Seizure Drugs

Question 1

seizures are due to increased or decreased circuit output in brain’?

Answer 1

increased

Question 2

describe the character of the brain firing in seizures

Answer 2

disordered and synchronous

Question 3

status epilepticus is what?

Answer 3

seizure longer than 5 mins or two within 5 mins

Question 4

what are two types of seizures?

Answer 4

partial or generalized

Question 5

what are two types of partial seizures?

Answer 5

simple and complex

Question 6

do you lose consciousness in simple partial seizure?

Answer 6

no

Question 7

do you lose consciousness in complex partial seizure?

Answer 7

yes

Question 8

do you lose consciousness in generalized seizures?

Answer 8

yes..in all types

Question 9

name the four ion changes that can lead to seizures

Answer 9

decreased Cl influx
decreased K+ efflux
increased Na or Ca influx

Question 10

name the four seizure meds that are inhibitors of the voltage gated Na channels

Answer 10

carbamazepine
lamotrigine
phenytoin
valproate

Question 11

how do Na channel blockers actual block the NA channels?

Answer 11

slow transition from inactivated to resting state…increase refractory period

Question 12

what is common toxicity with phenytoin?

Answer 12

gingival hyperplasia

Question 13

what is toxicity with carbamazepine?

Answer 13

water retention and hyponatremia

Question 14

how does carbamazepine induce water retention and hyponatremia?

Answer 14

increased ADH

Question 15

what are the two toxicities of valproate?

Answer 15

alopecia and weight gain

Question 16

what is MoA of valproate?

Answer 16

voltage Na blocker

Question 17

what is MoA of carbamazepine?

Answer 17

voltage Na blocker

Question 18

what is MoA of phenytoin?

Answer 18

voltage Na blocker

Question 19

what is MoA of lamotrigine?

Answer 19

voltage Na blocker

Question 20

aside from voltage gated Na channel blockers what is another presynaptic mechanism to block excitatory pathway in seizures?

Answer 20

voltage gated caclium channel blockers

Question 21

name the two voltage gated calcium channel blockers for seizures

Answer 21

gabapentin and pregabalin

Question 22

what Nt tract do gabapentin and pregabalin work in?

Answer 22

glutamate

Question 23

what is MoA of gabapentin?

Answer 23

block Vg Ca channels in glutamate path

Question 24

what is MoA of pregabalin?

Answer 24

block Vg Ca channels in glutamate path

Question 25

what is the molecular target of levetiracetam?

Answer 25

SV2A

Question 26

what is SV2A important for?

Answer 26

vesicle fusion for Nt release of glutamate

Question 27

what drug targets the SV2A vesicle fusion protein?

Answer 27

levetiracetam

Question 28

what does levetiracetam prevent?

Answer 28

vesicle fusion and Nt release of glutamate

Question 29

how do topiramate and felbamate work to be anti seizure?

Answer 29

block ligand gated Na channels in post synaptic neuron in glutamate tracts

Question 30

name the two drugs that block glutamate post synaptic ligand gated Na channels

Answer 30

topiramate and felbamate

Question 31

what is the target of topiramate?

Answer 31

AMPA

Question 32

what is the target of felbamate?

Answer 32

NMDA

Question 33

what are two severe tox of felbamate?

Answer 33

aplastic anemia and acute liver failure

Question 34

what are two tox of topiramate?

Answer 34

weight loss and renal calculi

Question 35

what is MoA of ethosuximide?

Answer 35

slows Ca2+ induced depol in post synaptic neuron in Glutamate tract

Question 36

what is drug that inhibits Ca2+ entry into post synaptic neuron in glutamate tract?

Answer 36

ethosiximide

Question 37

what is MoA of tiagabine?

Answer 37

reuptake inhib of GABA

Question 38

what Nt path does tiagabine work in?

Answer 38

GABA

Question 39

what drug inhibits uptake of GABA?

Answer 39

tiagabine

Question 40

what is MoA of vigabatrin and valproate in GABA pathway?

Answer 40

they inhibit breakdown of GABA in pre synaptic neuron

Question 41

what two drugs inhibit breakdown of GABA in pre synaptic neuron?

Answer 41

vigabatrin and valproate

Question 42

what is side effect of vigabatrin?

Answer 42

progressive permanent blindnes

Question 43

what is class of drugs that positively modulates GABA receptors on post synaptic neurons and is used to treat seizures?

Answer 43

Benzos

Question 44

what is main benzo ued for anti seizure med?

Answer 44

clonazepam

Question 45

aside from benzos what other class of meds can positively modulate GABA receptor in seizure treatment?

Answer 45

phenobarbitol

Question 46

what drug for anti seizure inhibits CYP2C9?

Answer 46

valproate

Question 47

inhibiting CYP2C9 leads to increase in conc of what drugs?

Answer 47

lot of other anti seizures...carbamazepine, phenytoin, topiramate, felbamate, lamotrigine

Question 48

what two anti seizure drugs induce CYP3A4

Answer 48

phenytoin and carbamazepine

Question 49

how is phenytoin cleared at high dose?

Answer 49

zero order...saturated...constant mg/hour, T1/2 not constant

Question 50

how is phenytoin cleared at low conc?

Answer 50

1st order, T1/2 constant

Question 51

what two seizure drugs lead to ineffective OCP use?

Answer 51

phenytoin and carbamazepine

Question 52

how do phenytoin and carbamazepine lead to ineffective OCP?

Answer 52

induce CYP3A4 which leads to quick breakdown of ethinyl estradiol making OCP ineffective

Question 53

name the four seizure meds that are teratogenic

Answer 53

phenytoin carbamazepine topiramate valproate

Question 54

name the two seizure drugs that decreae folate in women of child bearinf age

Answer 54

carbamazepine and phenytoin