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Neuro Pharmacology > Epilepsy Pharm > Flashcards

Epilepsy Pharm Flashcards

1
Q

What is epilepsy

A

Enduring predisposition to generate epileptic seizures and associated cognitive , psychological and social consequences.
Abnormal excessive or synchronous electric discharges in the brain

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2
Q

Provoked vs Unprovoked Seizures

A

Provoked: Ex: take drugs which cause patient to have seizure , reversible risk factors

Unprovoked: no acutely reversible risk factor for the seizure ( structural or functional problem)

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3
Q

If you have 2 seizures within more than 24hrs then this means what

A

Patient is more likely to have more seizures later in life , think epilepsy

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4
Q

Can 1 seizure cause epilepsy ?

A

Yes

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5
Q

What is Resolution Epilepsy

A

If it’s an age dependent syndrome and patient has grown out of it

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6
Q

What is drug refractory epilepsy

A

Pharmacoresistant epilepsy

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7
Q

Considerations taken in when prescribing Anti-seizure Medication ( ASM ) for patient ?

A 
1- Type ( focal/generalized ) 
2- Spectrum or efficacy 
3- Comorbidities ( migraine , bipolar ) 
4- Tolerability ( compliance) 
5- pharmacokinetics and dynamics 
6- Speed of titration 
7- Cost, blood tests , frequency of administration
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8
Q

What is the goal for medication for epilepsy patients

A

Patient to be seizure free without adverse effects

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9
Q

Classification of Seizure

A 
1- Focal Onset 
 - Aware / impaired awareness
 - motor onset 
 - non motor onset 
 - focal to bilateral tonic-clonic 
2- Generalized onset 
 - motor : tonic-clonic / the motor 
 - non motor( absence ) 
3- Unknown onset 
 - tonic-clonic / other motor 
 - non motor
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10
Q

What is a focal onset seizure ?

A

Seizure that starts in one area of the brain

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11
Q

Symptoms of focal onset seizure in Limbic region

A
  • Changes in taste , smell
  • funny feeling in epigastrium
  • memory disturbance
  • psychiatric dysfunction ( extreme fear / goosebumps )
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12
Q

What is a Generalized Onset Seizure

A

Seizure that has a widespread disturbance of brain function

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13
Q

If patient has seizure in the inferior frontal lobe, what symptoms will they present with

A

Speech disturbance

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14
Q

What cell stages are targeted by anti-epileptic medications

A

1- Sodium channels on presynaptic area that release neurotransmitters
2- GABAa receptors : GABA causes CL- to rush in , inactivating neurone
3- NMDA/AMPA receptors that block glutamate from binging to receptors and causing excitation
4-

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15
Q

What is the key excitatory and inhibitory neurotransmitter for neuronal transmission

A

Excitatory : glutamate

Inhibitory : GABA

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16
Q

Which Anti-seizure medications promote inhibition

A

1- Topiramate
2- Benzodiazepines
3- Valproate

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17
Q

Which Anti-seizure medications reduce excitation

A 
1- Phenytoin 
2- Carbamazepine 
3- Lamotrigine 
4- Valproate 
5- Topiramate 
6- Levetiracetam
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18
Q

Which Anti-seizure medications are the sodium channel blocking drugs

A

Carbamazepine and Phenytoin

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19
Q

Which seizures should Carbamazepine and Phenytoin not be used for

A

Absence and Myoclonic

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20
Q

If someone presents with focal or generalized seizures which medication will be chosen and why ?

A

Drugs with least interactions , side affects and with priority to comorbidities. Could be used for all seizure types

Lamotrigine or Levetiracetam

21
Q

Which ASM is most affective for generalised seizures, but why is it not the one always used

A

Sodium Valproate but it’s side effects , especially for women make it not possible to prescribe sometimes

22
Q

Explain Carbamazepine , MOA , side effects , interactions

A

MOA : sodium channel blocker

Hepatically metabolized

Interactions: Strong hepatic enzyme inducer ( CYP3A4 ) - messes up a lot of medications

  • auto-induction of liver enzymes : liver gets better at metabolizing carbamazepine the more it’s used = need to increase dose later
  • bone health , can metabolize vitamin D more rapidly
  • Abnormal lipid function & CVS risk

Side effect :

  • reduces liver function
  • dizziness, headaches, double vision
  • fatigue , nausea , GI disturbance
  • Hyponatraemia through SIAH mechanism
  • Idiosyncratic : bone marrow suppression , hypersensitivity , hepatic derangement , rash
23
Q

