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Pharmacology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the drug (classes) used to manage epilepsy?

A

Lamotrigine
Sodium valproate
Diazepam
Levetiracetam

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2
Q

What is the primary mechanism of action of Lamotrigine?

A

Blocks voltage gated Na+ channels preventing Na+ influx. Prevents depolarisation of glutamatergic neurones and reduces glutamate excitotoxicity

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3
Q

What is the primary mechanism of action of Sodium valproate?

A

Inhibition of GABA transaminase, prevents the breakdown of GABA. Increases GABA concentrations directly in the synapse presynaptically. Indirectly prolongs GABA in the synapse.

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4
Q

What is the primary mechanism of action of Diazepam?

A

Increase chloride ion influx in response to GABA binding at the GABA A receptor. Increased chloride ion influx — hyperpolarisation

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5
Q

What is the primary mechanism of action of Levetiracetam?

A

Inhibition of the synaptic vesicle protein SV2A. Inhibits this protein and prevents vesicle exocytosis.
Reduction in glutamate secretion, reduces glutamate excitoxicity

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6
Q

What is the drug target of Lamotrigine?

A

Voltage gated Na+ channels

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7
Q

What is the drug target of Sodium Valproate?

A

GABA transanimase

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8
Q

What is the drug target of Diazepam?

A

Benzodiazepine site on GABA A receptor

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9
Q

What is the drug target of Levetiracetam?

A

Synaptic vesicle protein SV2A

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10
Q

What is seen in the EEG of a person wtih Generalised Tonic - Clonic seizures?

A

interictal epileptiform discharge - delayed spikes

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11
Q

What is the main side effect of Lamotigrine?

A

Common: Rash, Drowsiness

Serious: SJS, Suicidal Thoughts

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12
Q

What is the main side effect of Diazepam?

A

Common: Drowsiness, Respiratory Depression
Uncommon: Haemolytic anaemia, jaundice

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13
Q

What is the main side effect of Sodium Valproate?

A

Common: Drowsiness, Hair Loss, Stomach Pain & Diarrhoea, Weight Gain

Serious: Pancreatitis, Hepatotoxicity, Teratogenicity

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14
Q

What is the main side effect of Levetiracetam
?

A

Fatigue, Somnolence, Dizziness and headache

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15
Q

Extra infromation for lamotigrine

A

Smaller dose to delay risk of SJS allergic reaction

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16
Q

Extra information for Diazepam

A

Can’t take long term as is addictive and you build tolerance

17
Q

Extra information for Sodium Valproate

A

Broad Inhibition of CYP enzymes means it increases serum concentration of co administered drugs

18
Q

Extra information for Levetirecetam

A

It has no effect on cytochrome P450 so is favourable in terms of drug interaction

19
Q

What is the first line treatment for absent seizures
a) women/ girls
b) boys/ men/ women

What can you add to both for adjuvant therapy

A

a) Ethosuximide
b) Ethosuximide or Sodium Valproate

  1. Lamotrigine
20
Q

What is the first line treatment for focal seizures
a) women/ girls
b) boys/ men/ women

What can you add to both for adjuvant therapy

A

a) Carbamazepine or Levetiracetam
b) Carbamazepine or Lamotigrine

Any but sodium valproate for women of child bearing potential

21
Q

What is the first line treatment for generalised tonic clonic seizures
a) women/ girls
b) boys/ men/ women

What can you add to both for adjuvant therapy

A

a) Lamotrigine
b) Sodium Valproate

Levetiracetam or Topirimate

22
Q

What is the first line treatment for myoclonic seizures
a) women/ girls
b) boys/ men/ women

What can you add to both for adjuvant therapy

A

a) Levetiracetam or Topirimate
b) Sodium Valproate

Lamotrigine, Levetiracetam or Topirimate

23
Q

What is the first line treatment for tonic or atonic seizures
a) women/ girls
b) boys/ men/ women

What can you add to both for adjuvant therapy

A

a) Sodium Valproate ( pregnancy prevention programme)
b) Sodium Valproate

Lamotrigine

24
Q

How does Combined Oral Contraceptive drug affect Lamotrigine serum concentration and why?

A

It reduces it as it increases lamotrigine metabolism so more is cleared from blood
COC- induction of UDPGA

1) Increase dose of lamotrigine (COC can reduce lamotrigine by 50%)
2) Change contraception

25
Q

How does COC affect Lamotrigine over the course of the menstrual cycle?

A

COC taken over four weeks:
First three weeks: active drug
Fourth week: nothing or ‘dummy’

So, fourth week - no COC affecting
liver enzymes:
Liver enzymes normalise
Lamotrigine levels increase

26
Q

Epileptic episode leading to admission management

A

Primary options
lorazepam: 4 mg intravenously as a single dose initially, repeat dose after 5-10 minutes if required

Pharmacology (7 decks)

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