Anti-Epileptic

Question 1

Na+channel inactive state stabilizers

Answer 1

1. Phenytoin
2. Carbamazepine
3. Oxcarbamazepine
4. Lamotrigine

Question 2

Phenytoin: indication?

Answer 2

1. Tonic-Clonic of Primary generalized
2. Partial onset
3. Secondarily generalized
4. Effective for acute seizures (even non epilepsy)
5. Less effective for absence, atonic and myoclonic seizures

Question 3

Phenytoin: unique side-effects

Answer 3

1. gingival hyperplasia
2. contraceptive ineffective bc enzyme inducer
3. hirsutism
4. lupus like rxn
5. IV can cause hypotension (status epilepticus use?)

Question 4

Carbamazepine: indication?

Answer 4

1. most effective= COMPLEX PARTIAL
2. bipolar
3. neuropathic pain

Question 5

carbamazepine: unique side effects

Answer 5

1. highly binds protein
2. contaceptive use inefective
3. epoxide metabolite causes SE
4. increase LFTs, myelosuppression

Question 6

oxcarbamazepine:

Answer 6

same indication as carbamazepine

Question 7

oxcarbamazepine:side effects

Answer 7

1. less protein bound
2. less toxic
3. longer half-life

Question 8

Lamotrigine: iindications

Answer 8

1. Primary generalized epilepsy
2. Absence -only 1 indicated for kids
3. partial complex and secondary gen
4. bipolar
5. neuropathic pain

Question 9

Lamotirigine: SE unique

Answer 9

1. may exacerbate myoclonic seizures
2. competes with valproic acid for excretion
3. synergistic w. depakote (valproic acid)
4. contraceptive failure
5. titrate slow

Question 10

Na+ channel blockers- general side-effects (toxic)

Answer 10

1. ataxia, diplopia, sedation

Question 11

Na+ channel blockers- general side-effects

Answer 11

1. RASH (rare SJS)
2. contraceptive ineffective-enzyme inducers
3. mild myelosuppression (all cept lamotrigine)

Question 12

GABA-A System: drugs

Answer 12

increases chloride channel hyperpolarization

1. phenobarb and benzos
2. Vigabatrine
3. Tiagabine

Question 13

Benzos: actions

Answer 13

1. bind gaba-a receptor
2. dose limited by sedation
3. long use limited by tolerance
4. Used in status epilepticus
5. shortacting due to redistribution
6. Midazolam-IV used in anesthesia and refractory status epilipticus

Question 14

Vigabatrine

Answer 14

Gaba transaminase binder

Question 15

Tigabine

Answer 15

Gaba re-uptake inhibitor

Question 16

Valproic Acid:general

Answer 16

1. not sure mech
2. works on all types of seizures- absence tonic, clonic, primary generalized, secondary generalized
3. bipolar
4. migraine prophylaxis

Question 17

Valproic Acid: SE

IV IN STATUS EPILIPTICUS

Answer 17

1. hair loss
2. weight gain
3. teratogen
4. increased ammonia

Question 18

Ca channel blockers: include

Answer 18

1. block presynaptic ca channels
2. gabapentin, pregabalin
3. Ethuxsomide
4. Topiramate,
5. Felbamate
6. also treat neuropathic pain

Question 19

gabapentin and pregabalin

Answer 19

1. Gaba analogs
2. block HIGH VOLTAGE TYPE ca channels
3. adjunct therapy for PARTIAL COMPLEX
4. more commonly used for neuropathic pain

Question 20

Gabapentin: pharm considerations

Answer 20

1. toxicity related to sedation
2. no serious organ toxicity
3. no evidence of metabolism

Question 21

Ethosuximide: General

Answer 21

1. T-type Ca channel blockers, against thalamocortical system
2. effective against absence seizures only
3. 40-60 hrs
4. not protein bound, minimal first pass metabolism

Question 22

Ethoxsumide: SE

Answer 22

nausea, sedation, irritability

Question 23

Topiramate: Indication

Answer 23

1. Glutamate receptor blocker: Partial AMPA, kainate Ca receptor
2. Na and GABA receptor activity
3. partial, primary and secondary generalized
4. Migraine prophylaxis
5. some carbonic anhydrase activity

Question 24

Topiramate: Unique SE

Answer 24

1. word finding
2. sedation
3. tingling
4. metabolic acidosis

Question 25

Levitiracetam

Answer 25

1. parital, secondary generalized, some primary gen
2. BINDS TO SYNAPTIC VESICLE 2
3. well tolerated but sedating
4. aphasia, thrombocytopenia, irritability