Explain Phenytoin , MOA , side effects , interactions

A

MOA: Sodium channel blockers

Side effects :
Acute : dizziness, ataxia , fatigue , diplopia , nystagmus, rash , sedation
Chronic: gum hyperplasia, coarse face, hirsutism, osteopenia, enhanced Vitamin D metabolism , low folate, peripheral neuropathy
Idiosyncratic: fever, rash , lymphadenopathy, teratogenic

Interactions : Hepatic enzyme induced = reacts with most drugs

24
Q

Which contraceptive is not effective while on Carbamazepine

A

Progesterone

25
Q

Which contraceptive is not effective while on Carbamazepine

A

Progesterone only

26
Q

Can sodium channel blocker ASM be combined

A

Better to combine drugs with other MOA. There could be compounding side effects

27
Q

What is the therapeutic range of Phenytoin

A

10-20ug/ml

28
Q

How can Phenytoin be dangerous

A

Has First order kinetics at first and the zero order kinetics. Can suddenly become toxic since there will be a high saturation of it and the liver will not accommodate to metabolize it

29
Q

What ASM can displace and inhibit the metabolism of Phenytoin and what is the effect

A

Sodium Valproate.

Effect: increases free phenytoin and toxicity

30
Q

Explain Sodium Valproate, MOA , side effects , interactions

A

MOA = multiple

  • Sodium/calcium blocker
  • CABA & glutamate receptor actions

Hepatic metabolism

Side effect : 
- Extremely Teratogenetic ( have to do legal paper work if prescribing to women )
V ( nemonic VALPROATE)  
- A ppetite increase/gain weight 
- L iver failure 
- p ancreatitis 
- R eversible hair loss 
- O edema 
- A taxia 
- T eratogenicity , tremor , thrombocytopenia 
- E ncephalopathy

Interactions :
- Lamotrigine ( very effective combination therapy for epilepsy )

31
Q

Which ASM can double the dose of Lamotrigine if interact together

A

Sodium Valproate

32
Q

Explain Levetiracetam , MOA , side effects , interactions

A

MOA : SV2A ligand , blocks synaptic vesicle release

Few side effects :

  • irritability , anxiety , anger , fatigue , dizziness, behavioural changes, rare psychosis
  • highly rare hepatic failure

No significant interactions : Doesn’t effect liver enzymes

Not teratogenic

Really excreted

33
Q

If patient comes after being prescribed ASM with behavioural changes , which ASM were they most likely prescribed

A

Levetiracetam

34
Q

Explain Lamotrigine, MOA , side effects , interactions

A

MOA: Sodium channel modulators

Pregnancy Safe

Side effects
KEY: Rash/ Stevens-Johnson syndrome = could cause death
- insomnia
- mood stabilizing drug ( good if person has depression )

Interactions

  • OCP ( combined pill ) could cause drop in lamotrigine levels
  • other AEDs especially Valproate could increase concentration
35
Q

Explain Topiramate , MOA , side effects , interactions

A

MOA : multiple

  • Sodium/calcium blocker
  • GABA / Glutamte affects

Interactions :
- enzyme inducer and inhibitor

Side effects : 
- sedation 
- anorexia 
- weight loss ( big one ) 
- psychiatric 
- word finding difficulties 
Rare: kidney stones, acute angle closure glaucoma
- Teratogenic
36
Q

Topiramate is also used for

A

Migraines

37
Q

Is lamotrigine or Levetiracetam more first line prescribed

A

lamotrigine but needs slower titration

38
Q

Which ASM can cause weight gain

A

Valproate , Carbamazepine , Gabapentin

39
Q

If trying to promote weight loss what ASM could be prescribed

A

Topiramate

40
Q

What Is often prescribed with Carbamazepine for bone health

A

Vitamin D

41
Q

Which ASM should not be given in those with mental health issues

A

Levetiracetam

42
Q

Are there interactions with ASM and antidepressants ? will they be prescribed

A

Yes there is but antidepressants are still prescribed , rarely to affect the seizures

43
Q

For neuropathic pain which ASM could be used

A

Carbamazepine, Gabapentin / pregablin

44
Q

For Bipolar disorder which ASM could be used

A

Carbamazepine , lamotrigine and Valproic acid

45
Q

For migraine which ASM could be used

A

Topiramate

46
Q

For Trigeminal neuralgia which ASM could be used

A

Carbamazepine

47
Q

For obesity which ASM could be used

A

Topiramate and zonisamide

48
Q

For anxiety which ASM could be used

A

Clobazam and prcegablin

49
Q

What are the ASMs of choice in pregnancy

A

Lamotrigine and Levetiracetam

Neuro Pharmacology (2 decks)

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