1 Antiepileptic

Question 1

Epilepsy is a __________ neurologic disorder

characterized by ___________________.

Answer 1

Epilepsy is a chronic neurologic disorder

characterized by recurrent seizures.

Question 2

Epilepsy is associated with the presence
of a group or focus of cerebral neurons
that are ______________.

Answer 2

hyperexcitable, or irritable.

Question 3

What initiates an epileptic seizure?

Answer 3

The spontaneous discharge of these
irritable neurons initiates the epiletic
seizure.

Question 4

What are the classifications of an epileptic seizure?

Answer 4

Partial
Generalized
Unclassified

Question 5

Partial seizures affect ___________ the

brain.

Answer 5

Partial seizures affect only part of the

brain.

Question 6

Generalized seizures affect __________

brain.

Answer 6

Generalized seizures affect the whole

brain.

Question 7

What are two other names for a generalized seizure?

Answer 7

Grand mal

Tonic-clonic

Question 8

True or false: Antiepileptic medications are used to stop seizures and are administered when one has commenced.

Answer 8

False

• Seizures are self-limiting.
• Drugs are used to stop the recurrence of
seizures to prevent further damage to
already damaged neurons.

Question 9

True or false: Barbiturates for epilepsy are safe for adults and not children

Answer 9

True.

• Phenobarbital is prescribed for all
types of adult seizures.

• Very safe and effective.

• Limited because of strong tendency
to produce sedation.

Question 10

Why are barbiturates unsafe to treat pediatric epilepsy?

Answer 10

Paradoxical increase in seizures and an increase in hyperactivity in some children.

Question 11

What is the mechanism of action for barbiturates in the treatment of epilepsy?

Answer 11

Increase the effects of GABA
(See Steph’s post 10/9/16 or page 107)

Decrease release of glutamate

Question 12

What are the side effects of barbiturates in treating epilepsy?

Answer 12

• Sedation, nystagmus, ataxia, folate deficiency, vitamin K deficiency, and skin problems.
• Paradoxical increase in seizures and an increase in hyperactivity in some children.

Question 13

Barbiturates to treat epilepsy have one HUGE flaw in regards to when they take effect, what is it?

Answer 13

It takes a lot to build up in system so patient has a bunch of seizures before they even realize they’re not helping

Question 14

Why are Benzodiazepines limited?

Answer 14

Limited in use because of sedation and tolerance.

Question 15

What are some examples of benzodiazepines to treat epilepsy?

Answer 15

Valium and Ativan

Question 16

What is the most common benzodiazepine chosen to treat epilepsy, especially in children?

Answer 16

Ativan

Question 17

What are the side effects of benzodiazepines used to treat epilepsy?

Answer 17

• Sedation, ataxia, and behavioral changes.

Question 18

What are some examples of hydantonins used to treat epilepsy?

Answer 18

Dilantin and Cerebyx

Question 19

What is the mechanism of action of how hydantoins treat epilepsy?

Answer 19

Decrease neural excitability

Question 20

What are the side effects of hydantoins?

Answer 20

Gastric irritation, 
confusion,
sedation,  
dizziness, 
headache, 
ataxia,  
nystagmus, 
increased body and facial hair👨🏽

Question 21

Iminostilbenes not starred are prescribed how often?

Answer 21

Rarely prescribed for epilepsy

Last choice if the others don’t work

Side effect: cardiac arrhythmias and CHF

Question 22

My patient was experiencing global seizures and was prescribed this drug years ago. Now, they’re presenting with Parkinson’s like symptoms. What was the drug?

Answer 22

not starred, she said this as a side bar thing

Succinimides

Question 23

Neurontin is prescribed for which populations of epileptics?

Answer 23

Partial seizures in adults and children

Question 24

What is the neurological mechanism of neurontin for epilepsy?

Answer 24

It is a GABA agonist

Question 25

What are the side effects of neurontin?

Answer 25

Sedation
Fatigue
Dizziness
Ataxia

Question 26

True or false: Neurontin can be use to treat both partial seizures and musculoskeletal pain

Answer 26

False, it treats partial seizures and neurological pain

Question 27

What are the first generation epilepsy drugs?

Answer 27

*Barbiturates
*Benzodiazepines
*Hydantonins
(Iminostilbenes and Succinimides)

Question 28

What is the only second generation epileptic drug?

Answer 28

Neurontin

Question 29

What are the pharmacokinetics of anti-epileptic drugs?

Answer 29

• When given long-term to control epilepsy, drugs are given orally.
• Distributation in body is extensive
• Biotransformation occurs via the liver.

Question 30

True or false: it is safer for both an epileptic mother-to-be and her offspring-to-be if she stays on her anti-epileptic medication during the pregnancy

Answer 30

It’s a toss up.

You can have birth defects with the medication

You can miscarry if you have a grand mal seizure

Either way, it’s her call

Question 31

What is the protocol for going off anti-epileptic medication?

Answer 31

Seizure free for 2 years while on meds.

Having a normal neurologic examination prior to withdrawal.

Being young when the seizures started.

Must be done under close medical supervision.

Tapered over 6 months

Question 32

How long until one loses their diagnosis of epilepsy?

Answer 32

5 years

2 years of being seizure free on medication + 3 years. After you taper off

Question 33

What is Status Epilepticus?

Answer 33

• One long extended seizure.

• Untreated, it will result in permanent
damage or death.

• Treatment begins with standard
emergency procedures: airway, IV, blood sampling, drug administration. (valium or Ativan)

• Last resort, anesthesia to stop neural activity