Anti-epileptics = HARD, lots of pure memory; SHARKS - help with patterning a bit :)

Question 1

Describe: simple partial seizure

Answer 1

no loss of consciousness - SIMPLE partial - singal limb/muscle group invovled (ie can localize in brain) = FOCAL

Question 2

Describe: complex partial seizure

Answer 2

loss of consciousness = complex motor dysfucntion - chewing, movements, diarrhoea, urination

Question 3

Describe: partial with secondarily generalized tonic-clonic seizure

Answer 3

partial seizure (focal) evolved to a tonic-clonic seizure with loss of consciousness

Question 4

~~Describe: generalizes seizure

Answer 4

no evidence of localization convlusive or not **immediate loss of consciousness

Question 5

Describe: petit mal

Answer 5

aka Absence seizure brief, abrupt, self limiting loss of consciousness patient stares and exhibits rapid eye blinking **3 hz for a few seconds and the stops

Question 6

MOA fo seizures

Answer 6

decreased in INHIBITORY synpatic activity OR increased in exiciatory activity

Question 7

concept: Principal of antiepileptic drugs

Answer 7

a) block vt ion channels b) modulate sympatic transmission

Question 8

What type of ion channels would be beneficial to block?

Answer 8

vg Na channels vg T type Ca++ channels

Question 9

Please list the drugs that inhibit vg Na+ channels @ principal mechanism SHARK: flashbacks!

Answer 9

PLCZ (places) P: phenytoin (diabetes lecture flash back can cause hyperglycemia with clonidin and CCB) L: lamotrigine C: carbamazepine (flashback: bipolar treatment second option if lithium is no good) Z: zonisamide

Question 10

Please list the drugs that have blocking vg Na channels as a ‘‘contribution to the effects of’’

Answer 10

phenobarbital valproate topiramate

Question 11

concept: What role does the T type Ca++ channel have in seizures

Answer 11

governs oscillatory response in thalamic neurons - ie absence seizures that invovled oscillatory neuronal activity betwen thalamus and cortex

Question 12

Tx for Absence Seizures

Answer 12

Ethosiximide Valproate T type Ca++ inhibtion

Question 13

List T type Ca++ blockers SHARK: flash back!

Answer 13

Ethosiximide Valproate (also used for bipolar if lithium sucks with carbamezapine)

Question 14

Pharmacologically, how can you decrease synaptic transmission. times two ways

Answer 14

1) give em a drug that increases GABA 2) give em a durg that decreases glutamate = decreased synaptic transmission

Question 15

List the drugs that act post synaptically to enhance GABA

Answer 15

a) benzodiazepines b) barbiturates c) topiramate

Question 16

List the drugs that act pre synaptically to enhance GABA

Answer 16

tiaGAB(a)ine viGABAtrin

Question 17

MOA Tiagabine

Answer 17

inhibits reuptake of GABA

Question 18

MOA Vigabatrin

Answer 18

inhibts degradation fo GABA by inhibiting GABA aminotransferase

Question 19

Postsynaptic reducers of Glutamate and MOA

Answer 19

phenobarbitol topiramate ;) also inhibit Na vg channels ie the glutamate receptor apparently

Question 20

Presynaptic reducers of glutamate and MOA

Answer 20

gabapentin pregabalin block presynaptic vg Ca AND Levetiracetam - binds synaptic vescile glycoprotein 2A

Question 21

~*~MOA Levetiracetam

Answer 21

binds to synaptic vesicle glycoprtoein 2a ie SV2A - may alter glutamate and gaba

Question 22

SHARK: list all the drugs that alter GABA transmission

Answer 22

pre: tiaGAB(a)ine (prevents reuptake), viGABAtrine (inhibits degradation via stopping GABA aminotransferase), levitracetam (inhibits SV2a on vesicles) post: topiramate, barbituates, benzodiazepines WANT TO INCREASE bc seizures are spazzes

Question 23

SHARK: list all the drugs that alter GLUTAMATE transmssion

Answer 23

pre: ganapentin (inhibits vgCa), pregablin AND levetiracetam (inhibits SV2a) post: phenobarbital, topiramate WANT TO DECREASE bc seizures are spazzes

Question 24

~*~DOC @ tonic-clonic seizures + SHARK: their MOA

Answer 24

carbamazepine - inhibit vg Na PLCZ oxcarbazepine - inhibit vg Na valproate - inhibit vg Na most likely lamotrigine - inhibit vg Na PLCZ phenytoin - inhibit vg Na PLCZ topiramte - inhibit vg most likely

Question 25

DOC @ absence seizures + SHARK: MOA

Answer 25

ethosuximide and valproate - inhibit T type Ca @ thalamus to prevent osciltation between it and the cortex

