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Y2 LCRS Pharm HR COPY > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
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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2
Q

Describe the presentation of a tonic/clonic seizure

A

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

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3
Q

What is the most common type of generalised seizure?

A

Tonic/clonic

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4
Q

Describe the presentation of an absence seizure

A

Brief staring episodes with behavioural arrest

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5
Q

Describe the presentation of a tonic/atonic seizure

A

“Tonic” = sudden stiffening of muscles “Atonic” = loss of muscle control

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6
Q

Describe the presentation of a myoclonic seizure

A

Sudden, brief muscle contractions

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7
Q

How can tonic/atonic seizures and myoclonic seizures be differentiated

A

Presentations similar therefore use EEG

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8
Q

Describe the presentation of a status epilepticus

A

More than 5 mins of chronic seizure activity

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9
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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10
Q

Recall the types of partial/ focal seizure

A

Retained awareness = simple Impaired awareness = complex

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11
Q

Briefly summarise the transmission events at glutaminergic synapses

A

Neurotransmission

  1. Voltage-gated Na+ channel (VGSC) opens ® membrane depolarisation
  2. Voltage-gated K+ channel (VGKC) opens ® membrane repolarisation
  3. Ca2+ influx through voltage-gated calcium channels (VGCCs) ® vesicle exocytosis
    a) Synaptic vesicle associated (SV2A) protein allows vesicle attachment to presynaptic membrane
  4. Glutamate activates excitatory post-synaptic receptors (e.g. NMDA, AMPA & kainate receptors)
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12
Q

Recall 3 approaches to inhibiting the excitatory effect of GABA

A

Inhibit VGSCs Inhibit VGCCs inhibit SV2A docking protein

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13
Q

Give 2 examples of drugs that inihibit VGSCs in glutaminerguc neurons

A

Carbamazepine Lamotrigine

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14
Q

Recall the MOA of carbamazepine

A

Stabilises inactive state of VGSC, reducing neuronal activity

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15
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

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16
Q

Recall the indications for carbamazepine

A

Tonic/clonic seizures and partial/focal seizures

17
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

18
Q

Recall the MOA of lamotrigine

A

•Inactivates Na+ channels ® reducing glutamate neuronal activity

19
Q

Suggest an advantage of lamotrigine over carbamazepine as an anticonvulsant

A

Lamotrigine has higher specificity for Glu neurons

20
Q

Recall the indications for lamotrigine

A

Tonic/clonic seizures and absence seizures

21
Q

Recall an anticonvulsant that acts by inhibiting Glu vesicle docking

A

Levetiracetam

22
Q

Recall the MOA of levetirecetam

A

Binds SV2A to prevent Glu release

23
Q

Recall the MOA of topiramate

A

Inhibits NMDA and kainate Glu receptors

24
Q

Recall the indications for topiramate

A

Myoclonic seizures

25
Q

Recall the general PK of anticonvulsant drugs

A

Fast onset and long t1/2

26
Q

Recall 2 anticonvulsant drugs that work by interacting with GABA transmission

A

Diazepam Sodium valporate

27
Q

What is the MOA of valporate?

A

Inhibits GAT to increase synaptic GABA levels

28
Q

How is diazepam usually administered in a seizure?

A

Rectal gel

29
Q

Recall the indications for diazepam

A

Status epilepticus

30
Q

Recall the indications for valporate

A

All forms of epilepsy apart from SE

31
Q

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

A

Carbamazepine Lamotrigine Valporate

32
Q

Recall the drugs that are indicated for absence seizure treatment

A

Ethosuximide Lamotrigine Valporate

33
Q

Recall an anticonvulsant that acts via VGCC interference

A

Ethosuximide

34
Q

What type of VGCC are found in the CNS?

A

T-type (transient)

35
Q

Recall the indications for ethosuximide

A

ONLY absence seizures

36
Q

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

A

Valporate

37
Q

Recall the drugs that are indicated for myoclonic seizure treatment

A

Levetiracetam Topiramate Valporate

38
Q

Recall the drugs that are indicated for simple partial seizure treatment

A

Valporate Carbamazepine Lamotrigine Levetiracetam

Y2 LCRS Pharm HR COPY (31 decks)

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