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Questions and Answers
Which of the following drugs, primarily used to treat seizures, decrease glutamate release by acting on the synaptic protein SV2A?
Which of the following drugs, primarily used to treat seizures, decrease glutamate release by acting on the synaptic protein SV2A?
- Levetiracetam (correct)
- Topiramate
- Phenytoin
- Ethosuximide
Vigabatrin elevates GABA levels by enhancing the response of GABAA receptors to GABA.
Vigabatrin elevates GABA levels by enhancing the response of GABAA receptors to GABA.
False (B)
Match each drug with its primary mechanism of action:
Match each drug with its primary mechanism of action:
Phenytoin = Blocks Na+ channels and decreases glutamate release Tiagabine = Blocks GABA re-uptake Gabapentin = Reduces calcium currents (T-type) Topiramate = Alters phosphorylation state at the synapse and blocks Na+ channels
Which of the following antiseizure drugs primarily enhance the response of GABAA receptors to GABA?
Which of the following antiseizure drugs primarily enhance the response of GABAA receptors to GABA?
Phenytoin's mechanism of action in preventing seizures primarily involves:
Phenytoin's mechanism of action in preventing seizures primarily involves:
Levetiracetam directly blocks voltage-gated sodium channels to reduce neuronal excitability.
Levetiracetam directly blocks voltage-gated sodium channels to reduce neuronal excitability.
Phenytoin follows zero-order kinetics at therapeutic concentrations, allowing for predictable dose adjustments.
Phenytoin follows zero-order kinetics at therapeutic concentrations, allowing for predictable dose adjustments.
Match the following antiseizure drugs with their primary mechanisms of action:
Match the following antiseizure drugs with their primary mechanisms of action:
Match the following antiseizure drug characteristics with their corresponding descriptions.
Match the following antiseizure drug characteristics with their corresponding descriptions.
Which of the drugs listed below inhibits GABA-transaminase, leading to increased GABA levels in the synapse?
Which of the drugs listed below inhibits GABA-transaminase, leading to increased GABA levels in the synapse?
Which of the following is NOT a primary approach to antiseizure drug discovery?
Which of the following is NOT a primary approach to antiseizure drug discovery?
Current antiseizure drugs are generally considered curative rather than palliative.
Current antiseizure drugs are generally considered curative rather than palliative.
Vigabatrin's mechanism of action in treating seizures is most closely associated with which of the following enzymatic effects?
Vigabatrin's mechanism of action in treating seizures is most closely associated with which of the following enzymatic effects?
All drugs classified as 'tricyclics' (carbamazepine, oxcarbazepine, and eslicarbazepine) primarily exert their antiseizure effects by enhancing GABA-mediated chloride influx.
All drugs classified as 'tricyclics' (carbamazepine, oxcarbazepine, and eslicarbazepine) primarily exert their antiseizure effects by enhancing GABA-mediated chloride influx.
Match each antiseizure medication with its primary mechanism of action:
Match each antiseizure medication with its primary mechanism of action:
Which of the following statements accurately describes the mechanism of action of vigabatrin?
Which of the following statements accurately describes the mechanism of action of vigabatrin?
Primidone's anticonvulsant activity is solely attributed to its direct action on sodium channels, independent of its metabolites.
Primidone's anticonvulsant activity is solely attributed to its direct action on sodium channels, independent of its metabolites.
Match each antiseizure drug with its primary mechanism of action:
Match each antiseizure drug with its primary mechanism of action:
A patient on carbamazepine exhibits diplopia and ataxia. While these are common side effects, what other potentially serious idiosyncratic reaction should the healthcare provider monitor for?
A patient on carbamazepine exhibits diplopia and ataxia. While these are common side effects, what other potentially serious idiosyncratic reaction should the healthcare provider monitor for?
Pregabalin directly acts on GABA receptors to exert its anticonvulsant effects.
Pregabalin directly acts on GABA receptors to exert its anticonvulsant effects.
Which property makes primidone distinct from other barbiturates?
Which property makes primidone distinct from other barbiturates?
Which of the following antiseizure drugs directly enhances the opening of potassium channels?
Which of the following antiseizure drugs directly enhances the opening of potassium channels?
Fosphenytoin is an active form of phenytoin and directly blocks sodium channels without requiring metabolic conversion.
Fosphenytoin is an active form of phenytoin and directly blocks sodium channels without requiring metabolic conversion.
Which of the following drugs is NOT a benzodiazepine but a benzodiazepine derivative?
Which of the following drugs is NOT a benzodiazepine but a benzodiazepine derivative?
Tiagabine elevates GABA levels in the synapse by directly inhibiting the synthesis of GABA.
Tiagabine elevates GABA levels in the synapse by directly inhibiting the synthesis of GABA.
Which antiseizure drug's mechanism primarily involves antagonism of AMPA receptors?
Which antiseizure drug's mechanism primarily involves antagonism of AMPA receptors?
What is the primary mechanism of action for ethosuximide in controlling seizures?
