Pharm - Epilepsy Flashcards
What are the 4 main drugs we can give for epilepsy
Lamotrigine
Sodium valproate
Levetiracetam
Diazepam
What is the drug target of lamotrigine
Voltage gated sodium channels
What the primary action of lamotrigine
Blocks VGCS to prevent the depolarisation of glutaminergic neurones and reduce glutamate excitotoxicity
What are the common side effects for lamotrigine?
Rash
Drowsiness
What are the less common side effects of lamotrigine
Steven Johnsons syndrome
Suicidal thoughts
What happens if we don’t introduce lamotrigine gradually
We have an increased risk and frequency of severe allergic skin reactions
What is the target for sodium valproate
GABA transaminase
What is the primary action of sodium valproate?
Inhibits GABA-transaminase
What are the common side effects for sodium valproate?
Stomach pain Diarrhoea Drowsiness Weight gain Hair loss
What are the serious side effects for sodium valproate?
Hepatotoxicity
Teratogenicity
Pancreatitis
What is the target of diazepam?
Benzodiazepine site on the GABA-A receptor
What is the primary action of diazepam?
Increases chloride influx in response to GABA binding therefore hyperpolarises excitable neurones
What are the common side effects of diazepam
Drowsiness
Respiratory depression if IV/high dose
What are the serious side effects of diazepam?
Haemolytic anaemia
Jaundice
Why is diazepam not used long term?
Long term use is associated with development of tolerance
What does a Schedule 4 controlled drug e.g. diazepam indicate
This means that addiction prone individuals are more likely to become dependent on diazepam
What is the target of levetriacetam?
Synaptic vesicle protein SV2A
What is the primary action of levetiracetam?
Inhibits SV2A therefore prevents exocytosis of glutamate
What are the side effects of levetiracetam?
Dizziness
Somnolence
Fatigue
Headaches
What anti-epileptic is best for avoiding drug-drug interaction?
Levetiracetam
Why is levetiracetam good at avoiding drug-drug interaction?
Its metabolism has no effect on the cytochrome p450 enzyme system
What are the 6 types of seizures?
Absence Focal Generalised tonic-clonic Myoclonic Tonic Atonic
What does tonic refer to
Stiffness and rigidity
What does clonic refer to
Repetitive rhythmic jerking, usually preceded by the tonic phase
What is IED from an EEG?
Interictal epileptiform discharge - indicates and increased chance of reoccurring seizures
What is the first line treatment for most seizures (epilepsy)
Sodium valproate
What is the first line treatment for focal seizures?
Carbamazepine or lamotrigine
