Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
What are the original six anti-epileptic drugs?
|
1. Phenobarbital
2. Phenytoin 3. Ethosuximide 4. Diazepam 5. Carbamazepine 6. Valproate |
|
|
What do we know now about the basic targeting of the anti-epileptic drugs?
|
Targets neurotransmitters to slow excitatory glutamate transmission or enhance the inhibitory (GABA) transmissions
|
|
|
2 main problems with phenobarbital?
|
Besides sedation
1. Respiratory depression 2. Abuse and addiction potential |
|
|
What is the main difference between Phenytoin vs. Phenobarbital?
|
phenytoin inhibits excitation whereas Phenobarbital enhances inhibition
|
|
|
Which drugs antagonize voltage gated Na channels?
|
PHT, CBZ, VAL
|
|
|
Explain in detail the mechanism of phenytoin and carbamazepine...
|
antagonists of voltage-dependent Na channels which blocks depolarization and vesicle fusion and release
|
|
|
Phenytoin & carbamazepine uses
|
Primiary drug carbamazepine for treatment of epilepsy except absence seizures
- more tolerability and efficacy is better with Carbamazepine |
|
|
Complications with phenytoin
|
zero order pharmacokinetics- yet does adjustment is difficult
Also... 1. CYP 450 enzymes 2. GINGIVAL HYPERPLASIA 3. HIRSUTISM 4. HYPOCALCEMIA 5. OSTEOPOROSIS |
|
|
Complications with carbamazepine
|
1. CYP 450 enzymes
2. LEUKOPENIA 3. NEUTROPENIA 4. THROMBOCYTOPENIA (INFECTIONS, BRUISING) - very narrow therapeutic window which leads to loss of efficacy and induction of seizures |
|
|
Starting carbamazepine needs to be careful for women on what drug and why?
|
Women on Oral Contraceptives are cleared faster thus 4x increase risk of pregnancy
|
|
|
Pt. has heart attack and then was put on anti-coag what problem does carbamazepine do?
|
increases clearance of warfarin and causes rapid coagulation
Also increases clearance of statins |
|
|
What causes typical absence seizures?
Drugs to treat it? |
disruption of T-type Ca ion channels
- Ethosuxmide and Valproate |
|
|
Complications with Valproate?
|
weight gain
hepatotoxicity |
|
|
Status epilepticus what is DOC?
What if seizure does not stop? |
use benzodiazapam to stop seizure/eeg bursts by GABA-ergic agents that increase inhibition
- Lorazepam/diazepam - if seizure does not stop use fosphenytoin |
|
|
MOA for BZD (benzodiazepines)
|
bind to distinct site which potentiates GABA binding and opens Cl channels
|
|
|
List the new AEDs
|
Gabapentin
Lamotrigine Topiramate Tiagabine Oxcarbazepine Levetiracetam Zonisamide Pregabalin |
|
|
Two broadspectrum agents
|
Topirimate
Valproic acid |
|
|
Topiramate MOA
|
receptor antagonist of glutamate
also a GABAa receptor agonist |
|
|
MOA of tiagabine
MOA of valproate |
- inhibits GABA re-uptake
- Valproate inhibits GABA metabolism |
|
|
Which drugs inhibit conjugation of drugs by UGT enzymes?
|
valproate and lamotrigine- causing accumulation of parent drug
|
|
|
Black box warning are in what two drugs?
|
CArbamazepine- Life-threatening
• Allergic reaction (Stevens-Johnson syndrome) • Aplastic anemia LAmotrigine- allergy (steven Johnson syndrome) |
|
|
Which drug is associated with major congenital malformations
|
Valproic acid
1. spina bifida 2. Atrial septal defect |
