Anti-epileptic Drugs

Question 1

What are the two broad MOA of anti-epileptic drugs?

Answer 1

reduce excitability, increase inhibition

Question 2

What 1 receptor and 2 channels have decreased excitability from anti-epileptic drugs?

Answer 2

Glutamate receptor, Na+ Channel, Ca2+ channel

Question 3

What is the MOA of phenytoin, carbamazepine, oxcarbazepine, and lamotrigine?

Answer 3

stabilize inactive conformation of Na+ channel

Question 4

SE of carbamazepine, oxcarbazepine, lamotrigine?

Answer 4

Rash (rarely Stevens-Johnson); slow initial titration important, may cause contraceptive failure

Question 5

SE of phenytoin?

Answer 5

Rash, gingival hyperplasia, hirsutism, lupus-like reaction, can cause contraceptive failure

Mild myelosuppression, increase LFT
long term- cerebellar degeneration, peripheral neuropathy, osteoporosis

Question 6

What are carbamazepine and oxcarbazepine used to treat?

Answer 6

complex partial seizures, bipolar disorder and neuropathic pain

Question 7

What is Lamotrigine used to treat?

Answer 7

generalized epilepsies, absence seizures, bipolar, neuropathic pain

Question 8

What is phenytoin used to treat?

Answer 8

Acute seizure

tonic/clonic

Question 9

Toxicities related to Phenytoin? EXAM QUESTION

Answer 9

Dizziness, nystagmus, ataxia, incoordination

Question 10

Which three Na+ channel blockers are hepatic enzyme inducers?

Answer 10

phenytoin, carbamazepine, lamotrigine

Question 11

What drug does lamotrigine compete with for excretion?

Answer 11

Depakote (Valproic Acid)

Question 12

Who can absolutely not be taking valproate? possible exam question

Answer 12

Pregnant women- teratogenicity

Question 13

SE of valproate?

Answer 13

weight gain, hair turnover, hyperammonemia, blood dyscrasias, teratogenicity

Question 14

When are benzodiazepines used as anti-epileptic medications?

Answer 14

Status Epilepticus

Question 15

What can valproate be used to treat?

Answer 15

Broad spectrum use in seizures, IV for status epilepticus, bipolar, migraine, cluster headaches

Question 16

Name two drugs besides benzodiazepines that GABAergic and used as anti-epileptics.

Answer 16

Vigabatrin and Tigabine

Question 17

MOA of vigabatrin?

Answer 17

GABA transaminase binder (slows down inrtacellular breakdown of GABA)

Question 18

MOA of tigabine?

Answer 18

GABA reuptake inhibitor

Question 19

MOA of GABA analogs?

Answer 19

Block presynaptic influx of Ca2+

Question 20

Name two GABA analogs.

Answer 20

Gabapentin, Pregabalin

Question 21

SE of gabapentin?

Answer 21

Sedation

Question 22

What are gabapentin and pregabalin used to treat?

Answer 22

adjunct for partial complex epilepsy

neuropathic pain

Question 23

Name two glutamate receptor blockers.

Answer 23

Topiramate and Felbamate

Question 24

MOA of felbamate

Answer 24

Primarily NMDA receptor blocker

May have effect Na, Ca, GABA

Question 25

SE of felbamate?

Answer 25

Aplastic Anemia, Acute Hepatic Failure (not used much anymore)

Question 26

Use of felbamate?

Answer 26

partial onset of seizures, epilepsy

Question 27

MOA of topiramate?

Answer 27

Primarily AMPA and Kainate Ca channel blocker | May have effect Na, and GABA

Question 28

SE of topiramate?

Answer 28

mild metabolic acidosis, kidney stones, modest weight loss, acute glaucoma, sedation

Question 29

Use of topiramate?

Answer 29

partial onset seizures secondary generalized seizures primary generalized epilepsy migraines and cluster headache prevention

Question 30

MOA of ethosuximide?

Answer 30

blocks t-type ca+ channels in thalamo-cortical circuits

Question 31

SE of levetiacetam?

Answer 31

well tolerated, mostly sedation | rarely irritabilty, aphasia, thrombocytopenia

Question 32

Use of ethosuximide?

Answer 32

Absence seizures only

Question 33

SE of ethosuximide?

Answer 33

nausea, sedation, irritability

Question 34

MOA of levetiacetam?

Answer 34

binds synpatic vesicle protein 2, leading to less NT release

Question 35

Use of levetiacetam?

Answer 35

partial onset seizures | secondary generalized seizures

Question 36

Carbamazepine toxicity?

Answer 36

Dizzy (sedation), drunk (Ataxic), double vision (Diplopia)

Question 37

Difference between toxicity and adverse reactions?

Answer 37

Toxicity is based on the expected mechanism of action while adverse reactions are not.