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Pharmacology > Neuro: Antiepileptic Drugs > Flashcards

Neuro: Antiepileptic Drugs Flashcards

1
Q

What neuronal imbalance causes seizures?

A

Glutamate/Aspartate overload= over-excitation

Need more GABA!

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2
Q

What state do Na-channel blockers work in? Open or closed?

A

Only in the open and inactivation; so it is state and use dependence

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3
Q

MOA of Lamotrigine

A

Prolong fast inactivation state of Na(v) ion channels

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4
Q

MOA of carbamazepine

A

Prolong fast inactivation state of Na(v) ion channels

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5
Q

MOA of penytoin

A

Prolong fast inactivation state of Na(v) ion channels

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6
Q

MOA of topiramate**

A
  1. Prolong fast inactivation state of Na(v) ion channels
  2. AMPA antagonist
  3. Activates GABAa receptor Cl channels on post-synaptic
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7
Q

MOA of Valproic acid***

A
  1. Prolong fast inactivation state of Na(v) ion channels
  2. Activates glutamic acid decarboxylase
  3. inhibits GABA transaminase and SSD
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8
Q

MOA of lacosamide**

A
  1. Prolong fast AND 2. slow inactivation state of Na(v) ion channels

different than other Na channel blockers

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9
Q

MOA of PerAMPAnel

A

Blocks the AMPA receptor

so Glutamate cannot excite the post-synaptic neuron

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10
Q

MOA of felbamate

A

NMDA receptor antagonist

so Glutamate cannot excite the post-synaptic neuron

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11
Q

What channels cause absence seizures?

A

T-type Ca+ channels in the thalamus

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12
Q

What wave types characterize absence seizures?

A

3-Hz spike and wave

-from T-type Ca channels

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13
Q

MOA of Ethosuximide

A

Blocks T-type Ca+ channels in Thalamus in Absence!

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14
Q

MOA of Zonisamide**

A
  1. Blocks T-type Ca+ channels in Thalamus

2. prolongs slow inactivation state of Na(v) ion channels

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15
Q

MOA of levetiracetam

A

inhibits synaptic vesicle 2A protein

-less Glutamate release

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16
Q

MOA of Brivaracetam

A

inhibits synaptic vesicle 2A protein

-less Glutamate release

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17
Q

MOA of Gabapentin**

A
  1. Blocks α2δ subunit of T-type Ca channels

2. Activates glutamic acid decarboxylase

18
Q

MOA of Pregabalin**

A
  1. Blocks α2δ subunit of T-type Ca channels

2. Activates glutamic acid decarboxylase

19
Q

MOA of ezogabine**

A
  1. KCNQ K+ Channel blocker on both pre- and post-synaptic

2. Activates GABAa receptor Cl channels on post-synaptic neurons

20
Q

MOA of viGABATrin

A

Inhibits GABA transaminase

21
Q

MOA of tiagabine

A

Inhibits GAT-1 reuptake channel

22
Q

MOA of Benzodiazepines

A

Activates GABAa receptor Cl channels on post-synaptic neurons

23
Q

MOA of Barbiturates (phenobarbitol)

A

Activates GABAa receptor Cl channels on post-synaptic

24
Q

Suffix of all benzodiazapines

A

-azepam

25
Q

Which GABAa receptor agonists are GABA independent?

A

Barbiturates

-simply bind and increase duration of Cl channel opening

26
Q

Which Which GABAa receptor agonists are GABA dependent?

A

Benzodiazepine

-requires GABA in channel already and allows Cl to open more readily

27
Q

What is a broad risk of all AEDs?

A

Abrupt withdrawl can cause status epilepticus

Suicidal behavior and ideation

28
Q

Which drug is removed via Zero-order pharmacokinetics

A

Phenytoin

-saturable!

29
Q

Which drugs are CYP450 and UGT conjugation inducers?

A

Phenytoin,
carbamazepine, and
phenobarbital

30
Q

What two seizure syndromes may cannabidiol treat?

A

Lennox-Gastaut syndrome and Dravet syndrome

31
Q

Adverse effects of Phenytoin (2)

A

Gingival hyperplasia

Hypocalcemia/osteoporosis

32
Q

Adverse effects of carbamazepine

A

Agranulocytosis and aplastic anemia

-get CBC

33
Q

What is unique about cabamazepines metabolism?

A

It induces auto-induction of Cyp450=self metabolism after 14 days

34
Q

Why would you use oxcarbazepine instead of carbamazepine?

A

Does not generate the toxic epoxide that causes the aplastic anemia of carbamazepine

35
Q

Adverse effects of Phenobarbitol

A

CNS depressant

36
Q

Adverse effect of vigabatrin

A

Perminent concentric vision loss

37
Q

What drugs inhibit conjugation by UGT?

A

Valproate and lamotrigine

=build up of drugs

38
Q

What drugs are most affected use of CYP450 inducers (phenytoin,
carbamazepine, and
phenobarbital)?

A

Oral contraceptives
Anticoagulants (warfarin)
HIV Medications

39
Q

How are the newer drugs cleared from the body?

A

Renal clearance

40
Q

How do you initially treat status epilepticus? both first and second

A

1st IV: Lorazepam*
-oral midzaolam if no IV

2nd: Levetiracetam*, fosphenytoin, or valproate

Pharmacology (50 decks)

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