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Y2 LCRS Pharm HR > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

What is the prevalence of epilepsy in the UK?

A

7-9% of the population

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2
Q

Recall the 5 types of generalised seizure

A
  1. Tonic/clonic
  2. Absence
  3. Tonic/atonic
  4. Myoclonic
  5. Status epilepticus
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3
Q

Describe the presentation of a tonic/clonic seizure

A

Loss of consciousness, muscle stiffening, twitching + jerking –> deep sleep –> wake

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4
Q

What is the most common type of generalised seizure?

A

Tonic/clonic

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5
Q

Describe the presentation of an absence seizure

A

Brief staring episodes with behavioural arrest

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6
Q

Describe the presentation of a tonic/atonic seizure

A 
"Tonic" = sudden stiffening of muscles 
"Atonic" = loss of muscle control
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7
Q

Describe the presentation of a myoclonic seizure

A

Sudden, brief muscle contractions

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8
Q

How can tonic/atonic seizures and myoclonic seizures be differentiated

A

Presentations similar therefore use EEG

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9
Q

Describe the presentation of a status epilepticus

A

More than 5 mins of chronic seizure activity

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10
Q

What is a partial/ focal seizure?

A

Seizure that begins within a particular area of brain and may spread out

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11
Q

Recall the types of partial/ focal seizure

A

Retained awareness = simple

Impaired awareness = complex

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12
Q

Briefly summarise the transmission events at glutametergic synapses

A

VGSC and VGKC action –> AP
Glu stored in vesicle which is bound to presynaptic membrane via SV2A
Upon release, acts on excitatory receptors

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13
Q

Recall 3 approaches to inhibiting the excitatory effect of glutamate

A

Inhibit VGSCs
Inhibit VGCCs
inhibit SV2A docking protein

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14
Q

Give 2 examples of drugs that inihibit VGSCs in glutamatergic neurons

A

Carbamazepine

Lamotrigine

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15
Q

Recall the MOA of carbamazepine

A

Stabilises inactive state of VGSC

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16
Q

Recall 2 advantages and 2 disadvantages of carbamazepine use

A 
Advantages:
1. Fast onset
2. Long DOA
Disadvantages:
1. Low selectivity
2. Enzyme inducer --> many DDIs
17
Q

Recall the indications for carbamazepine

A

Tonic/clonic seizures and partial/focal seizures

18
Q

What are the side effects associated with carbamazepine in individuals with a certain HLA haplotype, and what is this HLA allele?

A

HLA-B*1502
Severe skin conditions
Stephen Johnson syndrome
Toxic epidermal necrolysis

19
Q

Recall the MOA of lamotrigine

A

Pushes VGSCs into the inactive state

20
Q

Suggest an advantage of lamotrigine over carbamazepine as an anticonvulsant

A

Lamotrigine has higher specificity for Glu neurons

21
Q

Recall the indications for lamotrigine

A

Tonic/clonic seizures and absence seizures

22
Q

Recall an anticonvulsant that acts by inhibiting Glu vesicle docking

A

Levetiracetam

23
Q

Recall the MOA of levetirecetam

A

Binds SV2A to prevent Glu release

24
Q

Recall the MOA of topiramate

A

Inhibits NMDA and kainate Glu receptors

25
Q

Recall the indications for topiramate

A

Myoclonic seizures

26
Q

Recall the general PK of anticonvulsant drugs

A

Fast onset and long t1/2

27
Q

Recall 2 anticonvulsant drugs that work by interacting with GABA transmission

A

Diazepam

Sodium valproate

28
Q

What is the MOA of valproate?

A

Inhibits GABA-T to increase synaptic GABA levels

29
Q

How is diazepam usually administered in a seizure?

A

Rectal gel

30
Q

Recall the indications for diazepam

A

Status epilepticus

31
Q

Recall the indications for valproate

A

All forms of epilepsy apart from SE

32
Q

Recall the drugs that are indicated for tonic/clonic seizure treatment

A

Carbamazepine
Lamotrigine
valproate

33
Q

Recall the drugs that are indicated for absence seizure treatment

A

Ethosuximide
Lamotrigine
valproate

34
Q

Recall an anticonvulsant that acts via VGCC interference

A

Ethosuximide

35
Q

What type of VGCC are found in the CNS?

A

T-type (transient)

36
Q

Recall the indications for ethosuximide

A

ONLY absence seizures

37
Q

Recall the drugs that are indicated for tonic/atonic seizure treatment

A

valproate

38
Q

Recall the drugs that are indicated for myoclonic seizure treatment

A

Levetiracetam
Topiramate
valproate

39
Q

Recall the drugs that are indicated for simple partial seizure treatment

A

valproate
Carbamazepine
Lamotrigine
Levetiracetam

Y2 LCRS Pharm HR (31 decks)

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