Anti-epileptic drugs

Question 1

Brief recurrent myoclonic jerks of body with sudden flexion or extension of the body and limbs that presents before 1 yo

Answer 1

Infantile spasms/West syndrome

Question 2

Severe myoclonic epilepsy in infancy

Answer 2

Dravet syndrome

Question 3

More than 5 minutes of generalized convulsive seizure, or 2+ seizure episodes without recovery of consciousness in between

Answer 3

Status epilepticus

Question 4

Drugs for epilepsy that act on Na channels

Answer 4

Phenytoin
Carbamazepine
Lamotrigine
Topiramate
Valproic acid

Question 5

Drugs for epilepsy that act on Ca channels

Answer 5

Ethosuximide
Valproic acid

Question 6

Strategies of epilepsy treatment

Answer 6

-stabilize membrane by blocking voltage-gated channels to prevent depolarization
-Increase GABA-ergic transmission
-Decrease excitatory glutamate transmission

Question 7

Mechanism of phenobarbitone

Answer 7

Potentiation of synaptic inhibition through action on GABA-A receptors by prolonging opening of Cl channels

Question 8

Toxicity of phenobarbitone

Answer 8

Sedation
Nystagmus and ataxia
Rashes
Megaloblastic anemia
Osteomalacia

Question 9

Drugs for generalized tonic clonic seizures

Answer 9

Phenobarbitone
Phenytoin
Carbamazepine **
Valproic acid
Zonisamide
Topiramate
Parampanel (adjuvant)

Question 10

Drugs for simple partial/focal aware seizures

Answer 10

Phenobarbitone
Phenytoin
Lacosamide
Carbamazepine **
Valproic acid
Tiagabine (adjuvant)
Vigabatrin (adjuvant)
Zonisamide
Levetiracetam
Topiramate
Parempanel (adjuvant)

Question 11

Drugs for complex partial/focal impaired awareness

Answer 11

Phenobarbitone
Phenytoin
Lacosamide
Carbamazepine
Valproic acid
Lamotrigine (adjuvant)
Levetiracetam

Question 12

Drugs for status epilepticus

Answer 12

Phenobarbitone (IM or IV)
Phenytoin

Question 13

Prodrug of phenobarbital

Answer 13

Primidone

Question 14

Mechanism of phenytoin/dilantin

Answer 14

Limits the sustained high frequency repetitive firing of APs

Slows the rate of recovery of voltage activated NA channels

Question 15

Pharmacokinetics of phenytoin

Answer 15

Highly protein bound
Microsomal enzyme inducer
Metabolism shifts from first order to zero order kinetics (saturation kinetics)

Question 16

Adverse effects of phenytoin

Answer 16

Gum hypertrophy
Hirsutism
Coarse facial features
Acne
Drug induced lupus
Megaloblastic anemia
Osteomalacia

Question 17

Epilepsy drug that can cause fetal hydantoin syndrome if taken in pregnancy

Answer 17

Phenytoin

Question 18

Therapeutic range of phenytoin

Answer 18

10-20 mcg/mL

Question 19

Additional use of phenytoin, other than epilepsy

Answer 19

Trigeminal neuralgia

Question 20

IV form of phenytoin

Answer 20

Fosphenytoin

Question 21

Mechanism of lacosamide

Answer 21

Na channel blocking antiseizure drug

Question 22

Mechanism of carbamazepine

Answer 22

Inhibits high frequency repetitive firing by prolonging the inactivated state of Na channels

Question 23

Adverse effects of carbamazepine

Answer 23

Drowsiness
Vertigo
Ataxia
Diplopia
Blurred vision
Hyponatremia and water intoxication
Idiosyncratic reactions –> agranulocytosis and aplastic anemia

Question 24

Most effect drug for complex partial/focal impaired awareness

Answer 24

Carbamazepine

Question 25

First choice drug for general tonic-clonic and simple partial/focal aware seizures

Answer 25

Carbamazepine

Question 26

Other, non epileptic, uses for carbamazepine

Answer 26

Neuralgias Bipolar disorder Acute mania

Question 27

Drug interactions of carbamazepine

Answer 27

Induces microsomal enzymes Metabolism inhibited by macrolide antibiotics

Question 28

Less potent analog of carbamazepine

Answer 28

Oxcarbazepine

Question 29

Mechanism of ethosuximide

Answer 29

Primarily on thalamocortical system that selectively inhibits low threshold, high amplitude, T type Ca current

Question 30

Toxicity of ethosuximide

Answer 30

Gastric distress Lethargy and fatigue Hypersensitivity Drug induced lupus

Question 31

Drugs used for absence seizures

Answer 31

Ethosuximide Valproic acid Clonazepam

Question 32

Mechanism of valproic acid

Answer 32

Inhibits sustained repetitive firing, reduces low threshold T type Ca current, and increases levels of GABA

Question 33

Toxicity of valproic acid

Answer 33

Transient GI symptoms Alopecia Curling of hair Rashes Stimulation of appetite Fulminant hepatitis Hyperammonemia

Question 34

Effect of using valproic acid in pregnancy

Answer 34

NTDs

Question 35

Drugs used in myoclonic and atonic seizures

Answer 35

Valproic acid

Question 36

Other, non-epileptic, uses of valproic acid

Answer 36

Bipolar disorder Mania

Question 37

Mechanism of felbamate

Answer 37

Block NMDA receptor

Question 38

Side effects of felbamate

Answer 38

Aplastic anemia Severe hepatitis at unexpectedly high rates

Question 39

Third-line drug for refractory partial seizures

Answer 39

Felbamate

Question 40

Drugs for Lennox-Gestaut syndrome

Answer 40

Valproic acid Felbamate Clobazam

Question 41

Medications used for emergency control of convulsions in status epilepticus, tetanus, or eclampsia

Answer 41

Diazepam Lorazepam

Question 42

Add on drugs for partial and general tonic-clonic seizures

Answer 42

Gabapentin Pregabalin

Question 43

Mechanism of gabapentinoids

Answer 43

Bind to alpha-2-delta, decreasing glutamate

Question 44

Mechanism for tiagabine

Answer 44

Inhibitor of GABA uptake

Question 45

Drug of choice for infantile spasms

Answer 45

Vigabatrin

Question 46

Mechanism of lamotrigine

Answer 46

Blocks Na channels Prevents release of excitatory NTs

Question 47

Toxicity of lamotrigine

Answer 47

Rash Stevens-Johnson syndrome

Question 48

Mechanism of levetiracetam

Answer 48

Binds selective to SV2A, reducing the release of the excitatory NT glutamate

Question 49

Pharmacokinetics of levetiracetam

Answer 49

Not metabolized by cytochrome P450 No interactions with other antiepileptics

Question 50

Mechanism of topiramate

Answer 50

Block Na channels Potentiates actions of GABA May also block glutamate receptors

Question 51

Side effects of topiramate

Answer 51

Kidney stones

Question 52

Mechanism of parempanel

Answer 52

Selective non-competitive antagonist of AMPA receptors

Question 53

Only approved uses of cannabidiol

Answer 53

Dravet syndrome Lennox-Gestaut syndrome

Question 54

Drug interactions of carbamazepine

Answer 54

Phenytoin Valproate Macrolide antibiotics Phenobarbital

Question 55

Side effect of lacosamide

Answer 55

Small increase in PR interval

Question 56

Drug interactions of phenytoin

Answer 56

Phenobarbital Carbamazepine OCPs Valproate

Question 57

Interactions of phenobarbital

Answer 57

Valproate Carbamazepine Phenytoin Steroids