Neuro Drugs 1 - Epilepsy Drugs Flashcards
Clinical use: Tiagabine
Focal
Mechanism: Phenobarbital
Facilitate GABAA action by increasing duration of Cl- channel opening, thus decreasing neuron diring
Mechanism: Vigabatrin
Increase GABA by irreversibly inhibiting GABA transaminase
Clinical use: BDZs
Diazepam
Lorazepam
Midazolam
Status epilepticus (1st line for acute)
Eclampsia seizures (2nd line; 1st line is magnesium sulfate)
Clinical use: Topiramate
Focal
Tonic-clonic
Migraine prophylaxis
Adverse effects: Phenobarbital
- Sedation
- Tolerance
- Dependence
- Cardiorespiratory depression
- P-450 induction
Clinical use: Levatiracetam
Focal
Tonic-clonic
Mechanism: Lamotrigine
Blocks voltage-gated Na+ channels
Inhibits release of glutamate
Adverse effects: Phenytoin, Fosphenytoin
- Neuro: Nystagmus, diplopia, ataxia, sedation, peripheral neuropathy
- Hirsutism
- Stevens-Johnson syndrome
- Gingival hyperplasia
- DRESS syndrome
- MSK: Osteopenia, SLE-like syndrome
- Heme: Megaloblastic anemia
- Teratogen (fetal hydantoin syndrome)
- P-450 induction
Clinical use: Lamotrigine
Focal
Tonic-clonic
Absence
Clinical use: Gabapentin
Focal
Peripheral neuropathy (e.g., DM)
Postherpatic neuralgia
Adverse effects: Lamotrigine
- Stevens-Johnson syndrome (must titrate slowly)
Adverse effects: BDZs
Diazepam
Lorazepam
Midazolam
- Sedation
- Tolerance
- Dependence
- Respiratory depression
Clinical use: Valproic acid
Focal
Tonic-clonic (1st line; phenytoin also 1st line)
Absence (combo tonic-clonic + absence)
Myoclonic seizures
Bipolar disorder
Migraine prophylaxis
Clinical use: Carbamazepine
Focal (1st line)
Tonic-clonic
Trigeminal neuralgia (1st line)
Mechanism: Levatiracetam
Unknown
May modulate GABA and glutamate release
Clinical use: Ethosuximide
Absence (1st line)
Mechanism: Ethosuximide
Blocks thalamic T-type Ca2+ channels
Adverse effects: Carbamazepine
- SIADH
- Steven-Johnson syndrome
- Diplopia
- Ataxia
- Blood dyscrasias - agranulocytosis, aplastic anemia
- Hepatoxicity
- Teratogenesis
- P-450 induction
Mechanism: Gabapentin
Designed as GABA analog:
Primarily inhibits high-voltage-activated Ca2+ channels (essentialy for fusion/release of NT)
Mechanism: Valproic acid
Increase Na+ channel inactivation
Increase GABA concentration by inhibiting GABA transaminase
Clinical use: Vigabatrin
Focal
Adverse effects: Topiramate
- Sedation
- Mental dulling
- Kidney stones
- Weight loss
- Glaucoma
Adverse effects: Gabapentin
- Sedation
- Ataxia
Adverse effects: Ethosuximide
- Stevens-Johnson syndrome
- Itching and urticaria
- Fatigue
- GI distress
- Headache
Adverse effects: Vigabatrin
- Permanent visual loss (black box warning)
Adverse effects: Valproic acid
- Weight gain
- Hepatotoxicity (measure LFTs)
- Neural tube defects (contraindicated in pregnancy)
- Pancreatitis
- GI distress
- Tremor
Mechanism: BDZs
Facilitate GABAA action by increasing frequency of Cl- channel opening, thus decreasing neuron firing
Mechanism: Phenytoin, Fosphenytoin
Blocks Na+ channels
(zero-order kinetics)
Clinical use: Phenobarbital
Focal
Tonic-clonic
(1st line in neonates)
Mechanism: Tiagabine
Increase GABA by inhibiting reuptake
Mechanism: Carbamazepine
Blocks Na+ channels
Clinical use: Phenytoin, Fosphenytoin
Focal
Tonic-clonic (1st line; valproic acid also 1st line)
Status epilepticus (1st line prophylaxis)
Mechanism: Topiramate
Blocks Na+ channels
Increases GABA action
Adverse effects: Levetiracetam
- Fatigue
- Drowsiness
- Headache
- Neuropsychiatric symptoms (e.g., personality changes)