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Year II Pharmacology > Anti-epilectic Drugs (NEURO) > Flashcards

Anti-epilectic Drugs (NEURO) Flashcards

1
Q

Name 4 mechanisms for anti-epi drugs involving channels

A

Antagonists: Na, Ca and Glu
Agonist: GABA

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2
Q

Name 5 Na channel blockers

A
  • Phenytoin
  • Carbamazepine
  • Valproate
  • Topiramate
  • Lamotrigine
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3
Q

Name the only Ca blocker and its use

A

Ethosuximade

Petit male seizure

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4
Q

Name 1 GABA agonist antiepleptic

A

• Topiramate

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5
Q

Name 2 glutamate antagonists

A
  • Lamotrigine

* Topiramate

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6
Q

What 2 clearance systems are used by the liver to clear anti-epileptic drugs

A

CYP45

UDP-Glucuronosyltransferase (UGT)

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7
Q

Which anti-epeileptic is neither an CYP45 enzyme inducer nor inhibitor

A

Levetiracetam

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8
Q

Name 3 CYP45 enzyme inducers that are antiepleptics

A
  • Phenobarbital
  • Ethosuximide
  • Phenytoin
  • Carbamazepine
  • Tobacco, cigarettes
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9
Q

Name 1 CYP45 enzyme inhibitors that is an antiepleptic

A
  • Erythromycin
  • Ca channel blockers
  • Trimethoprim/sulfa
  • Fluconazole
  • Valproate
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10
Q

Between pregnant women, pediatric patient and the elder, which one receives a higher dose of anti-epileptic medications? The rest receive?

A

Pregnant - higher dose

Kids + elderly - lower dose

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11
Q

Which 2 drugs are not CNS depressants

A

phenytoin and lamotrigine

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12
Q

Which drugs are associated with polycystic ovaries

Which drug should be used instead

A

VPA, CBZ

Use LTG instead

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13
Q

Which 3 drugs are associated with osteoporsis

A

o Phenobarbital, phenytoin and carbamazepine

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14
Q

Anti-E Drugs associated with birth defect

What should you use instead

A

o Valproate is bad

o Carbamazepine safer than phenytoin and phenobarbital

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15
Q 
Phenobarbital
Class
Use
Metabolism
Toxicity
A

Class
GABA agonist

Use
Everything but absence seizure
PO or Oral

Metabolism
Long half life so loaded
CYP450 inducers

Toxicity
Children - Hyperactivity
Adult - Sedative
Joint problems
Osteoporosis
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16
Q 
Phenytoin
Class
Use
Metabolism
Toxicity
A

Class
Na channel blocker

Use
Everything but absence
IV or PO (PO not for children)

Metabolism
Hepatic
Inducer
0 order kinetics

Toxicity
Narrow therapeutic index
Vitamin depletion
Osteoporosis

Gum hyperplasia

17
Q 
Ethosuximide
Class
Use
Metabolism
Toxicity
A

Class
Ca channel blocker (T-type)

Use
Absense seizure

Use
Only oral

Metabolism
GI absorbtion
Hepatic inducer

Toxicity
Well tolerated, behavioral changes, Gi distress, sedation

18
Q 
Benzodiazepines (diazepam or lorazepam)
Class
Use
Metabolism
Toxicity
A

Status, explicit us, muscle relaxation, anterograde amnesia

Class
GABA agonist

Use
All seizure types

Metabolism
Hepatic
PO or IV

Toxicity
Sedation, depression, withdrawal seizures

Alpha 2 anxiolytic
Alpha 1 sleep and amnesia and addiction and muscle

19
Q 
Carbamazepine
Class
Use
Metabolism
Toxicity
A

Class
Na channel blocker

Use
Focal or 2ndarly generalized seizures

Metabolism
Only oral preparation
Hepatic
Levels increased by Ca channel blockers and macrlide antibiotics

Toxicity
Neutropenia
Weight gain blurred vision, sedation

20
Q 
Valproic Acid
Class
Use
Metabolism
Toxicity
A

Class
Na, Ca antagonists
GABA and K agonists

Use
All seizure types

Metabolism
Hepatic
Not an inducer

Toxicity
Hepatic encephalopathy without elevated enzymes but elevated ammonia or carnatine deficiency 
Birth defects
Menstrual changes
Hair loss
Low platelet count
21
Q 
Gabapentin
Class
Use
Metabolism
Toxicity
A 
Class
Increase GABA (unknown why)

Use
Focal and 2ndary generalized seizure

Metabolism
PO
Excreted unchanged

Toxicity
Sedation 
GI distress
Pedal edema
O
22
Q 
Lamotrigine
Class
Use
Metabolism
Toxicity
A

Class
Na channel block

Use
All seizure types
Bipolar
Neuropathic pain

Metabolism
PO
Hepatic

Toxicity
Allergy
Rash
Insomnia

Sbm

23
Q 
Topiramate (Topamax)
Class
Use
Metabolism
Toxicity
A

Class
Na blocker, GABA agonist and glutamate antagonist

Use
All seizures but absense

Metabolism
Renal (mostly) & hepatic

Toxicity
Sedation, weight loss, aphasia, parathsias & kidney stones

24
Q 
Levetiracetam (Keppra)
Class
Use
Metabolism
Toxicity
A

Class
Ca channel blockers

Use
Generalized & focal

Metabolism
Renal unchanged

Toxicity
Cognitive & behavioral problems

25
Q

Generalized seizure drugs for general pop and for child-bearing women

A

General population
- Valporate

Pregnant women
- Lamotrigine and levetiracetam

26
Q

Focal seizure drugs for general pop and for child-bearing women

A

General population
- Carbamezapine
Gabapentine

Pregnant women
- Lamotrigine and levetiracetam

27
Q

Absence seizures

A

Ethosuximide

28
Q

In general as a patient “fails” more and more anti-E drugs it less likely

A

that you will find one that is effective

29
Q

Which anti-E drug has 0 order kinetics and is poorly absorbed orally in children

A

Phenytoin

30
Q

Which anti-E drug has to be loaded because of a long half life

A

phenobarbital

31
Q

Drug that is only effective against absence seizures

A

Ethosuximide

32
Q

Which anti-E drug has risk of withdrawal seizures

A

Benzodiazepines

33
Q

Which anti-E drug is not a benzodizapine despite its name

A

Carbamazepine

34
Q

Which anti-E drug’s levels increase in the presence of Ca blocker or macrolide antibiotic

A

Carbamazepine

35
Q

Which anti-E drug causes weight gain and blurred vission

A

Carbamazepine

36
Q

2 anti-E drugs that are also good for bipolar disorder , neuropathic pain i.e. trigeminal neurolgia

A

Carbamazepine
Lamotrigine
Gabapentin

37
Q

Which anti-E drug has pedal edema as a side effect

A

Gabapentin

Year II Pharmacology (14 decks)

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