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pharm > anticonvulsants > Flashcards

anticonvulsants Flashcards

1
Q

What is the primary mechanism of action of lamotrigine?

A
  • Blocks voltage gated Na+ channels preventing Na+ influx
  • Prevents depolarisation of glutamatergic neurones and reduces glutamate excitotoxicity
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2
Q

What is the drug target of lamotrigine?

A

Voltage gated Na+ channels

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3
Q

What are the main common side effects of lamotrigine?

A
  • Rash
  • Drowsiness
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4
Q

What are the less common but serious side effects of lamotrigine?

A
  • Steven-Johnson’s syndrome
  • Suicidal thoughts
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5
Q

Why is lamotrigine introduced gradually?

A

Introduction of lamotrigine is gradual to reduce frequency and severity of allergic skin reactions

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6
Q

What is the primary mechanism of action of sodium valproate?

A
  • Inhibition of GABA transaminase prevents breakdown of GABA
  • Increases GABA conc directly in synapse presynaptically
  • Also indirectly prolongs GABA in synapse since extraneuronal GABA metabolism is slowed which also slows GABA removal from synapse
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7
Q

What is the drug target of sodium valproate?

A

GABA transaminase

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8
Q

What are the main common side effects of sodium valproate?

A
  • Diarrhoea
  • Drowsiness
  • Weight gain
  • Hair loss
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9
Q

What are the main serious side effects of sodium valproate?

A
  • Hepatotoxicity
  • Teratogenicity
  • Pancreatitis
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10
Q

What else does sodium valproate act as?

A

It’s a broad CYP enzyme inhibitor: increases serum concentration of many co-administered drugs

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11
Q

What is the primary mechanism of action of diazepam?

A
  • Increases Cl- influx in response to GABA binding at GABA A receptor
  • This hyperpolarises the excitatory neurones
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12
Q

What is the drug target of diazepam?

A

Benzodiazepine site on GABA A receptor

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13
Q

What are the main common side effects of diazepam?

A
  • Drowsiness
  • Respiratory depression (if IV or at high dose)
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14
Q

What are uncommon but serious side effects of diazepam?

A
  • Haemolytic anaemia
  • Jaundice
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15
Q

Why is diazepam not used long term for suppression of seizures?

A

Tolerance develops, and it is also an addictive drug

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16
Q

What is the primary mechanism of action of levetiracetam?

A
  • Inhibition of synaptic vesicle protein SV2A
  • This prevents vesicle exocytosis
  • Reduces glutamate secretion and therefore glutamate excitotoxicity
17
Q

What is the drug target of levetiracetam?

A

Synaptic vesicle protein SV2A

18
Q

What are the main side effects of levetiracetam?

A
  • Somnolence (drowsiness)
  • Dizziness
  • Fatigue
  • Headache
19
Q

What makes levetiracetam favourable in terms of drug-drug interactions?

A

Levetiracetam has no effect on cytochrome P459 enzyme system

20
Q

What is the first line treatment for absence seizures from boys/men/women with no child-bearing potential?

A

Ethosuximide or sodium valproate

21
Q

What is the first line treatment for absence seizures from girls/women with child bearing potential?

A

Ethosuximide

22
Q

What is the adjunctive treatment for absence seizures from boys/men/women with no child-bearing potential?

A

Combine 2 of ethosuximide, sodium valproate or lamotrigine

23
Q

What is the adjunctive line treatment for absence seizures from girls and women with child-bearing potential?

A

Combine 2 of ethosuximide and lamotrigine

24
Q

What is the first line treatment for focal seizures from boys/men/women with no child-bearing potential?

A

Carbamazepine or lamotrigine

25
Q

What is the first line treatment for focal seizures from girls/women with child-bearing potential?

A

Carbamazepine or levetiracetam

26
Q

What is the adjunctive treatment for focal seizures from boys/men/women with no child-bearing potential?

A

Any

27
Q

What is the adjunctive treatment for focal seizures from girls/women with child-bearing potential?

A

Any (not sodium valproate)

28
Q

What is the first line treatment for general tonic-clonic seizures from boys/men/women with no child-bearing potential?

A

Sodium valproate

29
Q

What is the first line treatment for general tonic-clonic seizures from boys/men/women with no child-bearing potential?

A

Lamotrigine (or carbamazepine)

30
Q

What is the adjunctive treatment for general tonic-clonic seizures from boys/men/women with no child-bearing potential?

A

Combine 2 of sodium valproate, levetiracetam or topiramate

31
Q

What is the adjunctive line treatment for general tonic-clonic seizures from girls/women with child-bearing potential?

A

Combine levetiracetam and topiramate

32
Q

What is the first line treatment for myoclonic seizures from boys/men/women with no child-bearing potential?

A

Sodium valproate

33
Q

What is the first line treatment for myoclonic seizures from girls/women with child-bearing potential?

A

Levetiracetam or topiramate

34
Q

What is the adjunctive treatment for myoclonic seizures from boys/men/women with no child-bearing potential?

A

Clobazam, lamotrigine, levetiracetam or topirimate

35
Q

What is the first line treatment for myoclonic seizures from girls/women with child-bearing potential?

A

Levetiracetam or topiramate

36
Q

What is the first line treatment for tonic or atonic seizures from boys/men/women with no child-bearing potential?

A

Sodium valproate

37
Q

What is the first line treatment for tonic or atonic seizures from girls/women with child-bearing potential?

A

Sodium valproate (pregnancy prevention programme)

38
Q

What is the adjunctive treatment for tonic or atonic seizures from boys/men/women with no child-bearing potential?

A

Lamotrigine

39
Q

What is the adjunctive treatment for tonic or atonic seizures from girls/women with child-bearing potential?

A

Lamotrigine

pharm (10 decks)

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