10. Antiepileptics used in partial seizures and generalized tonic-clonic seizures except for the “broad spectrum” agents

Question 1

Antiepileptics used in partial seizures and generalized tonic-clonic seizures

Answer 1

drugs that ...
acting on the voltage-gated Na+ channel
acting on the GABA system
acting on the glutamate system
and some others and newer drugs

Question 2

drugs acting on the voltage-gated Na+ channel

Answer 2

Carbamazepine
Oxcarbazepine
Phenytoin
Fosphenytoin

Question 3

drugs acting on the GABA system

Answer 3

Phenobarbital
Primidone
Vigabatrin
Tiagabine

Question 4

drugs acting on the glutamate system

Answer 4

Gabapentin
Pregabalin
Felbamate

Question 5

Carbamazepine & Oxcarbazepine

Answer 5

First line
AE: neurological prob., leukopenia
For trigeminal neuralgia!!!, neuropathy
influences ADH

Oxcarbazepine is a prodrug of Carbamazepine

Question 6

Phenytoin

Answer 6

zero order pharmacokinetics

AE: teratogenic, gingival hyperplasia

Anti-arrhythmic

Question 7

Fosphenytoin

Answer 7

for acute seizures

given IV

Question 8

Phenobarbital

Answer 8

2nd / 3rd line due to AE
cuss Dependence
acts on GABAA receptors & also blocks Na+ channels

Question 9

Primidone

Answer 9

prodrug

for tremors

Question 10

Vigabatrin

Answer 10

selective, irreversible GABA-transaminase inhibitor (presynaptic)
AE: might provoke psychosis

Question 11

Tiagabine

Answer 11

Inhibitor of GABA uptake

Question 12

Gabapentin & Pregabalin

Answer 12

inhibiting presynaptic N-type calcium channels
AE: obesity and ataxia
used as adjuvan

Question 13

Felbamate

Answer 13

Inhibits postsynaptic NMDA receptors

used as last resort drugs

Question 14

newer drugs

Answer 14

Zonisamide 
Lacosamide 
Rufinamide 
Levetiracetam 
Retigabine

Question 15

Zonisamide

Answer 15

Carboanhydrase inhibitor, Inhibition of Na+ and Ca++ channels, Might have GABAergic and glutamatergic effects
AD: kidney stones

Question 16

Lacosamide

Answer 16

Inhibition of Na+ channels

Question 17

Rufinamide

Answer 17

Inhibition of Na+ channels

for Lennox-Gastaut syndrome

Question 18

Levetiracetam

Answer 18

Inhibits N-type calcium channels

Also used as nootropic drug

Question 19

Acetazolamide

Answer 19

part of the other sub group
Carboanhydrase inhibitor
can enter CNS

Question 20

partial seizures

Answer 20

involve one part of the brain

3 types
simple - no loss of consciousness
complex - consciousness altered
simple followed by generalized (seconderly generalized)

Question 21

generalized tonic-clonic seizures

Answer 21

involves the entire body

loss of consciousness followed by tonic & clonic phases