Pharm of Seizures and Epilepsy - Fitz Flashcards
Broad spectrum AEDs
- valproate
- lamotrigine
- topirimate
- levetiracetam
- zonisamide
AEDs for simple/complex disorder
- gabapentin
- pregabalin
- oxycarbazepine
- lacosamide
- tiagabine
- vigabatrin
- ezogabin
AEDs for tonic/clonic disorder
- carbamazepine
- phenytoin
- phenobarbital
AEDs for atonic clonic disorder
- benzodiazepines (diazepam/lorazepam)
- clonazepam
AEDs for absence seizure
ethosuximide
MOA: Phenytonin
presynaptic, antagonize VGNaC, enhance fast inactivation
MOA: Carbamazepine
presynaptic, antagonize VGNaC, enhance fast inactivation
MOA: Lacosamide
presynaptic, antagonize VGNaC, enhance slow inactivation
MOA: Lamotrigine
presynaptic, antagonize VGNaC, enhance fast inactivation; acts at N- and P-type VGCaC in cortical neurons, acts at neocortical K+ currents
MOA: Oxcarbazepine
presynaptic, antagonize VGNaC, enhance fast inactivation
MOA: zonisamide
presynaptic, blocks VGNaC, blocks t-type Ca2+ channels
MOA: Ethosuximide
T-type Ca2+ channels
AEs: Valproate
weight gain, tremor, hair loss, lethargy, NTDs in offspring of pregnant women on drug (class D teratogen)
MOA: Tiagabine
presynaptic, inhibits GABA re-uptake
MOA: Vigabatrin
presnyaptic, inhibits GABA metabolism
MOA: Benzodiazepines
postsynaptic, allosteric potentiation of GABA receptor
MOA: Phenobarbital
postsynaptic, allosteric potentiation of GABA (potentially lethal)
Status epilepticus treatment
1) IV lorazepam/diazepam ~ 5 min, no change then…
2) use IV fosphenytonin
Tx: Clonazepam
myoclonic seizures, available IV or suppository form
MOA: Valproate
VGNaC, T-type Ca2+ channels, increase GABA
MOA: Topirimate
VGNaC, LGNaC, Type-T Ca2+ channels, increase GABA, potentiate GABA(a) receptors
MOA: Gabapentin
VGCaC
MOA: Leviteracetam
bind synaptic vesicle protein SV2A - blunts glutamate release
Elim: Pregabalin
100% renal clearance
MOA: Ezogabine
opens VGKC
AEs: Phenytonin
gingival hyperplasia, hirsutism, hypocalcemia, osteoporosis, class D teratogen
AEs: Carbamazepine
aplastic anemia, hypocalcemia, hyponatremia, osteoporosis, increased risk of unplanned pregnancy, increased rick of A/V thrombosis, allergic reaction (SJS), class D teratogen
Elim: Gabapentin
100% renal clearance
AEs: Lamotigine
allergic reaction (Stevens-Jonson syndrome (SJS) when used with valproate)
AE: Levetriacetam
none
AEs: Oxycarbazepine
hyponatremia (MC in elderly), rash
AEs: Tiagabine
stupor
AEs: Topoiramate
nephrolithiasis, open angle glaucoma, hypohidrosis
AEs: Zonisamide
rash, renal calculi, hypohidrosis