epilepsy Flashcards
what do the 2 gaba analogs, that also block ca2+ influx into the presynaptic, treat?
used as a adjunct for partial complex epilepsy, also more commonly for neuropathic pain
2 GABA - analogs that also block presynaptic Ca2+ influx
gabapentin and pregabalin
which GABA analog is the absorption limited to intestinal AA transport (i.e. a Tm)?
gabapentin
which GABA analog has limited protein binding, and is not metabolized, and no interaction with other drugs; therefore few side effects (sedation)?
gabapentin (no organ toxicity)
the 4 voltage-gated Na channel stabilizer?
- phenytoin
- carbamazepine
- oxcarbamazepine
- lamotrigine
(PCOL)
what are the glutamate receptor blockers? (2)
- topiramate
- felbamate
(glue topless and feel circuits together!)
which one of the glutamate receptor blockers works via this mechanism? partial AMPA, Kainate Ca receptor blocker, with a secondary effect on voltage-gated Na channel and GABA system?
topiramate
which one (voltage-gated Na channel stabilizers, gabaergic anti-epileptics, GABA analogs, Glutamate receptor blockers, synaptic vesicle binders, or voltage-gated Ca channel blockers) has the following SE: RASH, GINGIVAL HYPERPLASIA, HIRSUTISM, LUPUS-LIKE RX, AND CAN CAUSE CONTRACEPTIVE FAILURE, mild hepatotoxicity and myelosuppression but long term can cause cerebellar degeneration, peripheral neuropathy, and osteoporosis?
voltage-gated Na channel stabilizers:
phenytoin
how do the voltage-gated na channel stabilizers work?
stabilize inactive conformation of Na channel
which drug of the Na channel blockers is a liver enzyme inducer, highly protein bound, and must increase dose overtime bc of autoinduction?
carbamazepine,
phenytoin is also livery enzyme induce, protein bound. it is also assoc with limited IV infusion bc hypotension
which of the sodium channel blockers’s side effects are mostly due to epoxide metabolite?
carbamazepine
which drug is used for complex partial epilepsies? also useful for bipolar affective disorder and neuropathic pain?
carbamazepine
SE: rash (rarely stevens-johnson), mild myelosuppression, mild LFT inc, can cause contraceptive failure
carbamazepine, oxcarbamazepin, lamotrigine (this one needs to be slowly titrated and is indicated in children), phenytoin
which of the Na channel stabilizers can be used in children? used for primary generalized epilepsies, absence seizures, bipolar disorder, neuropathic pain
lamotrigine (kids love lamb)
which drug is effective against acute Tonic-clonic seizures, less effective for absence, myoclonic or atonic seizures?
phenytoin
Toxicity of the Na channel stabilizers ?
dizziness, sedation, ataxia, diplopia
which Na channel stabilizer competes for excretion with Valproic acid, and is synergistic with it?
lamotrigine
IV for status epilepticus, bilpolar tx, migraine, long-term cluster headache prophylaxis?
valproate
3 GABAergic antiepileptics? (GABA-A system)
vigabatrin, tigabine, benzodiazapines
which one of the gabaergic anti-epileptics acts at GABA-A receptors and its long term use is limited by tolerance?
benzodiazepines
But tigabine and vigabatrin also acts on GABA-A
which of the gabaergics act by inhibiting GABA reuptake?
tigabine ( take a bin to storage stuff (thus increase concentration!))
which gabaergic’s binds GABA transaminase to slow down intracellular breakdown of GABA?
vigabatrin (bats … nights…pretty slow…thus inc gaba)
which drug is only effective against absence seizures?
ethosuximide
ethosuximide (class and mech?)
voltage-gated Ca channel blocker, blocks T-type Ca channels in thalamo-cortical circuits
