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PHA333 > epilepsy 3 > Flashcards

epilepsy 3 Flashcards

1
Q

patient education for epilepsy

A
  1. psychosocial issues
    - fear/anxiery about diagnosis
    - driving restrictions
  2. lifestyle
    - avoid seizure triggers
  3. AED therapy issues
    - Tx plan
    - AED s/e
    - compliance and LT therapy
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2
Q

counselling

A
  • 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
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3
Q

generally, how to AEDs work

A

alteration in balance between neuronal excitation and inhibition

NOT disease modifying

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4
Q

4 MOA of AEDs

A
  1. modulation of voltage dependenc ion channels *Na, ca, K)
  2. enhancement of GABA mediated inhibitory NTm
  3. reduction of excitatory NTm
  4. modulation of NT release via presynaptic action
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5
Q

blockade of VG Na channels

A
  • drug binds to inactivated Na channel
  • delay its recovery from inactivation
  • dec neuronal excitability
  • dec repetitive firing and spread of seizures
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6
Q

examples of AEDs that block VG Na channels

A

blockers of fast inactivated state

  • phenyoin
  • carbamazepine
  • oxcarbazepine
  • lamotrigine
  • eslicarbazepine
  • rufinamide

blockers of slow inactivated state
- lacosamide

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7
Q

blockade of VG Ca channels

A
  • block ca channels

- inhibit pacemaker currents/transmitter release

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8
Q

examples of blockers of VG Ca channels

A

2 classes:

  • block low voltage activated channels (T types)
  • ethosuximide
  • block high voltage activated channels
  • bind to a1d subunit
  • gabapentin
  • pregabalin
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9
Q

4 types of drugs that potentiate inhibitory GABAergic NTm

A
  1. positive allosteroic modulation at GABAa R
  2. inhibition of metabolism of GABA via irreversible inhibition of GABA transaminase
  3. inhibition of synaptic GABA reuptake via competitive inhibitor of GAT-1 transporter
  4. enhancement of synaptic GABAergic transmission via multiple effects on GABA disposition
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10
Q

examples of GABA AEDs

A
  1. positive allosteris at GABAa
    - BDZs
    - barbiturates
    - stiripentol
    - felbamate
    - topiramate
    - cenobamate
  2. inhibition of GABA metab
    - vigabatrin
  3. inhibition of GABA reuptake
    - tiagabine
  4. enhancement of synaptic GABAergic transmission via effects on GABA disposition
    - sodium valoprate
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11
Q

How does enhancement of synaptic GABAergis transmission via effects on GABA disposition work (sodium valproate)?

A

inc synthesis of GABA

inc release of GABA

inhibition of catabolism of GABA

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12
Q

How do AEDs that work by inhibition of carbonic anhydrase work?

A

inhibition of carbonic anhydrase

localosed acidosis

suppression of neuronal activity

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13
Q

examples of drugs that inhibit carbonic anhydrase

A

acetazolamise

topiramate

zonisamide

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14
Q

How do AEDs that work by blockade of excitatory neurotransmission work?

A
  1. blockade of AMPA receptors
    dec fast excitatory neurotransmission
    dec seizure generation
  2. blockade og NMDA receptors
    dec fast excitatory NTm
    dec seizure generation
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15
Q

examples of drugs that block excitatory neurotransmission

A 
AMPA: 
perampanel
levetiracetam
phenobarbital
topiramate

NMDA:
felbamate

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16
Q

How do AEDs that work by modulationo of NT release work?

A
  1. selective binding to synaptic vesicle protein 2A (SV2A)
    inhibition of glutamate release
    dec fast excitatory NTm
    dec seizure generation
  2. selective inhibition of presynaptic glutamate release via blockade of presynaptic VG Na and Ca channels
17
Q

examples of AEDs that work vis modulation of NT release

A

inhibition of glutamate:
levetiracetam
brivaracetam

blockade of presynaptic VG Na/Ca:
lamotrigine

18
Q

egs of AEDs that target VG Na channels

A 
phenytoin
carbamazepine
lamotrigine
lacosamide
topiramate
19
Q

egs of AEDs that target VG Ca channels

A

ethosuximide

20
Q

egs of AEDs that target VG K channels

A

Retigabine (Ezogabine)

21
Q

egs of AEDs that have GABA mediated inhibiton

A

barbiturates - phenobarbital, primidone

benzodiazepines - diazepam, lorazepam, clonazepam

22
Q

egs of AEDs that target synaptic release of SV2A

A

levetiracetam

brivaracetam

23
Q

egs of AEDs that target synaptic release of alpha2delta

A

gabapentin

pregabalin

24
Q

egs of AEDs that target inotropic glutamate receptors (AMPA receptor)

A

perampanel

25
Q

criteria for starting AED

A
  • diagnosis of epilepsy (usually after 2nd epileptic seizure)
  • risk of recurrence and nature of seizures mut justify Tx
  • good compliance likely
  • patient fully counselled
  • patient’s wishes taken into account
26
Q

factors that determine choice of AED

A
  • seizure type
  • epilepsy syndrome
  • efficacy
  • tolerability and ease of use/adverse effects
  • PK profile
  • patient’s related medical conditions (co-morbidity/co-medication)
  • cost
27
Q

factors relating to the epilepsy that determine choice fo AED Tx

A

syndrome and seizure type

severity and frequency

aetiology

28
Q

personal/patient factors that detemine choice of Tx

A
  • age/gender
  • co-morbidity (physical/mental)
  • social circumstances (job, education, domestic)
  • emotional circumstances
  • attitude to risks of seixures and meds
29
Q

factors relating to the drug that detemine choice of Tx

A
  • MOA
  • strength of therapeutic effects
  • strength/nature of s/e
  • formulation
  • drug interactions and PK properties
  • cost

PHA333 (27 decks)

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