A.33.Antiepileptics used in abscence seizures. "Broad spectrum" Antiepileptic drugs. status epilepticus

Question 1

what is valproic acid (valproate)?

Answer 1

broad- spectrum anticonvulsants

Question 2

what is the mechanism of valproate?

Answer 2

1. inhibits T-type Ca²⁺ channels (in thalamic neurons)
2. inhibits Na⁺ channels
3. ↑ the inhibitory effects of GABA

Question 3

what are the indications for Valproate?

Answer 3

JJ-Joly Jocker (good for all types of seizures)
including absence seizures
bipolar disorders
migraine prophylaxis

Question 4

side effects of valproate

Answer 4

"VALPPROaTTE"
Vomiting
Alopecia
Liver damage  (hepatotoxic)
Pancreatitis 
P-450 inhibition 
Rash 
Obesity (weight gain)
Thrombocytopenia
Teratogenesis (neural tube defects)
Epigastric pain

Question 5

what antiepileptics are good in pregnancy?

Answer 5

Lamotrigine
Levetiracetam

*according to the internet

Question 6

what is Lamotrigine?

Answer 6

glutamate antagonist (AMPA receptor)

Question 7

what does Lamotrigine do?

Answer 7

inhibit Na⁺ and Ca²⁺ channels

Question 8

what does Levetiracetam do?

Answer 8

interferes with synaptic release of glutamate (SV2A receptor blockage)

Question 9

what are the indications for lamotrigine and levetiracetam?

Answer 9

broad spectrum
partial seizures
generalized tonic clonic seizures
lamotrigine–> absence seizures as well

Question 10

side effects of lamotrigine

Answer 10

“SHD”

SJS
Hepatotoxicity
Dizziness

Question 11

side effects of levetiracetam

Answer 11

depression

nervousness

Question 12

what does Ethosuximide do?

Answer 12

inhibits T-type Ca²⁺ channels

Question 13

when is Ethosuximide given?

Answer 13

absence seizures  (narrow spectrum)
sux--> sucks to have silent (absence) seizures

Question 14

what is the T1/2 of Ethosuximide?

Answer 14

up to 60 hours

Question 15

side effects of Ethosuximide

Answer 15

“EFGHIJ”

Ethosuximide causes Fatigue, Gi distress, Itching and sJs.

Question 16

management of status epilepticus

Answer 16

1. Lorazepam/Midazolam IV/IM
   *phenobarbital IV can replace benzos if nothing else helps
2. phenytoin/levetiracetam IV-continuous infusion over 5- 20 min’
   prevent recurrence of seizures

valproate can be given

Question 17

what is the effect of benzos in status epilepticus?

Answer 17

potentiate inhibitory effects of GABA

↑ the opening frequency of Cl⁻ channels

Question 18

why benzos can’t be given for chronic antiepileptic treatment?

Answer 18

they are highly sedative and tolerance develops.

only acute applications