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Pharmacology And Theraputics 1b > Pharmacology of Epilepsy > Flashcards

Pharmacology of Epilepsy Flashcards

1
Q

What is the primary mechanism of action of Lamotrigine?

A
  • Blocks VGSCs, preventing sodium influx
  • Prevents depolarisation of glutamatergic neurons
  • reduces glutamate excitotoxicity
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2
Q

What is the drug target of Lamotrigine?

A

Voltage Gated Sodium Channels (VGSCs)

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3
Q

What are the main side effects of Lamotrigine?

A 
Common:
- rash
- drowsiness
Rare:
- Steven-Johnson's Syndrome
- Suicidal thoughts
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4
Q

What can be done to prevent the frequency and severity of allergic skin reactions when taking Lamotrigine?

A

introducing it gradually

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5
Q

What is the primary mechanism of action of Sodium Valproate?

A
  • Inhibition of GABA transaminase, preventing the breakdown of GABA
  • Increases GABA concentration directly in the synapse, pre-synaptically
  • Prolongs GABA in the synapse due to the extra-neuronal metabolism and removal being slowed
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6
Q

What is the drug target of Sodium Valproate?

A

GABA transaminase

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7
Q

What are the side effects of Sodium Valproate?

A 
MANY
Common:
- stomach pain
- diarrhoea
- drowsiness
- weight gain
- hair loss
SERIOUS:
- hepatotoxicity
- teratogenicity
- pancreatitis
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8
Q

Why should a broad CYP enzyme inhibitor be prescribed in conjunction with Sodium Valproate?

A

Increases the serum concentration of many co-administered drugs

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9
Q

What is the primary mechanism of action of Diazepam?

A
  • Increased Cl- influx in response to GABA binding to the GABA-A receptor
  • leads to hyperpolarisation of excitatory neurons
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10
Q

What is the drug target of Diazepam?

A

Benzodiazepine site on the GABA-A receptor

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11
Q

What are the side effects of Diazepam?

A 
common:
- drowsiness
- respiratory depression (IV or high dose)
SERIOUS:
- hemolytic anaemia
- jaundice
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12
Q

Why is Diazepam not used for the long term suppression of seizures?

A
  • tolerance development
  • Addictive, dependence likely (Schedule 4 controlled drug)
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13
Q

What is the primary mechanism of action of Levetiracetam?

A
  • Inhibition of the synaptic vesicle protein SV2A
  • prevents vesicle exocytosis
  • reduces glutamate secretion
  • reduces glutamate excitotoxicity
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14
Q

What is the drug target of Levetiracetam?

A

Synaptic Vesicle Protein, SV2A

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15
Q

What are the common side effects of Levetiracetam?

A
  • dizziness
  • somnolence
  • fatigue
  • headache
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16
Q

Why is Levetiracetam favorable?

A
  • no effect on the cytochrome P450 enzyme system
  • unlikely to have drug-drug interactions
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17
Q

What is important to note when prescribing therapeutic drugs for seizures?

A
  • must tell pateint, they CANNOT drive

- they MUST tell the DVLA

18
Q

Why does Lamotrigine cause drowsiness?

A
  • acts on all presynaptic glutamate receptors
  • non-specific
  • slows down the whole brain
  • depressant effect on the brain
19
Q

When can Sodium Valproate be prescribed to those of child-bearing age?

A

ONLY when prescribed by a neurologist

20
Q

Why can’t those of child-bearing age take Sodium Valproate?

A

teratogenic (reproductive toxicity)

21
Q

What is the treatment of epilepsy dependent on?

A
  • type of seizure
  • the individual patient
22
Q

What are the different types of seizures?

A
  • absence
  • focal
  • generalised tonic-clonic
  • myoclonic
  • tonic or atonic
23
Q

What on an ECG can indicate an increased risk of seizure recurrance?

A

interictal epileptiform discharge (IED)

24
Q

What are the main aims of antiepileptic drug (AED) therapy?

A
  • eliminate seizures (or reduce frequency)
  • avoid the adverse effects of long term treatment
  • aid patients to maintain/restore a normal lifestyle
25
What must be done when Anti-Epileptic drug therapy is started?
must document advice to tell the DVLA that they cannot drive.
26
What is the first line and adjunctive treatment for those with absence seizures? (NOT CHILDBEARING)
``` First line: - ethosuximide - sodium valproate Adjunctive treatment: combine 2 of: - ethosuximide - sodium valproate - lamotrigine ```
27
What is the first line and adjunctive treatment for those with absence seizures? (CHILDBEARING)
``` First line: - ethosuximide Adjunctive treatment combine: - ethosuximide - lamotrigine ```
28
What is the first line and adjunctive treatment for those with focal seizures? (NOT CHILDBEARING)
``` First line: - carbamazepine - lamotrigine Adjunctive treatment -any ```
29
What is the first line and adjunctive treatment for those with focal seizures? (CHILDBEARING)
``` First line: - carbamazepine - levetiracetam Adjunctive treatment - any (NO SODIUM VALPROATE) ```
30
What is the first line and adjunctive treatment for those with generalised tonic-clonic seizures? (NOT CHILDBEARING)
``` First line: -sodium valproate Adjunctive treatment: combine 2 of: - sodium valproate - levetiracetam - topirimate ```
31
What is the first line and adjunctive treatment for those with generalised tonic-clonic seizures? (CHILDBEARING)
``` First line: - Lamotrigine - Carbamazepine Adjunctive treatment: combine: - levetiracetam - topirimate ```
32
What is the first line and adjunctive treatment for those with myoclonic seizures? (NOT CHILDBEARING)
``` First line: - sodium valproate Adjunctive treatment: - clobazam - lamotrigine - levetiracetam - topirimate ```
33
What is the first line and adjunctive treatment for those with myoclonic seizures? (CHILDBEARING)
``` First line: - levetiracetam - topiramate Adjunctive treatment: - clobazam - lamotrigine - levetiracetam - topirimate ```
34
What is the first line and adjunctive treatment for those with tonic or atonic seizures? (NOT CHILDBEARING)
First line: - sodium valproate Adjunctive treatment: - lamotrigine
35
What is the first line and adjunctive treatment for those with tonic or atonic seizures? (CHILDBEARING)
``` First line: - sodium valproate (WITH PREGNANCY PREVENTION PLAN) Adjunctive treatment: - lamotrigine ```
36
What is the effect of sodium valproate with in utero exposure?
- neural tube defects - decreased IQ - autism
37
What is the impact of the combined oral contraceptive on lamotrigine blood levels?
- co-administration leads to low lamotrigine blood levels - lamotrigine has no effect on blood ethinyl estradiol levels - reduced seizure control - NO contraceptive failure
38
Why does the combined oral contraceptive have an effect on lamotrigine levels?
may: - reduce absorption - enhance metabolism - enhance excretion
39
How do you combat the effect of COC pill on lamotrigine?
- change anti-epileptic or contraception OR - increase the dosage of lamotrigine
40
What do drug-drug interactions tend to involve?
changes to liver metabolism

Pharmacology And Theraputics 1b (10 decks)

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