ICU Primary PrepCast #Epi 101 - ICU Primary Snippet - Gabapentin
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Feb 9, 2026 A concise tour of anticonvulsant classes and how different mechanisms control seizures. A clear breakdown of GABA enhancers, glutamate antagonists, and ion channel drugs. A focused look at gabapentin formulation, dosing, and how it works at the α2δ subunit. Practical notes on side effects, renal clearance, and dialysis removal.
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Framework For Anticonvulsant Mechanisms
- Anticonvulsant drugs work by enhancing GABA, inhibiting excitatory transmission, or modulating ion channels and other targets.
- Recognize categories: GABA enhancers, glutamate inhibitors, sodium/calcium channel modulators, potassium openers, and SV2A binders.
Multiple Ways To Boost GABAergic Tone
- GABA transmission can be enhanced via receptor modulation, reuptake inhibition, metabolism inhibition, or increased synthesis.
- Examples include benzodiazepines/barbiturates, tiagabine, vigabatrin/valproate, and valproate increasing GAD activity.
Ion Channel Modulation Is Central
- Sodium channel blockade is the most common anticonvulsant mechanism, with many mainstay drugs acting this way.
- Calcium channel blockers (e.g., ethosuximide, gabapentin/pregabalin) and potassium channel openers also reduce excitability.