pharmacology of anticonvulsants

Question 1

what is the primary action of lamotrigine

Answer 1

blocks voltage gated na+ channels preventing na+ influx. prevents depolarisation of glutamatergic neurones reduces glutamate excitotoxicity

Question 2

what is the drug target of lamotrigine

Answer 2

voltage gates na+ channels

Question 3

what are the main side effects of lamotrigine

Answer 3

common - rash, drowsiness

less common but severe - steven johnsons syndrome or suicidal thoughts

Question 4

extra info on lamotrigine

Answer 4

introducing gradually is one of keys to reducing frequency and severity of allergic skin reactions

Question 5

what is the primary action of sodium valproate

Answer 5

inhibition of gaba transaminase prevents breakdown of gaba. increases gaba concentrations directly in synapse pre synaptically also indirectly prolongs gaba in synapse.

Question 6

what is the target of sodium valproate

Answer 6

gaba transaminase

Question 7

what are the side effects of of sodium valproate

Answer 7

common - stomach pain, diarrhoea, drowsiness, weight gain, hair loss
serious - hepatotoxicity, teratogenicity, pancreatitis

Question 8

extra info on sodium valproate

Answer 8

broad cyp enzyme inhibitor - increases serum conc of many co administered drugs

Question 9

what is main action of diazepam

Answer 9

increases chloride ion influx in response to gaba binding at gaba a receptor. increases chloride ion influx associated with hyperpolarisation of excitatory neurones

Question 10

what are the side effects of diazepam

Answer 10

drowsiness, respiratory depression,

uncommon but serious - haemolytic anaemia, jaundice

Question 11

extra info on diazepam

Answer 11

not used for long term supression of seizures due to development of tolerance

Question 12

what is the action of levetiracetam

Answer 12

inhibition of synaptic vesicle protein sv2a. inhibits this protein and prevents vesicle exocytosis. reduction in glutamate secretion reduces glutamate toxicity

Question 13

target site of levetiracetam

Answer 13

synaptic vesicle protein sv2a

Question 14

side effects of levetiracetam

Answer 14

common - dizziness, somnolence, fatigue, headache

Question 15

extra info on levetiracetam

Answer 15

metabolism of drug has no effect on cytochrome p450 enzyme system so favourable in terms of long term drugs

Question 16

drug target of diazepam

Answer 16

benzodiazepine site on gaba a receptor

Question 17

what is the treatment for seizures dependant on

Answer 17

type of seizure

individual patients

Question 18

what are the main goals of antiepileptic drugs

Answer 18

eliminate seizures/reduce frequency to max degree
avoid adverse effects associated with long term treatment
aid patients in maintaining normal lifestyles

Question 19

first line treatment for absence seizures in boys/men and women of non child bearing potential

Answer 19

ethosuximide or sodium valproate

Question 20

first line treatment for absence seizures in women of child bearing potential

Answer 20

ethosuximide

Question 21

adjunctive treatment for absence seizures in boys/men or non child bearing potential women

Answer 21

combine ethosuximide, sodium valproate or lamotrigine

Question 22

adjunctive treatment for absence seizures in women of child bearing age

Answer 22

combine ethosuximide and lamotrigine

Question 23

first line treatment for boys/men/non child bearing potential women for focal seizures

Answer 23

carbamazepine or lamotrigine

Question 24

first line treatment in child bearing potential women with focal seizures

Answer 24

carbamazepine or levetriracetam

Question 25

adjuvant treatment for focal seizures

Answer 25

any except sodium valproate for women

Question 26

first line treatment for generalised tonic clonic seizures in men/non child bearing potential women

Answer 26

sodium valproate

Question 27

first line treatment for generalised tonic clonic seizures for child bearing potential women

Answer 27

lamotrigine or carbamazepine

Question 28

adjunctive treatment for generalised tonic clonic seizures in men/non child bearing potential women

Answer 28

combine 2 of sodium valproate, levetiracetam or topirimate

Question 29

adjunctive treatment for generalised tonic clonic seizures in child bearing potential women

Answer 29

combine levetiracetam and topirimate

Question 30

first line treatment for myoclonic seizures in men/non child bearing potential women

Answer 30

sodium valproate

Question 31

first line treatment for myoclonic seizures in child bearing potential women

Answer 31

levetiracetam or topirimate

Question 32

adjuvant treatment for myoclonic seizures for all

Answer 32

clobazam, lamotrigine, levetiracetam or topirimate

Question 33

what is first line treatment for tonic/atonic seizures in men/ non child bearing potential women

Answer 33

sodium valproate

Question 34

first line treatment for tonic/atonic seizures in child bearing potential women

Answer 34

sodium valproate( if pregnancy prevention programme)

Question 35

adjunctive treatment for tonic/atonic seizures for all

Answer 35

lamotrigine

Question 36

what are the issues with sodium valproate for child bearing potential women

Answer 36

neural tube defects
decreased iq
autism
(after in utero exposure)