Antiepileptic Drugs

Front 1

sezure classification

Back 1

partial - focally, from a single location within one hemisphere.
generalized - deeper subcortical midline structure and progects to both hemispheres.

Front 2

partial sezures:

Back 2

simple - minimal spread, normal consciousness and awareness.
complex - the discharge become more spread and almost always involves the limbic system, resulting in impaired conscious level.

Front 3

generalized seizures:

Back 3

Grand mal - tonic clonic - begins with a tonic phase of skeletal muscules rigidity (1 min) followed by a clonic phase (2-3 min) of massive jerking movements followed by loss of consciousness. the condition is presided by aura.
petit mal - absence seizure - by an abnormal Ca+ current of thalamic neurons. suddent onset. usually last for 10 sec and may occur up to 100 times a day. consciousness is alterd.

Front 4

Administration

Back 4

all orally, but phenytoin and clonazepam are given iv. all follow first order except phenytoin.

Front 5

drugs that inhibits voltage gated Na+ channels

Back 5

phenytoin
carbamazepine
lamotrigin
phenobarbital
valoproic acid
topiramat
they bind to inactivated channels and prolog the inactivation state.

Front 6

prolongation of the GABAergic inhibition

Back 6

Directly: benzodiazepines (increase frequency)
barbiturates (increase duration)
Indirectly: tiagabin - GABA reuptake inhibition
vigabatrin - GABA aminotransferase inhibitor
gabapentin - GABA a.a analoge

Front 7

inhibition of the glutamate

Back 7

Directly:
NMDA - remacerid
AMPA - phenobarbital
topiramat
Indirectly:
phenytoin
carbamazepine
lamotrigine
valporoic acid
felbamate

Front 8

inhibition of Ca+ current (T current)

Back 8

ethosuximide
dimethadione
useful against absence seizures

Front 9

drugs used for partial seizuers

Back 9

phenytoin
carbamazepine
barbiturates
lamotrigine
vigabatrin
gabapetrin
tiagabine

Front 10

drugs used for generalized absence seizuers

Back 10

ethosuximide
valproic acid
oxazolidinediones
lamotrigine

Front 11

phenytoin

Back 11

unpredictable pharmacokinetics due to the difference in its metabolism by the cyc p450.
בכמויות גדולות המראה שלו בדם עולה לא באופן פרופורציונלי לקצב האדמינסטרציה מאחר והכבד בסטורציה.
90% מהסם מובל בדם ע"י פרוטאינים ולכן יש לו אינטרקציה עם סמים אחרים.בנוסף הוא מעודד יצירת האינזים המפרק אותו ולכן סמים אחרים שמשתמשים באותו אינזים ע"מ להיתפרק יעובדו בצורה מהירה יותר ויהפכו ללא אקטיבים מוקדם יותר.
mechanism of action - Na+ channel inactivator + inhibits glutamate release.
side effects: nystagmus, diplpia, ataxia, megaloblastic anemia, gingival hyperplasia, teratogenic - palatine cleft

Front 12

carbamazepine

Back 12

tricyclic compaund was used for bipolar disorders and mania.
used for partial seizures. first choice for tonic clonic seizures.
induce micrisomal enzymes. have hulf life of 36 hu.
mechanism of action - block Na+ channels and decrease glutamate transmission.
side effects - increase the rate of elimination of pirimidone, phenytoin, ethosuximide, valproic acid.
bone marrow depression, diplopia, ataxia

Front 13

barbiturates

Back 13

sedative drugs, mostly used for infants.
phenobarbital - binds to an allosteric regulatory site on the GABA receptor and enhances the GABA receptor.
mephobarbital
methanbital
primidone - converted to phenobarbital, but acts like phenytoin.

Front 14

lamitrigine

Back 14

inactivator of Na+ channels + inhibits glutamate release
also used for petit mal due to its Ca+ current inhibition mostly in children.

Front 15

vigabatrin

Back 15

irreversible inhibitor of GABA aminotransferase (האנזים האחראי על פירוק ה"גבה")

Front 16

tiagabine

Back 16

inhibitor og GABA uptake