Quiz
NE5 Anti-epileptic drugs
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Questions in this quiz (16)
1Lamotrigine and zonisamide affect both Na+ and Ca++ channels.
- ATrue
- BFalse
2Ethosuximide and pregabalin affect calcium channels.
- ATrue
- BFalse
3Vigabatrin is used as an adjuct therapy for infantile seizures.
- ATrue
- BFalse
4Sodium valproate increases GABA levels by decreasing breakdown.
- ATrue
- BFalse
5GABA receptor upregulators: [blank_start]Barbiturates[blank_end].
- Examples: [blank_start]Phenobarbital, Primidone[blank_end]
- Action: Enhances GABA neurotransmission, [blank_start]mimics[blank_end] GABA neurotransmission, suppresses [blank_start]motor and polysynaptic[blank_end] transmission throughout the CNS
- Use: all forms of epilepsy EXCEPT [blank_start]absence[blank_end] epilepsy; status epilepticus, phenobarbitol 1st -line therapy for [blank_start]infantile seizures[blank_end]
- Pros: Oldest prescribed AED; WHO list; CHEAP; long [blank_start]half-life[blank_end]
- Cons: CNS [blank_start]sedation[blank_end]; phenobarbitol - relatively-[blank_start]narrow[blank_end] therapeutic window; substance [blank_start]abuse[blank_end] issues; CYP inducer- ABarbiturates
- BPhenobarbital, Primidone
- Cmimics
- Dmotor and polysynaptic
- Eabsence
- Finfantile seizures
- Ghalf-life
- Hsedation
- Inarrow
- Jabuse
6Zonisamide:
Action: Blocks [blank_start]Na+ VG and T-type Ca++[blank_end] ion channels; binds and activates GABA receptor
Use: mono- and adjunctive therapy for focal epilepsy; Lennox-Gastaut syndrome; Parkinson disease
Powerful antiepileptic, costly, [blank_start]not[blank_end] available in NZ.- ANa+ VG and T-type Ca++
- Bnot
7Topiramate
- Action: Blocks [blank_start]Na+ VG[blank_end] channels; potentiates GABA [blank_start]receptors[blank_end] and effect; inhibits carbonic anhydrase
- Use: mono- and adjunctive therapy for multiple forms of epilepsy; migraine prophylaxis, idiopathic intracranial
hypertension
- Pros: No serum monitoring; relatively [blank_start]cheap[blank_end]
- Cons: 20+yrs of use; CNS [blank_start]sedation[blank_end]; renal and ophthalmologic complications; side effects; unclear regarding pregnancy/lactation risk- ANa+ VG
- Breceptors
- Ccheap
- Dsedation
8Retigabine (Onelink)
Action: Activates [blank_start]K+[blank_end] ion channel to return depolarised neurons to [blank_start]resting[blank_end] state and reducing neuronal excitability
Use: [blank_start]adjunctive[blank_end] management of focal epilepsy
Pros: Quick [blank_start]absorption[blank_end]; unique [blank_start]mechanism[blank_end] of activity
Cons: cardiac and ophthalmologic complications; side effects; costly- AK+
- Bresting
- Cadjunctive
- Dabsorption
- Emechanism
9Racetams
- Examples: Levetiracetam (Keppra), Piracetam (Nootropil)
- Action: Block [blank_start]N-type Ca++[blank_end] ion channels; modulate AMPA receptors
- Use: focal epilepsy (mono- and adjunctive therapeutic uses); generalised GTC and myoclonic epilepsy
- Pros: Wide therapeutic use in epilepsy (L); limited [blank_start]side[blank_end] effects- AN-type Ca++
- Bside
10DA agonists - [blank_start]Non[blank_end]-ergot derivatives:
e.g. Pramipexole, Ropinirole
• [blank_start]Better[blank_end] tolerated (but still nausea, hypotension, constipation)
• Dyskinesias
• Sudden onset of [blank_start]sleep[blank_end] - caution re: driving
• Adjunct: [blank_start]confusion, hallucinations[blank_end]
[blank_start]Apomorphine[blank_end] (specialist supervision)
• Good for unpredictable ‘off’ periods, [blank_start]s.c.[blank_end] administration
• 2 days pre-treatment with [blank_start]domperidone[blank_end]- ANon
- BBetter
- Csleep
- Dconfusion, hallucinations
- EApomorphine
- Fs.c.
