epilepsy 3 Flashcards
patient education for epilepsy
- psychosocial issues
- fear/anxiery about diagnosis
- driving restrictions - lifestyle
- avoid seizure triggers - AED therapy issues
- Tx plan
- AED s/e
- compliance and LT therapy
counselling
- avoid seizure triggers (lack of sleep, stress, exercise, alcohol, caffiene, flashing lights)
- risk of seizures, SUDEP
- legal aspects of drivin
- purpose of meds and duration
- common s/e AEDs
- need to take meds regularly
- interaction with other drugs
generally, how to AEDs work
alteration in balance between neuronal excitation and inhibition
NOT disease modifying
4 MOA of AEDs
- modulation of voltage dependenc ion channels *Na, ca, K)
- enhancement of GABA mediated inhibitory NTm
- reduction of excitatory NTm
- modulation of NT release via presynaptic action
blockade of VG Na channels
- drug binds to inactivated Na channel
- delay its recovery from inactivation
- dec neuronal excitability
- dec repetitive firing and spread of seizures
examples of AEDs that block VG Na channels
blockers of fast inactivated state
- phenyoin
- carbamazepine
- oxcarbazepine
- lamotrigine
- eslicarbazepine
- rufinamide
blockers of slow inactivated state
- lacosamide
blockade of VG Ca channels
- block ca channels
- inhibit pacemaker currents/transmitter release
examples of blockers of VG Ca channels
2 classes:
- block low voltage activated channels (T types)
- ethosuximide
- block high voltage activated channels
- bind to a1d subunit
- gabapentin
- pregabalin
4 types of drugs that potentiate inhibitory GABAergic NTm
- positive allosteroic modulation at GABAa R
- inhibition of metabolism of GABA via irreversible inhibition of GABA transaminase
- inhibition of synaptic GABA reuptake via competitive inhibitor of GAT-1 transporter
- enhancement of synaptic GABAergic transmission via multiple effects on GABA disposition
examples of GABA AEDs
- positive allosteris at GABAa
- BDZs
- barbiturates
- stiripentol
- felbamate
- topiramate
- cenobamate - inhibition of GABA metab
- vigabatrin - inhibition of GABA reuptake
- tiagabine - enhancement of synaptic GABAergic transmission via effects on GABA disposition
- sodium valoprate
How does enhancement of synaptic GABAergis transmission via effects on GABA disposition work (sodium valproate)?
inc synthesis of GABA
inc release of GABA
inhibition of catabolism of GABA
How do AEDs that work by inhibition of carbonic anhydrase work?
inhibition of carbonic anhydrase
localosed acidosis
suppression of neuronal activity
examples of drugs that inhibit carbonic anhydrase
acetazolamise
topiramate
zonisamide
How do AEDs that work by blockade of excitatory neurotransmission work?
- blockade of AMPA receptors
dec fast excitatory neurotransmission
dec seizure generation - blockade og NMDA receptors
dec fast excitatory NTm
dec seizure generation
examples of drugs that block excitatory neurotransmission
AMPA: perampanel levetiracetam phenobarbital topiramate
NMDA:
felbamate
How do AEDs that work by modulationo of NT release work?
- selective binding to synaptic vesicle protein 2A (SV2A)
inhibition of glutamate release
dec fast excitatory NTm
dec seizure generation - selective inhibition of presynaptic glutamate release via blockade of presynaptic VG Na and Ca channels
examples of AEDs that work vis modulation of NT release
inhibition of glutamate:
levetiracetam
brivaracetam
blockade of presynaptic VG Na/Ca:
lamotrigine
egs of AEDs that target VG Na channels
phenytoin carbamazepine lamotrigine lacosamide topiramate
egs of AEDs that target VG Ca channels
ethosuximide
egs of AEDs that target VG K channels
Retigabine (Ezogabine)
egs of AEDs that have GABA mediated inhibiton
barbiturates - phenobarbital, primidone
benzodiazepines - diazepam, lorazepam, clonazepam
egs of AEDs that target synaptic release of SV2A
levetiracetam
brivaracetam
egs of AEDs that target synaptic release of alpha2delta
gabapentin
pregabalin
egs of AEDs that target inotropic glutamate receptors (AMPA receptor)
perampanel
