AEDs

Question 1

Which AEDs are indicated for focal seizures?

Answer 1

Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), Eslicarbazepine (Aptiom), Lacosamide (Vimpat), Perampanel (Fycompa)

Aptiom is primarily used as adjunct and Vimpat is expensive!

Question 2

Which AEDs are broad spectrum?

Answer 2

Valproate (Depakote), Lamotrigine (Lamictal), Levetiracetam (Keppra), Clobazam (Onfi), and Topiramate (Topomax)
***Onfi and Topomax mainly used as adjunct

Question 3

Which AEDs are used to treat absence seizures?

Answer 3

1st line: Ethosuximide, 2nd line: Valproate

Question 4

Which AED can be used for atonic seizures?

Answer 4

Rufinamide

Question 5

adverse effects of Carbamazepine? (3)

Answer 5

hyponatremia, aplastic anemia, pancytopenia

Question 6

adverse effects of Clobazam? (1)

Answer 6

somnolence

Question 7

adverse effects of Ethosuximide? (1)

Answer 7

aplastic anemia

Question 8

adverse effects of Felbamate? (2)

Answer 8

aplastic anemia, hepatotoxicity

Question 9

adverse effects of Gabapentin (2)?

Answer 9

edema, dizziness

Question 10

adverse effects of Lacosamide? (1)

Answer 10

PR interval prolongation

Question 11

adverse effects of Lamotrigine (1)

Answer 11

Stevens-Johnson syndrome

Question 12

adverse effects of Levetiracetam (1)?

Answer 12

agitation, somnolence

Question 13

adverse effects of Oxcarbazepine? (3)

Answer 13

hyponatremia, agranulocytosis, pancytopenia

Question 14

adverse effects of Perampanel (1)

Answer 14

aggressive behavior

Question 15

adverse effects of phenobarbital (2)

Answer 15

hepatotoxicity, somnolence

Question 16

adverse effects of phenytoin? (3)

Answer 16

neuropathy, ataxia, gum hyperplasia

Question 17

adverse effects of pregabalin (1)

Answer 17

edema

Question 18

adverse effects of Primidone (2)?

Answer 18

ataxia, vertigo

Question 19

adverse effects of Rufinamide (1)?

Answer 19

shortened QT interval

Question 20

adverse effects of Tigabine? (2)

Answer 20

Steven-Johnson syndrome, agitation

Question 21

adverse effects of Topiramate? (4)

Answer 21

weight loss, cognitive dysfunction, kidney stones, parasthesias

Question 22

adverse effects of Valproate? (1)

Answer 22

irreversible visual field defect

Question 23

adverse effects of Zonisamide? (2)

Answer 23

weight loss, kidney stones

Question 24

Which AEDs are enzyme inducers? (6)

Answer 24

Carbamazepine, Lamotrigine, Oxcarbazepine, Phenobarbital, Phenytoin, Topiramate

Question 25

Which AEDs are enzyme inhibitors? (2)

Answer 25

Felbamate and Valproic Acid

Question 26

What AED when coadministered with Valproate, increases Valproate levels?

Answer 26

Phenytoin; Valproate is 90% protein bound and phenytoin will compete for protein binding

Question 27

Which AED has autoinduction?

Answer 27

Carbamazepine has autoinduction with increased clearance over 2-4 wks

Question 28

Which AEDs reduces the efficacy of OCPs? (4)

Answer 28

Oxcarbazepine (at doses > 900mg/d), Eslicarbazepine, Perampanel (at dose of 12mg, not 8mg), Felbamate

Question 29

Name the Na channel blockers (6)?

Answer 29

Oxcarbazepine, Carbazepine, Eslicarbazepine, Lamotrigine, Phenytoin, Rufinamide

Question 30

How Lacosamide a different Na channel blocker?

Answer 30

blocks NA channels (enhancing slow inactivation, unlike most Na channel blockers that enhance fast Na channel activation)

Question 31

Which AEDs act on GABA? (8)

Answer 31

Valproate, phenobarbital, Clonazepam, Clobazam, Tigabine, Vigabatrin

Question 32

Which AEDs act on Ca channels? (3)

Answer 32

Ethosuximide, Gabapentin, Zonisamide

Question 33

Mechanism of Valproate?

Answer 33

GABA potentiation, blocks Ca channels, blocks Na channels

Question 34

Mechanism of action of Perampenel?

Answer 34

non-competitive AMPA glutamate receptor antagonist

Question 35

Mechanism of action of Primidone?

Answer 35

converted in the liver to phenobarbital and phenylethylmalonamide

Question 36

Mechanism of action of Levetiracetam?

Answer 36

binds to synaptic vesicle protein SV2A

Question 37

Mechanism of action of Felbamate?

Answer 37

NMDA receptor antagonist; GABA enhancement; NA blocker

Question 38

Mechanism of action of Topiramate?

Answer 38

antagonism of AMPA/kainate receptors, augment GABA, block vol gated Na channels

Question 39

Lacosamide has greater efficacy and bioavailability if combined with what type of AEDs?

Answer 39

non-Na channel drugs

Question 40

Comorbid indications of Carbamazepine?

Answer 40

Mood stabilization, trigeminal neuralgia

Question 41

Comorbid indications of Clobazam?

Answer 41

Anxiety

Question 42

Comorbid indications of Gabapentin?

Answer 42

neuropathy, postherpetic neuralgia

Question 43

Comorbid indications of Lamotrigine?

Answer 43

Mood stabilization

Question 44

Comorbid indications of Pregabalin?

Answer 44

Neuropathy, fibromyalgia neuropathic pain

Question 45

Comorbid indications of Primidone?

Answer 45

essential tremors

Question 46

Comorbid indications of Topiramate?

Answer 46

Migraine

Question 47

Comorbid indications of Valproate?

Answer 47

Migraine, mood stabilization