- Gdomperidone
11Amantadine:
• [blank_start]Weak[blank_end] DA agonist
• Modest anti-PD effect
• Tolerance
• Confusion/[blank_start]hallucinations[blank_end]
• Useful for [blank_start]L-DOPA induced dyskinesia[blank_end] in late disease
Unwanted Effects: [blank_start]insomnia, peripheral oedema[blank_end] (decrease dose in renal impairment)- AWeak
- Bhallucinations
- Cinsomnia, peripheral oedema
- DL-DOPA induced dyskinesia
12Selective MAO-[blank_start]B[blank_end] inhibitors: E.g. [blank_start]Selegiline[blank_end] and rasagiline
• Decrease [blank_start]breakdown[blank_end] of DA in [blank_start]striatum[blank_end]
• Prolong [blank_start]duration[blank_end] of action
• First used as adjunct to L-DOPA, to decrease dose requirement (1/3)
• ‘L-DOPA sparing’
• Mow also used with DA agonists
• Decreases end-of-dose [blank_start]deterioration[blank_end]
• UEs: Nausea, [blank_start]dry[blank_end] mouth, dyspepsia, constipation, [blank_start]transient dizziness[blank_end] (common)- AB
- BSelegiline
- Cbreakdown
- Dstriatum
- Eduration
- Fdeterioration
- Gdry
- Htransient dizziness
13Inhibition of cholinergic activity -
Anti[blank_start]muscarinic[blank_end] drugs e.g. Benztropine (benatropine), [blank_start]procyclidine[blank_end]
• Decrease relative [blank_start]central cholinergic excess[blank_end]
• Little effect on [blank_start]bradykinesia[blank_end]
• Modest effect - [blank_start]tremor and rigidity, sialorrhea[blank_end] (excessive salivation)
Unwanted effects:
- (peripheral) worsen PD-related [blank_start]constipation, dry[blank_end] mouth. Also [blank_start]blurred[blank_end] vision, urinary [blank_start]retention[blank_end].
- (Central) [blank_start]confusion, memory impairment,[blank_end] restlessness (elderly)- Amuscarinic
- Bprocyclidine
- Ccentral cholinergic excess
- Dbradykinesia
- Etremor and rigidity, sialorrhea
- Fconstipation, dry
- Gblurred
- Hretention
- Iconfusion, memory impairment,
14Drug-induced Parkinsonism - [blank_start]7[blank_end]% of PD. [blank_start]Women[blank_end]>men.
HIGH RISK
1. Dopamine [blank_start]D2 receptor blockers[blank_end]:
Antipsychotics -
Typicals e.g. [blank_start]haloperidol[blank_end]
Atypicals ((lower incidence): e.g. [blank_start]risperidone, olanzapine[blank_end]
[blank_start]Antiemetics[blank_end] - e.g. metoclopromide- A7
- BWomen
- CD2 receptor blockers
- Dhaloperidol
- Erisperidone, olanzapine
- FAntiemetics
15Methyldopa (centrally acting antihypertensive) is a dopamine depleter.
- ATrue
- BFalse
16Which of these drug classes is not an intermediate risk for drug induced PD?
- ACalcium channel blockers eg verapamil, diltiazem
- BMood stabilisers e.g. sodium valproate, lithium
- CSelective serotonin reuptake inhibitors e.g. fluoxetine, escitalopram
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- User has deleted their subject information Quiz on NE5 Anti-epileptic drugs, created by Deleted user on 11/10/2019.
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- Created on 11 Oct 2019 · updated on 11 Oct 2019
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