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thinking and Doing > AEDs > Flashcards

AEDs Flashcards

1
Q

What are the general mechanisms of actions of AEDs?

A

Suppress action potentials

  • Na+ channel blockers / modulators
  • K+ channel openers

Enhance GABA transmission

  • GABA uptake inhibitor: inhibit GABA transaminase ot inhibit GABA uptake transporters
  • GABA mimetics - enhance GABAa receptor activity

Suppression of excitatory transmission
- glutamate receptors antagonist

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2
Q

What are the key aims of AEDs?

A

Aim to reduce the frequency of the seizures and/or their severity - treating the symptoms NOT the cause

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3
Q

What are the 1st line treatments for partial/focal seizures and what are their MOA?

A

Carbamazepine - Binds to inactive state of Na+ channels to reduce depolarisation and slow recovery of the channel

Lamotrigine - Inhibits Na+/Ca2+ channels therefore modulating release of glutamate

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4
Q

What are the 2nd line treatments for partial/focal seizures and what are their MOA?

A

Levetiracetam - Inhibits synaptic vesicle proteins, inhibiting Ca2+ induced synaptic release - may also inhibit Ca2+ channel function directly

Oxacarbazepine - binds and inhibits inactive Na+ channels to reduce depolarisation and slow recovery

Sodium Valporate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

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5
Q

What are the side effects of Carbamazepine?

A

Induces cytochrome p450 enzymes - potentiating metabolism of other drugs e.g. warfarin

Dizziness, ataxia, drowsiness, water retention, GIT effects, mental and motor disturbances

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6
Q

What are the side effects of lamotrigine?

A

Overdose causes: decreased consciousness, coma, delayed heartbeat, lack of coordination, rolling eyeballs, increased seizures

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7
Q

What are the side effects of Levetiracetam?

A

Somnolence, dizziness, asthenia, ataxia, irritability- most are transient in nature

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8
Q

What are the side effects of oxacarbazepine?

A

less induction of cytochrome p450 than carbamazepine

vision disturbances, walking and balance changes, clumsiness, cough, fever, dizziness, false sense of well being, depression, uncontrolled rolling of the eyes

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9
Q

What are the side effects of sodium valporate?

A

Overdose: coma, extreme drowsiness, heart problems

Contraindicated in pregnancy and women trying for a child

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10
Q

What are the adjunctive therapies for focal/partial seizures if second well-tolerated AED is ineffective?

A

Clobazam - binds Cl- ionophore on post-synaptic GABA receptor to increase duration its open - increasing Cl- influx

Gabapentin - GABA analogue that inhibits L-type Ca2+ channels and decreases GABA turnover (inhibits succinic semialdehyde dehydrogenase)

Topiramate - may inhibit Na+ channels, augments GABA activity at GABAa receptors and acts antagonistically at AMPA/kainate receptors

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11
Q

What are the side effects of clobazam?

A

Somnolence, pyrexia, lethargy, upper respiratory tract infections

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12
Q

What are the side effects of Gabapentin?

A

Overdose: ataxia, laboured breathing, ptosis, sedation, hyperactivity and excitation

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13
Q

What are the side effects of topiramate?

A

Overdose: abdominal pain, agitation, blurred vision, convulsions, depression, dizziness, diplopia, impaired coordination, hypotension, impaired mental activity, reduced consciousness, severe diarrhoea, sluggishness and speech problems

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14
Q

What are the first line treatments for generalised tonic clonic seizures?

A

Sodium valproate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

Lamotrigine - inhibits Na+/Ca2+ channels therefore modulating release of glutamate

Carbamezapine - Binds to inactive state of Na+ channels to reduce depolarisation and slow recovery of the channel

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15
Q

What is the 2nd line treatment for generalised tonic-clonic seizures?

A

Oxcarbamezapine - binds and inhibits inactive Na+ channels to reduce depolarisation and slow recovery

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16
Q

What are the adjunctive treatments for generalised tonic clonic seizures, if a second well-tolerated AED is not effective?

A

Clobazam - binds Cl- ionophore on post-synaptic GABA receptor to increase duration its open - increasing Cl- influx

Levetiracetam - Inhibits synaptic vesicle proteins, inhibiting Ca2+ induced synaptic release - may also inhibit Ca2+ channel function directly

Topiramate - may inhibit Na+ channels, augments GABA activity at GABAa receptors and acts antagonistically at AMPA/kainate receptors

17
Q

What are the first line treatments for absence seizures?

A

Sodium valproate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

Ethosuximide - binds T-type Ca2+ channels and inhibits Ca2+ entry to reduce excitability

18
Q

What is the 2nd line treatment for absence seizures?

A

Lamotrigine - inhibits Na+/Ca2+ channels therefore modulating release of glutamate

19
Q

What are the side effects of ethosuximide?

A

acute overdose causes nausea, vomiting, CNS depression

20
Q

What is the 1st line treatment for myoclonic seizures?

A

Sodium valproate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

21
Q

What are the 2nd line treatments for myoclonic seizures?

A

Levetiracetam - Inhibits synaptic vesicle proteins, inhibiting Ca2+ induced synaptic release - may also inhibit Ca2+ channel function directly

Topiramate - may inhibit Na+ channels, augments GABA activity at GABAa receptors and acts antagonistically at AMPA/kainate receptors

22
Q

What is the 1st line treatment for tonic or atonic seizures?

A

Sodium valporate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

23
Q

What is the 2nd line treatment for tonic or atonic seizures?

A

Lamotrigine - inhibits Na+/Ca2+ channels therefore modulating release of glutamate

24
Q

What are the 1st line treatments for childhood absence epilepsy?

A

Sodium valproate - decreases GABA turnover by inhibiting GABA transaminase. Also blocks T type Ca2+ channels

Ethosuximide - binds T-type Ca2+ channels and inhibits Ca2+ entry to reduce excitability

25
Q

What is the 2nd line treatment for childhood absence epilepsy?

A

Lamotrigine - inhibits Na+/Ca2+ channels therefore modulating release of glutamate

26
Q

What are the adjunctive treatments for childhood absence seizures?

A

Clobazam - binds Cl- ionophore on post-synaptic GABA receptor to increase duration its open - increasing Cl- influx

Levetiracetam - Inhibits synaptic vesicle proteins, inhibiting Ca2+ induced synaptic release - may also inhibit Ca2+ channel function directly

Topiramate - may inhibit Na+ channels, augments GABA activity at GABAa receptors and acts antagonistically at AMPA/kainate receptors

27
Q

What non-pharmacological interventions are there to treat epilepsy?

A

Psychological interventions - relaxation, CBT - used to improve QOL - used in conjunction with AEDs

Ketogenic diet - for children/young people that don’t respond to AEDs - high fat, protein, low carb diet forcing body to burn fat instead of carbs producing ketones instead of glucose as energy

Vagus nerve stimulation - reduce seizure frequency

thinking and Doing (6 decks)

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