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NMSP Exam 1 > Pharm of Epilepsy > Flashcards

Pharm of Epilepsy Flashcards

1
Q

What are the excitatory neurotransmitters?

A

Glutamate and Aspartate

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2
Q

What neurotransmitter is inhibitory on neurons?

A

GABA

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3
Q

Explain the different states of the Voltage Na Channel

A
  1. Resting state- Activation gate closed; inactivation gate open
  2. Open state- both open and Na depolarizes cell
  3. Fast-Inactivation state- Inactivation gate closes but activation gate is open (refractory period)
  4. Inactivated Closed state- both closed
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4
Q

Which Na blockers prolong the fast inactivation state?

A 
Carbamazepine
Lamotrigine
Phenytoin
Topiramate
Valproic Acid 
Lacosamide
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5
Q

Which Na blocker additionally can bind to the Na gate even in the closed state?

A

Lacosamide

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6
Q

AMPA receptor antagonists

A

Topiramate

Perampanel

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7
Q

Explain why blocking the AMPA receptor works to treat status epilepticus

A

Prevents glutamate from binding AMPA and allowing influx of Na (and Ca) into post synaptic neuron

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8
Q

NMDA receptor antagonist

A

Felbamate

Same MOA as AMPA antagonists

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9
Q

What type of seizure is treated with T-Type Ca2+ channel blocker?

A

Absence (petit mal) seizures

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10
Q

T-Type Ca2+ channel blockers

A

Ethosuximide

Zonisamide (additionally is a Na blocker)

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11
Q

SV2A Protein inhibitors

A

Levetiracetam

Brivaracetam

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12
Q

T-type Ca2+ channel a2d subunit blockers

A

Gabapentin

Pregabalin

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13
Q

Why does blocking the T-type Ca2+ channel work to suppress glutamate excitatory actions?

A

Once a neuronal signal reaches the pre-synaptic knob, depolarization allows Ca2+ into the knob which directs vesicles of glutamate to be released into the synaptic junction.

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14
Q

KCNQ Channel activator and MOA

A

Ezogabine

Hyperpolarizes presynaptic and post synaptic neuron to prevent release of Glutamate

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15
Q

Explain how GABA works to inhibit a neuronal signal

A

GABA is released from the presynaptic neuron.

It binds the B-subunit of the GABA receptor and allow efflux of Cl- which hyperpolarizes the post-synaptic neuron.

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16
Q

How is GABA made?

A

L-glutamate is converted to GABA via Glutamic Acid decarboxylase

17
Q

What stimulates GAD (glutamic acid decarboxylase) and enhances inhibitory effects of GABA?

A

Valproic Acid
Gabapentin
Pregabalin

18
Q

2 enzymes that breakdown GABA

A

GABA-T

SSD

19
Q

GABA-T antagonists

A

Valproic Acid

Vigabatrin

20
Q

SSD antagonist

A

Valproic Acid

21
Q

What drug blocks the reuptake of GABA by GAT-1 in order to potentiate its effects?

A

Tiagabine

22
Q

2 classes of drugs that enhance post-synaptic GABA-ergic transmission

A
  1. Barbiturates

2. Benzodiazepines

23
Q

What is the most important difference between Benzo’s and Barbiturates?

A

Barbiturates are GABA-independent and therefore more lethal in toxicity

24
Q

Common Benzos

A
  1. Lorazepam
  2. Diazepam
  3. Clonazepam
  4. Clobazam
25
Q

Benzo MOA

A

Binds to allosteric site on GABA receptor and potentiates the Cl- efflux by allowing quicker recovery of the channel so it can open more frequently.

26
Q

Barbiturate MOA

A

Binds allosteric site on GABA receptor WITHOUT GABA present and holds Cl- channel open

27
Q

Name the 3 MOA of Topiramate

A
  1. Na blocker
  2. AMPA antagonist
  3. GABA receptor agonist
28
Q

Name the 3 MOA of Valproic Acid

A
  1. Na blocker
  2. GAD stimulation (more GABA)
  3. GABA-T blocker (block reuptake)
29
Q

Name the 2 MOA of Gabapentin and Pregabalin

A

1 a2d Ca channel blocker

2. GAD stimulator

30
Q

2 syndromes associated with Cannabidiol

A
  1. Dravet Syndrome

2. lennox-gastaut syndrome

31
Q

Black box warnings for all AEDs

A
  1. Abrupt withdrawal can cause seizures

2. Suicidal Ideation

32
Q

Side effect of Phenytoin

A 
Follow zero-order kinetics so can easily OD
CYP inducer 
Gingival Hyperplasia 
Hypothyroidism 
Hypocalcemia
33
Q

AED’s associated with osteopenia/osteoporosis

A

Carbamazepine
Phenytoin
Phenobarbital
Valproic acid

34
Q

Carbamazepine side effects

A

CYP inducer

Bone Marrow suppression (get baseline CBC)

35
Q

Vigabatrin Side effects

A

Loss of Vision

36
Q

3 categories of drug-drug interactions to watch for with CYP inducing AED’s

A
  1. OCP
  2. Anticoags
  3. Antivirals (HIV meds)
37
Q

Valproic acid and Lamotrigine inhibit what enzyme leading to increased concentration of other drugs?

A

UGT

38
Q

What AED’s cause increased UGT activity and therefore increased clearance of drugs?

A

Phenobarbital
Phenytoin
CBZ

39
Q

Standard of Care for a status epilepticus

A
  1. Benzo (Lorazepam)

2. SV2a blocker (Levetiracetam)

NMSP Exam 1 (17 decks)

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