Pharm - Neuro - Aeds

Front 1

Which kinds are easier to treat?

Back 1

Generalized (vs. focal/partial)

Front 2

Valproate

Back 2

Best for generalized epilepsy.
Blocks Na+ channels and increases endogenous GABA in brain.
BEST FOR IDIOPATHIC GENERALIZED EPILEPSY.
SE: weight gain, hair loss, neural tube defects.

Front 3

Generalized epilepsy

Back 3

Use valproate first
Can also try ethosuximide (petite mal), lamotrigine, topiramate, levetiracetam

Front 4

Focal epilepsy

Back 4

Tx with carbamazepine first, or phenytoin.

Front 5

secondary generalized seizures

Back 5

Carbamazepine and valproate are = effective.

Front 6

Phenobarbital

Back 6

Binds GABA-A to increase Cl- transport.

(note - this is at a different site than benzodiazepines--e.g. Valium)

Front 7

Phenytoin (Dilantin)

Back 7

Blocks Na+ channels.
SE: Gingival hyperplasia, hirsutism, coarsened features, osteoporosis.

Front 8

Ethosuximide (Zarontin)

Back 8

Only for pure absence sz.

Inhib T-type Ca++ channels.

Front 9

Carbamazepine (Tegretol)

Back 9

Blocks Na+ channels.
This is the best drug for complex partial and secondary generalized.
SE: sedation, BM suppression, hyponatremia.

Structurally similar to tricyclics.

Induces it's own metabolism (P450)

Front 10

Gabapentin (Neurontin)

Back 10

A NEW AED

Actually doesn't bing GABA-R. Unclear mechanism.

Main advantage is renal secretion without metabolism. No interactions so it is easy to load (add on for tx of refractory epilepsy)

Front 11

Advantages of new AEDs

Back 11

More benign SEs, don't stimulate P450s.

Front 12

Drugs that DO stimulate P450s

Back 12

Phenytoin(Dilantin), Carbamazepine (tegretol), barbituates

Front 13

Lamotrigine (Lamictal)

Back 13

A NEW AED

Inhib glutamate release and blocks Na+ channels.

Best drug in pregnant women.

Also tolerated well in the elderly.

Expensive, but pretty much as effective as carbamazepine.

Decent for generalized and focal epilepsy.

In his slides at one point is says "Lamotrigine is best for women who have generalized epilepsy..."

Front 14

Topiramate (Topamax)

Back 14

Blocks Na+ channels, inhibits carbonic anhydrase, binds subset of GABA-A receptors and glutamate-Rs.

Good for epilepsy (partial and secondarily generalized), migraine (prophylactic), and neuropathic pain.

Front 15

Levetiracetam (Keppra)

Back 15

Binds synaptic vesicle protein.

Front 16

How to tx status epilepticus

Back 16

IV diazepam or lorazepam. Then IV phenytoin.

IV phenobarbital can also be done instead of those two. But that is second-line.

Must also give thiamine and glucose.