What is the primary mechanism of action for ethosuximide in controlling seizures?
The anti-seizure drug __________, derived from Cannabis sativa, has an unknown mechanism of action for seizure control and is non-psychoactive.
The anti-seizure drug __________, derived from Cannabis sativa, has an unknown mechanism of action for seizure control and is non-psychoactive.
What is the primary mechanism by which ethosuximide exerts its antiseizure effect?
What is the primary mechanism by which ethosuximide exerts its antiseizure effect?
What is the primary advantage of using fosphenytoin over phenytoin in emergency situations?
What is the primary advantage of using fosphenytoin over phenytoin in emergency situations?
The antiseizure drug _______ is a prodrug that is converted to phenobarbital in the body.
The antiseizure drug _______ is a prodrug that is converted to phenobarbital in the body.
Common adverse drug reactions (ADR) associated with phenytoin use, affecting a significant number of patients, are:
Common adverse drug reactions (ADR) associated with phenytoin use, affecting a significant number of patients, are:
What was the first antiseizure drug that did not have sedative properties?
What was the first antiseizure drug that did not have sedative properties?
Unlike many antiseizure medications that act on sodium or GABA channels, topiramate influences neuronal activity through its effects on the process of __________.
Unlike many antiseizure medications that act on sodium or GABA channels, topiramate influences neuronal activity through its effects on the process of __________.
What is the primary mechanism of action of ethosuximide in treating absence seizures?
What is the primary mechanism of action of ethosuximide in treating absence seizures?
Carbamazepine induces microsomal liver enzymes (CYP), which can cause its half-life to ______ after chronic usage.
Carbamazepine induces microsomal liver enzymes (CYP), which can cause its half-life to ______ after chronic usage.
Besides seizures, for what other condition is pregabalin specifically approved?
Besides seizures, for what other condition is pregabalin specifically approved?
Valproic acid's discovery as an anticonvulsant was serendipitous; it was initially used as a ______ in drug studies.
Valproic acid's discovery as an anticonvulsant was serendipitous; it was initially used as a ______ in drug studies.
What is the mechanism of action (MOA) of vigabatrin?
What is the mechanism of action (MOA) of vigabatrin?
Levetiracetam modulates synaptic transmission by binding to synaptic vesicle protein ____________.
Levetiracetam modulates synaptic transmission by binding to synaptic vesicle protein ____________.
Besides its action on GABAA receptors, which other receptor type does felbamate affect?
Besides its action on GABAA receptors, which other receptor type does felbamate affect?
The antiseizure drug ______________ is known for enhancing slow inactivation of sodium channels, potentially offering a unique mechanism for seizure control.
The antiseizure drug ______________ is known for enhancing slow inactivation of sodium channels, potentially offering a unique mechanism for seizure control.
What percentage of phenytoin is bound to protein?
What percentage of phenytoin is bound to protein?
Which drug class can displace phenytoin from protein and increase free drug levels?
Which drug class can displace phenytoin from protein and increase free drug levels?
What percentage of carbamazepine is protein bound?
What percentage of carbamazepine is protein bound?
Which of the following is the oldest of the antiseizure drugs next to bromide?
Which of the following is the oldest of the antiseizure drugs next to bromide?
What percentage of primidone is free and unbound?
What percentage of primidone is free and unbound?
Which of the following drugs causes visual field disturbances and is only used when all others fail?
Which of the following drugs causes visual field disturbances and is only used when all others fail?
What is the most common adverse drug reaction (ADR) of ethosuximide?
What is the most common adverse drug reaction (ADR) of ethosuximide?
Which of the following enhances GABA transmission and is utilized in compassionate use for certain types of epilepsy in infancy?
Which of the following enhances GABA transmission and is utilized in compassionate use for certain types of epilepsy in infancy?
Flashcards
Voltage-gated sodium channel blockers
Voltage-gated sodium channel blockers
Drugs that block Na+ channels, decreasing glutamate release.
SV2A modulating drugs
SV2A modulating drugs
Drugs that act on synaptic protein SV2A to modify glutamate release.
Calcium current reducers
Calcium current reducers
Drugs that reduce T-type calcium currents, decreasing Ca++ entry.
