Lecture 3: Anti-seizure and epilepsy Flashcards
What is seizure?
Self-sustaining and self-limiting episode of synchronized neural hyperactivity that can be detected by EEG
Absence seizure
briefly unconscious, blank stare, no memory of attack
less than 30 seconds
Tonic Clonic seizure
unconscious, dramatic convulsions, no memory of attack
less than 5 minutes
Phenytoin, carbamazepine, felbamate, valproate
block voltage-gated sodium channel, inhibit neuron firing rate
Topiramate
Agonist of GABAa channel, increase inhibitory signal
Phenobarbital
barbiturates, PAMs, increase efficacy of GABA
Diazepam, lorazepam, clonazepam
benzodiazepine, PAMs, increase potency of GABA
Tiagabine, vigabatrin
block reuptake, block metabolism of GABA
Gabapentin, pregabalin
Gabapentin and pregabalin: block VGCC
increase GABA synthesis
Ethosuximide
inhibit VGCCs in thalamus (t-type calcium channel), FIRST LINE TREATMENT for absence seizure
Phenytoin and phenobarbital drug interaction
induce P450, decrease effectiveness of oral contraceptives, anticoagulants, carbamazepine, NSAIDs due to increase metabolism
Valproate drug interaction
Valproate: VG sodium channel blocker
increase serum level of phenytoin
Valproate + aspirin or warfarin can cause reduced clotting and bleeding
Propofol, thiopental, diazepam, lorazepam , ketamine
injected anesthetic (mostly GABA agonist, PAMs)
Sevoflurane, desflurane, isoflurane, halothane, nitrous oxide
inhaled anesthetic, easier to to reverse and adjust dose (mostly GABA agonist, PAMs)
Common anesthetic regime in 3 steps
- Benzodiazepine: reduce anxiety, muscle relaxant
- Propofol: iv, induce anesthetic (can be lethal)
- Sevoflurane: inhaled anesthetic
- Opioid (optional): to provide analgesic
