3.20.14 37 AEDs (anti-epileptics)

Question 1

What are the 6 mechanisms of AEDs?

Answer 1

1. Prevention of repetitive propagation (Na channel inactivity stabilizer)
2. Increased GABA inhibition
3. Reduced presynaptic release of excitatory NTs
4. Activate inhibitory K channels
5. Block AMPA glutamate receptors
6. Slow rhythmic firing reducers (T-type Ca2+ channel blocker)

Question 2

Name all of the repetitive propagation inhibitors.

Answer 2

Phenytoin (and fosphenytoin)
Carbamazepine
Oxcarbazepine
Valproic acid
Lamotrigine
Topiramate
Zonisamide
Phenobarbital

Question 3

Name the GABA inhibition promoters.

Answer 3

Clonazepam (benzodiazepines)
Phenobarbitol*
Topiramate
Gabapentin*
Valproic acid*

Question 4

Name the NT release inhibitors

Answer 4

Gabapentin (Ca2+ blocker)
Pregabalin (Ca2+ blocker)
Levatiracetam (SV2A protein binder; blocks vesicles)

Question 5

Name the K channel activator

Answer 5

Ezogabine (SMURFS)

Question 6

Name the AMPA glutamate receptor blocker

Answer 6

Perampanel

Question 7

Name the slow rhythmic firing reducers (T-type Ca channel blockers)

Answer 7

Ethosuximide
Valproic acid
Zonisamide
Lamotrigine

Question 8

Define status epilepticus

Answer 8

+5 min of continuous seizing or without recovery of consciousness

Question 9

Treatment for status epilepticus

Answer 9

Stabilize (ABCs)
IV Benzodiazepines
IV Fosphenytoin
Anesthetics if necessary

Question 10

What 6 (or 2x3) drugs are good for partial and GTC?

Answer 10

Phenytoin
Phenobarbitol

Gabapentin
Pregabalin

Carbamazepine
Oxcarbazepine

Question 11

What 1 drug is good for myoclonic seizure?

Answer 11

Levetiracetam

Question 12

What 2 drugs are most often used for absence?

Answer 12

Ethosuximide (absence sux)
Valproic acid (if GTC as well)

Question 13

What 5 drugs are good for virtually all types of seizure?

Answer 13

"VirTuaLLZ every seizure"
Valproic
Topiramate
Lamotrigine
Levetiracetam
Zonisamide

Question 14

What non-AED purpose does carbamazepine have?

Answer 14

Trigem neuralgia
Anxiety
Neuropathic pain

Question 15

What non-AED purpose does valproic acid have?

Answer 15

Headaches

Bipolar disorder

Question 16

What non-AED purpose does topiramate have?

Answer 16

Headache

Question 17

What is the first line for focal sz with secondary generalization?

Answer 17

Carbamazepine
Phenytoin
Lamotrigine

Question 18

What is the second line for focal sz with seconary generalization?

Answer 18

Valproic acid
Oxcarbazepine
Topiramate

Question 19

What is the treatment for primary generalized seizures?

Answer 19

Valproic acid
Lamotrigine
Topiramate
Levetiracetam

Question 20

What two drugs have serious teratogenic risk?

Answer 20

Valproic acid and carbamazepine

Question 21

What are the 3 unique pharmacokinetic features of phenytoin?

Answer 21

1. Limited water solubility (IV –> fosphenytoin)
2. High protein binding
3. Saturation of P450 changes to zero order metabolism

Question 22

What are the major adverse effects of repetitive action potential blockers?

Answer 22

Diplopia and nystagmus
Lethargy, cognitive slowing
Ataxia, vertigo

Question 23

What AED is similar to tricyclic antidepressants?

Answer 23

Carbamazepine

Question 24

What are the adverse effects of carbamazepine?

Answer 24

Aplastic anemia
Rash
Hyponatremia
Low WBCs (dose)

Question 25

What are the adverse effects of pheyntoin?

Answer 25

Gingival hyperplasia | Osteopenia

Question 26

What drug induces P450s?

Answer 26

Carbamazepine

Question 27

What drug inhibits hepatic metabolism of other drugs?

Answer 27

Valproic acid

Question 28

What are the various MOAs of valproic acid?

Answer 28

Na+ inactivity stabilizer GABA enhancement T-type Ca2+ blocker

Question 29

What are the key adverse effects of valproic acid?

Answer 29

``` Fat, shaky, bald, yellow -Weight gain -Tremor -Hair loss -Jaundice TERATOGENESIS ```

Question 30

What is the unique pharmacokinetic feature of lamotrigine?

Answer 30

Long half-life

Question 31

What is the unique adverse effect of lamotrigine?

Answer 31

Stevens-Johnson

Question 32

What is the MOA of phenobarbitol? What are the key adverse effects?

Answer 32

GABAa enhancement Paradoxical hyperactivity in kids Sedation, cognitive slowing, dizziness

Question 33

What is the major adverse effect of topiramate?

Answer 33

Renal stones | Excreted via kidneys

Question 34

What drug inhibits Ca2+ channels via the a2d subunit?

Answer 34

Gabapentin | Pregabalin

Question 35

What drug binds to SV2A, blocking release of vesicles?

Answer 35

Levetiracetam

Question 36

What drug causes smurf skin? What is its MOA?

Answer 36

Ezogabine | Activates potassium channels (hyperpolarization and inhibition)

Question 37

What drug is used exclusively for absence seizures?

Answer 37

Ethozuximide (absence sux)

Question 38

What drug changes from first order elimination to zero order elimination by saturating P450s?

Answer 38

Phenytoin

Question 39

What drug binds to proteins very strongly? What drug binds more strongly, displacing the first drug?

Answer 39

Phenytoin | Valproic acid