lecture 10

Question 1

65% of epileptic cases are cause by what?

Answer 1

idiopathic/cryptogenic

Question 2

some of the people at risk for epilepsy?

Answer 2

mental retardation, cerebral palsy, autism and storke

Question 3

epileptic patients are at risk for what in the mouth because of their medications?

Answer 3

gingival hyperplasia

Question 4

what shrinks in the brain of people who have epilepsy?

Answer 4

hippocampus and temporal lobe

Question 5

if patient has seizure, what should you be sure to pay attention to?

Answer 5

when it started, anything longer than 3 minutes may cause brain damage

Question 6

what can be used if pt has seizure?

Answer 6

midazolum

Question 7

1/3 of known genes linked to epilepsy encode what ?

Answer 7

ion channels

Question 8

class 1 drugs for epilepsy do what?

Answer 8

increase GABA transmission

Question 9

GABAa receptors mediate mostly what?

Answer 9

fast synaptic inhibition

Question 10

phenobarb, benzos, and topiramate all act at what level?

Answer 10

GABAa receptor postsynaptic

Question 11

tiagabine work where

Answer 11

GABA transporter

Question 12

vigabatrin and valproate work where?

Answer 12

GABA breakdown

Question 13

what does vigabatrin do?

Answer 13

inhibits GABA-transaminase which breaks down GABA. works to increase amount of GABA.

Question 14

what is the drug of choice for myoclonic seizures? (juvenile)

Answer 14

valproate

Question 15

explain valproate

Answer 15

reversible gaba T inhibitor by inhibiting histone deacetylase. metabolism through glucuronide, associated with hepatic toxicity

Question 16

explain tiagabine

Answer 16

GABA reuptake inhibitor, metabolism through P450 (important to be carful on cocktail of drugs). common side effects: confusion, difficulty speaking, mild sedation

Question 17

topiramate is structurally related to what?

Answer 17

fructose

Question 18

explain topiramate

Answer 18

GABAa receptor positive modulator, and inhibits neurotransmission through kainite and AMPA receptors. metabolism 30% liver and rest secreted unchanged

Question 19

class 2 drugs for epilepsy do what?

Answer 19

slow rate of recovery of sodium channels from inactivation

Question 20

what is the most widely used anti seizure agents?

Answer 20

class 2, phenytoin and carbamazepine to slow rate of recovery of sodium channels

Question 21

phenytoin and carbamazepine only used for what kind of seizures?

Answer 21

partial and tonic clonic generalized

Question 22

important side effects of phenytoin

Answer 22

gingival hyperplasia mostly in children. may affect bone support of teeth and tooth position. xerostomai, postoperative bleeding

Question 23

carbamazepine should not be taken with what?

Answer 23

pain relievers and erythromycin

Question 24

explain some things about oxcarbazepine.

Answer 24

slow rate of sodium channel recovery. also used in treatment of bipolar disorder.

Question 25

Lamaotrigine can cause what

Answer 25

steves johnson syndrom-rash

Question 26

class 3 drugs for epilepsy do what?

Answer 26

reduce calcium flow through t-type calcium channels

Question 27

t-type calcium channels play important role in burst firing of action potentials where?

Answer 27

thalmus

Question 28

valproate does what 3 things?

Answer 28

GABA transaminase inhibitor, inhibits t-type calcium channels, inhibits histone deacetylase

Question 29

valproate is secondary choice for what kind of seizures?

Answer 29

absence

Question 30

explain ethosuximide

Answer 30

t-type calcium channel blocker. lacks hepatotoxicity of valproic acid. 80% metabolism is hepatic. syrup form

Question 31

gabapentin major use to relieve what

Answer 31

neuropathic pain

Question 32

gabapentin made to mimic what? how does it work?

Answer 32

mimic structure of GABA, doesn't work on GABAa receptor. works by inhibition of voltage gated calcium channels

Question 33

best drug for partial seizure?

Answer 33

lamotrigine, carbamazepie, pheyntoin

Question 34

best drug for tonic clonic

Answer 34

valproate

Question 35

best drug for absence seizure

Answer 35

ethosuximide

Question 36

diazepam and lorazepam are what

Answer 36

positive modulators of gab a receptor

Question 37

vigabatrin involved in what

Answer 37

gabaeric transmission

Question 38

problem with anti convulsive drugs

Answer 38

p450 interactions