anti-epileptic drugs

Question 1

Benzodiazepines exert their anti-convulsant effect by acting on or through:

a. Ca2+ channels
b. GABA transaminase
c. Na+ channels
d. GABA receptors

Answer 1

d. GABA receptors

Question 2

Which is INCORRECT for partial seizures?

a. have tonic clonic contractions of the musculature
b. they show automatism
c. consciousness is altered
d. a large proportion originate in the temporal lobe

Answer 2

a. have tonic clonic contractions of the musculature (refers to generalised seizures)

Question 3

Which statement is true for valproate?

a. is safe during pregnancy
b. it targets and inhibits GABA transaminase
c. is restricted only for absence type generalized seizures
d. it inhibits high voltage activated Ca2+ channels

Answer 3

b. it targets and inhibits GABA transaminase (GABA-T)

Question 4

Which statement is INCORRECT for ethosuximide?

a. it inhibits T-type Ca2+ channels
b. it causes drowsiness as an adverse effect
c. it is a first-line agent for absence seizures only
d. it is an analogue of GABA

Answer 4

d. it is an analogue of GABA

Question 5

Which statement for lamotrogine is CORRECT?

a. it results in insomnia and agitation
b. it targets and inhibits voltage dependent Na+ channels
c. it is exclusively used in absence seizures
d. it is a GABA-transaminase inhibitor

Answer 5

b. it targets and inhibits voltage dependent Na+ channels

Question 6

what is MOA of valproate?

Answer 6

MOA: inhibit GABA transaminase –> stop breakdown of GABA in presynaptic neuron

Question 7

which AED has difficult pharmacokinetics and what is its MOA?

Answer 7

Phenytoin
MOA: Na+ channel blocker –> Block high frequency firing through Na+ channels

Question 8

What drug is indicated in absence (petit mal) seizure and what is its MOA?

Answer 8

Ethosuximide
MOA: Ca2+ channel blocker –> selectively block T-type Ca2+ channels (within thalamus)

Question 9

which two AEDs are teratogenic?

Answer 9

valproate and phenytoin

valproate (neural tube defects)
phenytoin (cleft palate, congenital heart defects)

Question 10

what drug is associated with acne, hirsutism, gingival hyperplasia and birth defects (cleft palate, congenital heart defect)?

Answer 10

phenytoin

Question 11

what are the first line drugs for partial seizures?

Answer 11

Valproate (GABA-T)
Carbamazepine (Na+ channels)

Question 12

what are the first line drugs for generalised tonic clonic seizures?

Answer 12

Valproate (GABA-T)
Lamotrigine (Na+ channels)

Question 13

what are the first line drugs for absence (petit mal) seizure?

Answer 13

Ethosuximide (T-type Ca2+ channels)
Valproate (GABA-T)

Question 14

what is Tiagabine?

Answer 14

GABA reuptake antagonist

Question 15

what is the MOA of Carbamazepine and phenytoin?

Answer 15

Na+ channel blocker

Question 16

what drug inhibits T-type Ca2+ channels?

Answer 16

Ethosuximide

Question 17

which of the following anti-epileptics has a narrow therapeutic window?

a. carbamazepine
b. valproate
c. phenytoin
d. phenobarbitone

Answer 17

c. phenytoin

Question 18

what are the side effects of valproate?

Answer 18

1. weight gain
2. teratogenic (neural tube defects)
3. tremors

Question 19

what anti-epileptic drugs can be used for neuralgia / neuropathic pain?

Answer 19

HVA Ca2+ channel blockers:
1. gabapentin
2. pregabalin

Question 20

what is status epilepticus?

Answer 20

seizure that lasts for more than 5min
more than 1 seizure within 5min

Question 21

how to treat status epilepticus?

Answer 21

IV benzodiazepine

Question 22

what anti-epileptic drug causes gingival hyperplasia?

Answer 22

phenytoin

Question 23

Benzodiazepines are first-line drugs for status epilepticus, these drugs: (more than one choice to be selected)

a. Status epilepticus is defined as a seizure of 5 min or more without recovery
b. Have a high risk of congenital abnormalities
c. Inhibit GABAergic transmission
d. Have first order elimination kinetics

Answer 23

a. Status epilepticus is defined as a seizure of 5 min or more without recovery
d. Have first order elimination kinetics

Question 24

Which drug is the first line treatment in neonates?

a. phenobarbitone
b. valproate
c. lamotrigine
d. carbamazepine

Answer 24

a. phenobarbitone

Question 25

Which drug, in addition to blocking high frequency firing through Na+ channels, also interferes with glutamate release and activation of excitatory receptors?

a. lamotrigine
b. vigabatrin
c. valproate
d. tiagabine

Answer 25

a. lamotrigine

Question 26

I am a drug used to treat infantile spasms. I can cause irreversible vision loss.

a. valproate
b. vigabatrin
c. phenobarbitone
d. tiagabine

Answer 26

b. vigabatrin