AEDS

Question 1

What new AED is associated with aggression?

Answer 1

Perampanel

Question 2

Does perampanel cause a dose dependent side effect of aggression?

Answer 2

Yes

Question 3

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

Answer 3

Adolescents it is about 7.8% and in adults 1.3%

Question 4

What is the most common psychological side effect of perampanel?

Answer 4

Irritability, seen in 11.8%

Question 5

What AEDs have been sown to be effective for JME?

Answer 5

LEV, VPA, TPM, CLB

Question 6

What AED can aggravate seizures in JME?

Answer 6

LTG

Question 7

What AEDs aggravate absence seizures?

Answer 7

CBZ, OXC, GBP, TGB

Question 8

What are the neuropsychological effects of AEDs?

Answer 8

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

Question 9

Can AEDs effect IQ in aldolescents and adults?

Answer 9

No, when used in mono therapy

Question 10

Can AEDs effect IQ in a fetus or young?

Answer 10

Yes

Question 11

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

Answer 11

Dosing above 200 mg/day

Question 12

What AEDS have the lowest risk for congenital malformations?

Answer 12

CBZ, LTG, LEV, and OXC

Question 13

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

Answer 13

HLA-B 1502 in Asians only.

Question 14

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

Answer 14

HLA-A 3101 in a variety is ethnic groups

Question 15

What drugs are mostly renal excreted?

Answer 15

Levetiracetam, gabapentin, and pregabalin

Question 16

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

Answer 16

Drugs that undergo oxidation or glucuronidation

Question 17

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

Answer 17

Valporic acid

Question 18

What AEDs alter oral contraceptive efficacy?

Answer 18

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

Question 19

Congenital malformations are increased with what AEDs?

Answer 19

Valproic acid are dose dependent, and TPM

Question 20

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

Answer 20

Registries have not shown differences between the two.

Question 21

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

Answer 21

Conversion to mono therapy superiority design.

Question 22

What type of proof will the FDA accept for monotherapy?

Answer 22

Only proof of superiority over standard treatment.

Question 23

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

Answer 23

PHE and CBZ

Question 24

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

Answer 24

As high as 15%

Question 25

What other AED has cross-reactivity to CBZ?

Answer 25

Phenobarbital, but less than PHT

Question 26

How does St John's Wort alter AED levels?

Answer 26

Induction of cytochrome P450 enzymes.

Question 27

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

Answer 27

Hypericum perforating, magnesium, calcium, iron or ginkgo

Question 28

When are serum concentrations beneficial to obtain?

Answer 28

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 6. Guiding dose adjustments for AEDs with dose dependent pharmacokinetics- Dilantin

Question 29

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

Answer 29

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

Question 30

How is LTG metabolized?

Answer 30

Glucuronidation

Question 31

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

Answer 31

LTG

Question 32

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

Answer 32

First trimester

Question 33

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

Answer 33

Shortly after delivery

Question 34

When should LTG be monitored during pregnancy?

Answer 34

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

Question 35

What drug significantlyj reduces CBZ?

Answer 35

Grapefruit juice

Question 36

How does grapefruit juice lower CBZ levels?

Answer 36

Lowers absorption.

Question 37

What common antibiotics that inhibit the metabolism of CBZ?

Answer 37

Amoxicillin and macrolides

Question 38

What can be given after surgery that would elevate CBZ?

Answer 38

Dacron

Question 39

How does vigabrin work?

Answer 39

Increasing GABA by GABA trans Amina's inhibition

Question 40

Does vigabatrin block type A type B GABA receptors?

Answer 40

No

Question 41

How does Tiagabine work?

Answer 41

Blocking presynaptic reuptake of GABA

Question 42

What is the mechanism of action of LEV?

Answer 42

Binding of synaptic vesicle protein SV2A

Question 43

What are the signs of CBZ toxicity?

Answer 43

Ataxia, lethargy, dizziness, and nystagmus

Question 44

What antibiotic class reduce clearance of CBZ by blocking metabolism?

Answer 44

Macrolides

Question 45

What are the major side effects of eslicarbazepine?

Answer 45

Dizziness, somnolence, and headaches

Question 46

What are minor side effects of eslicarbazepine?

Answer 46

Hyponatrmia and dermatologist

Question 47

Does eslicarbazepine alter birth control pills?

Answer 47

Yes, lowers the levels

Question 48

What is the major side effect of ezogabine?

Answer 48

Urinary retention

Question 49

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

Answer 49

Modulation of the sodium channel

Question 50

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

Answer 50

OXC was found in 12% versus 3% for CBZ

Question 51

What is the predictive finding hyponatremia with OXC?

Answer 51

The first measurement of sodium was found to be predictive

Question 52

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

Answer 52

Valproic acid and ethosuximide

Question 53

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

Answer 53

LEV, ZNS, VPA, and CBZ

Question 54

What is propofol infusion syndrome?

Answer 54

Severe metabolic acidosis, renal failure, cardiovascular collapse

Question 55

What makes a patient particularly susceptible?

Answer 55

On the Ketogenic diet

Question 56

What evidence exists for effectiveness for cannibidiol?

Answer 56

Anecdotal evidence

Question 57

What is Type A adverse effects?

Answer 57

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

Question 58

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

Answer 58

Hypotension

Question 59

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

Answer 59

Hypoventilation

Question 60

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

Answer 60

Single dose study in volunteers

Question 61

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

Answer 61

Pentobarbital

Question 62

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

Answer 62

Pentobarbital

Question 63

How common is weight gain with VPA?

Answer 63

10% - 70%

Question 64

What are the most common metabolic side effects of VPA?

Answer 64

Insulin resistance and hyperlipidemia

Question 65

How frequent are congenital malformations in VPA exposure?

Answer 65

10%

Question 66

What AEDs are poorly absorbed rectally?

Answer 66

Gabapentin, oxcarbazepine, lorazepam, and phenytoin

Question 67

What AEDs are absorbed well when given rectally?

Answer 67

Topiramate, clonazepam, and levetiracetam

Question 68

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

Answer 68

Ethosuximide

Question 69

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

Answer 69

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

Question 70

In the infant what cation chloride transporter is dominant?

Answer 70

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

Question 71

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

Answer 71

Free VPA levels increase due to competition for protein binding sites

Question 72

What drugs increase free VPA levels?

Answer 72

CBZ, phenytoin, and salicylate

Question 73

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

Answer 73

No

Question 74

Does Perampanel have a black box warning for behavioral reactions?

Answer 74

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

Question 75

What is the mechanism of action is eslicarbazepine?

Answer 75

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

Question 76

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

Answer 76

LEV

Question 77

What factors are associated with VGB and visual effects?

Answer 77

Visual effects increased with duration of exposure and higher cumulative dosage

Question 78

Which AEDs are associated with fewest cognitive side effects?

Answer 78

LTG, LEV LAC, GPB, VGB

Question 79

What are the signs of lamotrigine toxicity?

Answer 79

Double vision, dizziness and ataxia

Question 80

What AEDS do not interact with oral contraceptives?

Answer 80

GBP, LEV, ZNS

Question 81

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

Answer 81

Intramuscular midazolam

Question 82

What AEDs have been associated with spina bifida?

Answer 82

VPA and CBZ

Question 83

What AEDs have no relevant metabolic drug-drug interactions?

Answer 83

GBP, LEV, Pregabalin