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

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

Flashcards in Anti-epileptics = HARD, lots of pure memory; SHARKS - help with patterning a bit :) Deck (48):
1

Describe: simple partial seizure

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

2

Describe: complex partial seizure

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

3

Describe: partial with secondarily generalized tonic-clonic seizure

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

4

~~Describe: generalizes seizure

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

5

Describe: petit mal

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

6

MOA fo seizures

decreased in INHIBITORY synpatic activity OR increased in exiciatory activity

7

concept: Principal of antiepileptic drugs

a) block vt ion channels b) modulate sympatic transmission

8

What type of ion channels would be beneficial to block?

vg Na channels vg T type Ca++ channels

9

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

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

10

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

phenobarbital valproate topiramate

11

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

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

12

Tx for Absence Seizures

Ethosiximide Valproate T type Ca++ inhibtion

13

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

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

14

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

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

15

List the drugs that act post synaptically to enhance GABA

a) benzodiazepines b) barbiturates c) topiramate

16

List the drugs that act pre synaptically to enhance GABA

tiaGAB(a)ine viGABAtrin

17

MOA Tiagabine

inhibits reuptake of GABA

18

MOA Vigabatrin

inhibts degradation fo GABA by inhibiting GABA aminotransferase

19

Postsynaptic reducers of Glutamate and MOA

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

20

Presynaptic reducers of glutamate and MOA

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

21

~*~MOA Levetiracetam

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

22

SHARK: list all the drugs that alter GABA transmission

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

23

SHARK: list all the drugs that alter GLUTAMATE transmssion

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

24

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

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

25

DOC @ absence seizures + SHARK: MOA

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

26

~*~DOC for absence seizures if tonic clonic present

valproate

27

~*~DOC for atypical absence seizures

valproate

28

What else is probably effective for absences seizures

lamotrigine PLCZ - inhibit vg Na

29

~*~ DOC for myoclonic seizures

valproate - inhibit T type Ca at thalamus

30

Other drugs you can use for myoclonic seizures

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

31

~*~DOC for atonic seizures

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

32

~*~ DOC for infantile spasms

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

33

~*~ DOC febrile convulsions SHARK - flash back!

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

34

Treatment regimine for status epilepticus

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

35

Treatment for drug induced seizures in nonepileptic patients

a) diazepam b) lorazepam c) phenobarbital

36

Treatment for breakthrough seizures

diazepam rectal gel ;) breakthrough haha. its late.

37

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

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

38

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

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

39

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

tonic clonics

40

SHARK: what seizures respond to corticosteroids/glucocorticoids

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

41

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

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

42

A/se mania + MOA of each: valproate

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

43

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

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

44

A/se + MOA carbamazepine

vg Na channel inhibitor P450 inducer aplastic anemia leukopenia rash

45

a/se + MOA vigabatin

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

46

SHARK: antiepileptics that can be used to treat neuropathic pain

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

47

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

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)

48

SHARK: migraine

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