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Epilepsy > AEDS > Flashcards

AEDS Flashcards

1
Q

What new AED is associated with aggression?

A

Perampanel

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2
Q

Does perampanel cause a dose dependent side effect of aggression?

A

Yes

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3
Q

What age is the most common for dose dependent aggression with perampanel use?

A

Adolescents it is about 7.8% and in adults 1.3%

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4
Q

What is the most common psychological side effect of perampanel?

A

Irritability, seen in 11.8%

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5
Q

What AEDs have been sown to be effective for JME?

A

LEV, VPA, TPM, CLB

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6
Q

What AED can aggravate seizures in JME?

A

LTG

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7
Q

What AEDs aggravate absence seizures?

A

CBZ, OXC, GBP, TGB

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8
Q

What are the neuropsychological effects of AEDs?

A

Slowing of psychomotor speed and vigilance, and this risk is increased with rapid titration, higher dose, and polytherapy.

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9
Q

Can AEDs effect IQ in aldolescents and adults?

A

No, when used in mono therapy

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10
Q

Can AEDs effect IQ in a fetus or young?

A

Yes

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11
Q

When does the risk for TPM for cognitive side effects increase?

A

Dosing above 200 mg/day

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12
Q

What AEDS have the lowest risk for congenital malformations?

A

CBZ, LTG, LEV, and OXC

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13
Q

Which HLA alleles are associated with highest risk for TEN and Stevens-Johnson?

A

HLA-B 1502 in Asians only.

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14
Q

What HLA allele is associated with hypersensitive syndrome and maculopapular rash?

A

HLA-A 3101 in a variety is ethnic groups

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15
Q

What drugs are mostly renal excreted?

A

Levetiracetam, gabapentin, and pregabalin

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16
Q

What is the usual metabolism types that can be induced or inhibited by other drugs?

A

Drugs that undergo oxidation or glucuronidation

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17
Q

What AEDs does not reduce the efficacy of oral contraceptive pills?

A

Valporic acid

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18
Q

What AEDs alter oral contraceptive efficacy?

A

PHE, CBZ, TPM, OXC induce the clearance of ethinyl estradiol and/or synthetic progestin

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19
Q

Congenital malformations are increased with what AEDs?

A

Valproic acid are dose dependent, and TPM

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20
Q

Is there a difference between LTG and CBZ in congenital malformations?

A

Registries have not shown differences between the two.

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21
Q

What is the study design for obtaining FDA approval for the use of AED as mono therapy?

A

Conversion to mono therapy superiority design.

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22
Q

What type of proof will the FDA accept for monotherapy?

A

Only proof of superiority over standard treatment.

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23
Q

What two AEDs can induce skin rash due to cross-reactivity?

A

PHE and CBZ

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24
Q

What is the percentage of patients who gat skin rash from AED exposure?

A

As high as 15%

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25
Q

What other AED has cross-reactivity to CBZ?

A

Phenobarbital, but less than PHT

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26
Q

How does St John’s Wort alter AED levels?

A

Induction of cytochrome P450 enzymes.

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27
Q

What compounds in herbal medications have the greatest interactions with medications?

A

Hypericum perforating, magnesium, calcium, iron or ginkgo

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28
Q

When are serum concentrations beneficial to obtain?

A
  1. Individual level where a problem achieves desired outcome.
  2. Aid in diagnosis of toxicity.
  3. Assessing adherence
  4. Guiding dose adjustments during situations associated with pharmacokinetic variability
    5 . When a known pharmacokinetic change will happen- pregnancy
  5. Guiding dose adjustments for AEDs with dose dependent pharmacokinetics- Dilantin
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29
Q

What is the most important factor in determining the clearance of Dilantin?

A

Variants of CYP 2C9 and 2C19 the strongest predictors of clearance

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30
Q

How is LTG metabolized?

A

Glucuronidation

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31
Q

During pregnancy which AED can have increased clearance by up-to 200%?

A

LTG

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32
Q

When during pregnancy does estrogen have it’s largest effect on clearance of LTG?

A

First trimester

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33
Q

When does clearance of LTG return to pre-pregnancy levels?h

A

Shortly after delivery

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34
Q

When should LTG be monitored during pregnancy?

A

Prior to pregnancy, shortly after conception, during each trimester, and shortly after delivery:

35
Q

What drug significantlyj reduces CBZ?

A

Grapefruit juice

36
Q

How does grapefruit juice lower CBZ levels?

A

Lowers absorption.

37
Q

What common antibiotics that inhibit the metabolism of CBZ?

A

Amoxicillin and macrolides

38
Q

What can be given after surgery that would elevate CBZ?

A

Dacron

39
Q

How does vigabrin work?

A

Increasing GABA by GABA trans Amina’s inhibition

40
Q

Does vigabatrin block type A type B GABA receptors?

A

No

41
Q

How does Tiagabine work?

