Neuro, Epilepsy Flashcards
Carbamazepine inhibits neuronal Na+ channels to reduce excitability, it is the first line option for 2: which types of epilepsy and which type of pain?
-for generalised tonic-clonic seizure prophylaxis
-for focal seizures
-for trigeminal neuralgia to control pain and reduce # and severity of attacks
NB: CARLAMP VALLET
-CARbamazepine and LAMotrogine are focal
Name 2 SEs of Carbamazepine
- remember uses: generalised tonic-clonic, focal and trigeminal neuralgia
- clue: also has action like ADH
- GI upset (N&V)
- neuro effects (diziness/ataxia)
- hypersensitivity (maculopapular rash)
- antiepileptic hypersensitivity syndrome (1/5000) -> SJS 10% die
- oedema
- hyponatraemia
Suggest 2 things carbamazepine exposure in utero is associated with?
- neural tube defects
- cardiac and urinary tract abnormalities
- cleft palate
Carbamazepine has what effect on CYP enzymes?
NB: it is itself metabolised by these enzymes so CYP inhibitors will increase it’s conc and risk of toxicity
Induces CYP enzymes
Pts with epilepsy must not drive unless they have been seizure-free for ____ months and for ____ months after changing or stopping treatment.
- 12months seizure free
- 6months after change/stopping meds
What is the 1st line medication to treat trigeminal neuralgia?
Carbamazepine
Gabapentin and Pregabalin are options for add-on treatment of ___ epilepsies when other drugs provide inadequate control.
- They are 1st line options for _____-pain e.g painful d___ ____
- pregabalin is also used in ___
- add-on for focal epilepsies
- 1st line for neuropathic pain e.g. painful diabetic neuropathy
- pregabalin for generalised anxiety disorder too
MOA of gabapentin and pregabalin?
mediates GABA
-binds to presynaptic VGCa2+ inhibiting release of excitatory NT release
Give 2 SEs of gabapentin/pregabalin
-drowsiness, dizziness, ataxia
NB: these effects are worse if used with other sedating drugs
Gabapentin may cause false positive results for detection of what? Therefore the sample should be sent to the lab for quantitative analysis e.g spot ____
- detection of protein on urine dipstick
- spot Protein : Creatinine ratio
Levetiracetam is used for seizure prophylaxis in epilepsy of all types and for treatment of ___ that has not responded to rx with benzodiazepines
-status epilepticus
How does levetiracetam reduce the risk of seizure?
-interferes with synaptic vesicle function
What organ eliminates levetiracetam therefore dosage should be reduced when?
- kidney
- if renal impairment
Does levetiracetam interact with other drugs, contraception or warfarin?
side note: SEs are mood/depression/anxiety related
No
-this is a major adv of the drug
+ no obvious teratogenic effects seen
T COcP PP are inducers so COCP.POP, morning after -> less effective T C Oxy\_\_""\_\_ Phe\_\_\_ Phe\_\_\_\_\_\_ Prim\_\_\_
T TOPIRAMATE C CARBAMAZEPINE Oc OXYcarbazepine P PHENYTOIN P PHENOBARBITONE P PRIMIDONE
