Anticonvulsants and Antiplatelets Overview
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Questions and Answers

Primidone is an anticonvulsant of the pyrimidinedione class.

True (A)

Primidone is a prodrug requiring an oxidative metabolic activation to the major active metabolite phenobarbital.

True (A)

N-Oxidation prodrug activation reaction is represented by the reversible redox drug delivery strategy for getting drugs into the brain.

True (A)

In case of N-Methylpyridinium-2-carbaldoxime chloride (2-PAM = Pralidoxime) is used as an antidote to poisoning with cholinesterase inhibitors.

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Because of its charge and hydrophilicity, it does not penetrate the BBB.

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Pro-2-PAM, the reduced dihydropyridine form of 2-PAM, readily enters the CNS.

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There, it is oxidized to form 2-PAM, which remains trapped in the CNS since its charge reduces its rate of transfer from the brain back into the blood.

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Clopidogrel and Prasugrel (thienopyridine derivatives), inhibits platelet aggregation -> prolong bleeding time and delay clot retraction.

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They are irreversible antagonists of P2Y12 purinergic receptor -> selective inhibition of ADP-induced platelet aggregation (last for 7-10 days after discontinuation of the medications).

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They are pro drugs requiring cytochrome P450 activation.

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The thiol binds irreversibly to P2Y12 by forming a disulfide bridge to a cysteine in P2Y12.

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Flashcards

Primidone's activation

Primidone, an anticonvulsant, needs metabolic conversion into phenobarbital for action.

Pro-drug activation

Certain drugs need a chemical change in the body to become effective.

2-PAM as antidote

2-PAM is used to counteract nerve agent or pesticide poisoning.

Pro-2-PAM brain penetration

The reduced form of 2-PAM easily enters the brain.

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2-PAM brain trapping

2-PAM becomes trapped in the brain after conversion, limiting its exit.

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Clopidogrel/Prasugrel action

These drugs prevent blood clots by inhibiting platelet aggregation.

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P2Y12 receptor inhibition

Clopidogrel/Prasugrel stop platelets from sticking together by binding to the P2Y12 receptor.

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Irreversible P2Y12 antagonism

The effect of these drugs on the P2Y12 receptor is lasting or permanent.

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Cytochrome P450 Activation

The drugs Clopidogrel and Prasugrel must be activated by Cytochrome P450 to be effective.

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Thiol-disulfide bond Formation

These drugs form a disulfide bridge with the P2Y12 receptor, permanently inactivating it.

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Antiplatelet Effect Duration

Clopidogrel & Prasugrel's antiplatelet effects last around 7-10 days after stopping the medication.

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Study Notes

Primidone

  • Primidone is an anticonvulsant in the pyrimidinedione class
  • It's a prodrug, requiring oxidative metabolic activation to become its active form, phenobarbital
  • N-oxidation is the prodrug activation reaction, achieved via a reversible redox drug delivery strategy
  • In cases of N-methylpyridinium-2-carbaldoxime chloride poisoning, 2-PAM is used as an antidote to cholinesterase inhibitors
  • Primidone does not penetrate the blood-brain barrier (BBB) due to its charge and hydrophilicity
  • The reduced dihydropyridine form of 2-PAM (pro-2-PAM) readily enters the central nervous system (CNS)
  • Pro-2-PAM is oxidized to 2-PAM in the CNS, which remains trapped there due to its charge, slowing its transfer back into the blood.

Clopidogrel and Prasugrel

  • Clopidogrel and Prasugrel are thienopyridine derivatives, acting as antiplatelet drugs
  • They prolong bleeding time and delay clot retraction by inhibiting platelet aggregation
  • They are irreversible antagonists of the P2Y12 purinergic receptor, inhibiting ADP-induced platelet aggregation
  • They are prodrugs requiring cytochrome P450 activation
  • The active metabolites remain active for 7-10 days after discontinuation
  • The thiol group binds irreversibly to P2Y12 receptors, forming a disulfide bridge with cysteine residues.

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Description

This quiz covers the pharmacology of Primidone, an anticonvulsant, and compares it with Clopidogrel and Prasugrel, two antiplatelet agents. Explore their mechanisms of action, metabolic pathways, and clinical implications in treating resistance to clot formation. Test your knowledge of drug interactions and the role of prodrugs in therapeutic contexts.

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