GABA response enhancers
GABA response enhancers
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Cannabidiol's unknown mechanism
Cannabidiol's unknown mechanism
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Epilepsy
Epilepsy
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Seizures
Seizures
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GABA transmission
GABA transmission
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Glutamate transmission
Glutamate transmission
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Phenytoin
Phenytoin
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Fosphenytoin
Fosphenytoin
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Therapeutic levels of Phenytoin
Therapeutic levels of Phenytoin
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Common ADRs of Phenytoin
Common ADRs of Phenytoin
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Carbamazepine
Carbamazepine
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Phenobarbital
Phenobarbital
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Primidone
Primidone
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Vigabatrin
Vigabatrin
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Lamotrigine
Lamotrigine
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Gabapentin
Gabapentin
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Ethosuximide
Ethosuximide
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Valproic Acid
Valproic Acid
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Benzodiazepines
Benzodiazepines
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Lacosamide
Lacosamide
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Drugs blocking Na+ channels
Drugs blocking Na+ channels
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SV2A protein
SV2A protein
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Drugs enhancing K+ channels
Drugs enhancing K+ channels
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T-type calcium currents
T-type calcium currents
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Phosphorylation at synapses
Phosphorylation at synapses
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GABAA receptor response
GABAA receptor response
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GABA-transaminase inhibition
GABA-transaminase inhibition
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GABA Receptors
GABA Receptors
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Tiagabine
Tiagabine
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Felbamate
Felbamate
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Cyclic ureide analogs
Cyclic ureide analogs
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Levetiracetam
Levetiracetam
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Retigabine
Retigabine
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Topiramate
Topiramate
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Study Notes
Epilepsy and Antiseizure Drugs
- Epilepsy affects 1% of the global population, with 500,000 patients in the US alone.
- Antiseizure drugs are successful in around 80% of patients.
- Episodes of abnormal cerebral neuron discharge cause seizures.
- Epilepsy can stem from various causes, including neoplasms, head injuries, fevers, or unknown factors.
- Treatment selection depends on the epilepsy type.
Drug Development Approaches for Epilepsy
- Drug discovery involves three approaches:
- Enhancing GABA (inhibitory) transmission
- Reducing glutamate (excitatory) transmission
- Modifying ionic conductance.
- Current drugs primarily provide symptom relief rather than a cure.
Antiseizure Drug Chemistry
- Sixteen different antiseizure drugs are clinically approved.
- Thirteen of these fall into these categories:
- Barbiturates
- Hydantoins
- Oxazolidinediones
- Succinimides
- Acetylureas
Phenytoin and Fosphenytoin
- Phenytoin (diphenylhydantoin) was the first significant anti-seizure medication without sedative properties, discovered in 1938.
- Fosphenytoin, a prodrug, eliminates pain at injection sites.
- The drug inhibits repetitive action potential firing and sodium channel activity in axons.
- Therapeutic levels range from 10-20µg/mL.
- Common side effects include diplopia (double vision), ataxia, and gingival hyperplasia.
Carbamazepine
- Structure similar to phenytoin, also blocks sodium channels.
- Induces liver enzymes, potentially affecting drug half-life.
- Common side effects include diplopia and ataxia, and potentially an erythematous skin rash.
Phenobarbital
- An older (first line) antiseizure medication, along with bromide.
- Has derivatives such as mephobarbital and metharbital.
Primidone
- Metabolizes into phenobarbital and phenylethylmalonamide, thereby impacting activity.
- Common side effects are related to phenobarbital.
Vigabatrin
- Irreversible inhibitor of GABA aminotransferase (GABA-T).
- Increases GABA brain levels
- Potential side effect: visual disturbances in roughly one-third of patients.
Lamotrigine
- Primarily affects sodium channels and modulating glutamate release.
- Common side effects include rash, diplopia, and headache.
Gabapentin and Pregabalin
- Analogs of GABA, but act on different pathways
- Primarily used for pain or peripheral neuropathies, and affect calcium regulation.
Lacosamide
- Slows Na channel activation.
- Commonly used to treat various seizure types.
Levetiracetam
- Modifies synaptic release of GABA and glutamate.
Tiagabine
- Inhibits GABA reuptake, boosting GABA levels.
Topiramate
- A monosaccharide derivative, having effects on sodium channels regulation and modulates GABA activity.
Zonisamide
- A sulfonamide derivative targeted toward sodium channels.
Ethosuximide
- Structurally cyclic ureide, impacting calcium currents.
- Effective for absence seizures.
Valproic Acid (and Sodium Valproate)
- A carboxylic acid derivative affecting sodium currents.
- Has been associated with hepatic toxicity.
Benzodiazepines (Diazepam, Lorazepam, Clonazepam)
- Primarily used for status epilepticus (seizure control).
- Act on GABA sites.
- Common side effects are tolerance and sedation.
Miscellaneous Antiseizure Drugs
Other drugs with diverse mechanisms, including; Lamotrigine, Rufinamide, Zonisamide, Lacosamide, Felbamate, Trimethadione, Perampanel and Stiripentol.
Summary of Antiseizure Drug Mechanisms
- Drugs targeted at sodium channels: These drugs block sodium channels and reduce glutamate release.
- Drugs modulating synaptic protein SV2A: These drugs modify the release of glutamate.
- Potassium channel enhancement: Drugs that improve potassium channel function.
- Reduction of calcium currents: Drugs reducing certain types of calcium current (e.g., T-type).
- Alterations of synaptic phosphorylation: These drugs change the phosphorylation state at synapses.
- Modulation of GABA response: Drugs amplifying GABA reception or reducing GABA breakdown.
Drug Categories Based on Mechanism of Action
Several categories based on their mechanism of action, including the primary target of these drugs.
Drug Classification by Structure
A categorized approach based on the chemical structure of the drugs.
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