl- channel WITHOUT GABA to potentiate effect
- increases inhibition
19
Q
cannabidiol
A
- does not appear to bind to CBD receptors
- used specifically for Dravet syndrome and Lennox-Gastaut syndrome
20
Q
patient presents with status epilepticus:
A
- give lorazepam
2. give levetiracetam