Question 26

~\*~DOC for absence seizures if tonic clonic present

Answer 26

valproate

Question 27

~\*~DOC for atypical absence seizures

Answer 27

valproate

Question 28

What else is probably effective for absences seizures

Answer 28

lamotrigine PLCZ - inhibit vg Na

Question 29

~\*~ DOC for myoclonic seizures

Answer 29

valproate - inhibit T type Ca at thalamus

Question 30

Other drugs you can use for myoclonic seizures

Answer 30

topiramate - enhances post synaptic GABA levetiracetam - as adjunct - SV2a vesicle release

Question 31

~\*~DOC for atonic seizures

Answer 31

jk, usually refractory... OR valproate - t type Ca channel AN lamotrigine PLCZ - vg Na channels

Question 32

~\*~ DOC for infantile spasms

Answer 32

corticotropin/glucocorticoids vigabatrin - inhibits GABA aminotransferase ie enhances GABA presynaptic

Question 33

~\*~ DOC febrile convulsions SHARK - flash back!

Answer 33

if lasts more than 15 mins - diazepan IV or rectal solution (benzopine; long acting) diazepam also used for alcohol withdrawl with the benzo that starts wtih an o AND for status epilepticus with the benzo that starts wtih an L

Question 34

Treatment regimine for status epilepticus

Answer 34

IV lorazepam (intermediate benzo) --\> IV phenytoin (vg Na channel blocker) --\> IV phenobarbitaol (partially vg Na channel blocker) --\> general anesthetia with IV midazolam, propofol or barbiturates

Question 35

Treatment for drug induced seizures in nonepileptic patients

Answer 35

a) diazepam b) lorazepam c) phenobarbital

Question 36

Treatment for breakthrough seizures

Answer 36

diazepam rectal gel ;) breakthrough haha. its late.

Question 37

~\*~SHARK: what seizures can you treat with valproate

Answer 37

absent seizures wtih tonic clonic atypical absent seizures absent seizures (with ethosiximide) myoclonic atonic VALPROATE = ABSENT ANYTHINGS nad muscle-y

Question 38

~\*~SHARK: what seizures can you treat with diazepam

Answer 38

febrile convulsions drug induced seizures breakthrough seizures IE caused by external stuff, not just hte brain being a spazz

Question 39

~\*~SHARK: what seizures respond to vg Na inhibitors

Answer 39

tonic clonics

Question 40

SHARK: what seizures respond to corticosteroids/glucocorticoids

Answer 40

infantile spams --\> then vigabatrin (GABA aminotransferase inhibitor)

Question 41

A/se mania + MOA of each: inducers of P450 VRS inhibtors of P450

Answer 41

inducers - phenytoin, phenobarbital, carbamazepine = vg Na inhibitors inhibitors - valproate - T type Ca channel inhibotr

Question 42

A/se mania + MOA of each: valproate

Answer 42

highest teratogenecity - fetal malformations hepatotoxicity a) inhibits P450 b) inhibits its own metabolism c) inhibits metabolsim of other drugs = drugs building up everywhere, liver cnat handle it - toxivity inhibits T type Ca channcels

Question 43

A/se mania + MOA pheytoin ~\*~\*~\*~

Answer 43

vg Na inhibitor \* induces P450 \* diplopia \* ataxia ~\*\* GINGIVAL HYPERPLASIA \* coarsening of facial features \* hirsutism ZERO ORDER KINETICS (pea from first aid)

Question 44

A/se + MOA carbamazepine

Answer 44

vg Na channel inhibitor P450 inducer aplastic anemia leukopenia rash

Question 45

a/se + MOA vigabatin

Answer 45

inhibits GABA aminotrasnferase - presynatpic enhancement vision loss (v for vigabatin and vision loss)

Question 46

SHARK: antiepileptics that can be used to treat neuropathic pain

Answer 46

carbamazepine (causes blood s/e) gabapentin (inhibit presynaptic vg Ca) pregbalin (same zees)

Question 47

SHARK: antiepileptics that can be used to treat bipolar disorder when Lithium sucks out

Answer 47

carbamazepine (Causes blod s/e and rahs, and induces P450) lamotrigine (vg Na inhibitor - tx tonic clonics) valproate (absent seizures, myoclonic and atonic seizure treatment + fetal abnormalities, hepatotoxicity = P450 inhibition, inhibits its own and other drug metabolsim)

Question 48

SHARK: migraine

Answer 48

topiramoate (post synaptic Glutamate receptor/Na inhibitor) valproate (hepatotoxicity, P450 inhibit, self and other durg inhibi)