A

Blocking presynaptic reuptake of GABA

42
Q

What is the mechanism of action of LEV?

A

Binding of synaptic vesicle protein SV2A

43
Q

What are the signs of CBZ toxicity?

A

Ataxia, lethargy, dizziness, and nystagmus

44
Q

What antibiotic class reduce clearance of CBZ by blocking metabolism?

A

Macrolides

45
Q

What are the major side effects of eslicarbazepine?

A

Dizziness, somnolence, and headaches

46
Q

What are minor side effects of eslicarbazepine?

A

Hyponatrmia and dermatologist

47
Q

Does eslicarbazepine alter birth control pills?

A

Yes, lowers the levels

48
Q

What is the major side effect of ezogabine?

A

Urinary retention

49
Q

What is the mechanism of action of CBZ, PHE, LAC?

A

Modulation of the sodium channel

50
Q

Hyponatremia is more likely in patients treated with CBZ or OXC?

A

OXC was found in 12% versus 3% for CBZ

51
Q

What is the predictive finding hyponatremia with OXC?

A

The first measurement of sodium was found to be predictive

52
Q

Which medications have class Level A evidence as initial therapy in CAE?

A

Valproic acid and ethosuximide

53
Q

What AEDs have class Level A evidence for initial monotherapy for focal onset seizures?

A

LEV, ZNS, VPA, and CBZ

54
Q

What is propofol infusion syndrome?

A

Severe metabolic acidosis, renal failure, cardiovascular collapse

55
Q

What makes a patient particularly susceptible?

A

On the Ketogenic diet

56
Q

What evidence exists for effectiveness for cannibidiol?

A

Anecdotal evidence

57
Q

What is Type A adverse effects?

A

Common effects (>10%) that are related to known mechanism of action and dependent on dose or serum concentration.

58
Q

What is the most common adverse reaction from drug treatment of status?

A

Hypotension

59
Q

After hypotension, what is the next most common adverse reaction from drug treatment of status

A

Hypoventilation

60
Q

What is required by the FDA for approval of generic AED?

A

Single dose study in volunteers

61
Q

What AED is most likely to produce seizure suppression in super-refractory status?

A

Pentobarbital

62
Q

What drug associated with treatment of super-refractatory status has the most systemic adverse effects?

A

Pentobarbital

63
Q

How common is weight gain with VPA?

A

10% - 70%

64
Q

What are the most common metabolic side effects of VPA?

A

Insulin resistance and hyperlipidemia

65
Q

How frequent are congenital malformations in VPA exposure?

A

10%

66
Q

What AEDs are poorly absorbed rectally?

A

Gabapentin, oxcarbazepine, lorazepam, and phenytoin

67
Q

What AEDs are absorbed well when given rectally?

A

Topiramate, clonazepam, and levetiracetam

68
Q

What is the most effective and best tolerated for treatment of CAE?

A

Ethosuximide

69
Q

What cation chloride co-transporters are most important in adult neurons?

A

KCC2 which is responsible for low intracellular chloride concentrations. Then activation of GABA(A) receptors allows the entry of chloride and hyperpolarization and inhibition

70
Q

In the infant what cation chloride transporter is dominant?

A

NKCC1 and this elevates the intracellular chloride levels. Thus when GABA(A) is activated it causes an outward movement of chloride leading to neuronal depolarization and excitation

71
Q

In a patient already on VPA, what happens when CBZ is added?

A

Free VPA levels increase due to competition for protein binding sites

72
Q

What drugs increase free VPA levels?

A

CBZ, phenytoin, and salicylate

73
Q

Is there any clinical trial evidence for second line therapy for convulsive status?

A

No

74
Q

Does Perampanel have a black box warning for behavioral reactions?

A

Yes, for hostility, aggression, but seems to beside related

75
Q

What is the mechanism of action is eslicarbazepine?

A

Enhances slow inactivation of sodium channels. It might also inactivate calcium currents.

76
Q

In pregnant women what AED is thought to be superior to LTG and TPM and similar to CBZ and VPA?

A

LEV

77
Q

What factors are associated with VGB and visual effects?

A

Visual effects increased with duration of exposure and higher cumulative dosage

78
Q

Which AEDs are associated with fewest cognitive side effects?

A

LTG, LEV LAC, GPB, VGB

79
Q

What are the signs of lamotrigine toxicity?

A

Double vision, dizziness and ataxia

80
Q

What AEDS do not interact with oral contraceptives?

A

GBP, LEV, ZNS

81
Q

What non-intravenous medication has the best evidence for treating seizures lasting at least 5 minutes?

A

Intramuscular midazolam

82
Q

What AEDs have been associated with spina bifida?

A

VPA and CBZ

83
Q

What AEDs have no relevant metabolic drug-drug interactions?

A

GBP, LEV, Pregabalin

Epilepsy (17 decks)

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