Anti-Epileptics

Question 1

Seizures are a ______ event due to an abnormal, hypersynchronous discharge from a mass of CNS neurons. It has diverse manifestations ranging from convulsion (observable) to an experience (subjective).

Answer 1

paroxysmal

Question 2

A Single seizure due to \_\_\_\_\_\_\_\_\_\_  (i.e. provoked) is not necessarily epilepsy. They may include: 
\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
Pyrexia
Sleep deprivation

Answer 2

1 a correctable or avoidable circumstance

2. Alcohol
3. Hypoglycemia

Question 3

These have a lower Risk of being Epilepsy: Single Seizure, Normal ____ and ______.

Answer 3

1. EEG

2. Brain scan

Question 4

These have a higher Risk of being Epilepsy: ______ Seizures, ____ EEG and abnormal brain scan.

Answer 4

1. Previous (undiagnosed) seizures

2. Epileptiform

Question 5

Seizures occur due to unbalanced ______ and ______ receptor / ion channel function which favour depolarization, leading to dysregulated discharge.

Answer 5

1. excitatory

2. inhibitory

Question 6

Causes of Epilepsy include: 
Congenital or hereditary
Brain injury, scarring or \_\_\_\_\_\_
\_\_\_\_\_\_\_\_: meningitis or encephalitis
Blood \_\_\_\_\_ alterations
Metabolic disorders, eg., adrenal insufficiency leading to \_\_\_\_\_\_\_\_\_\_

Answer 6

1. tumor
2. glucose
3. Infections
4. hyponatremia

Question 7

Generalized seizures generally involve whole brain and loss of consciousness. They include 4 different types. They are: 1. _____ (most dramatic type in movies), 2. ______ (zoning out), 3. Myoclonic and 4. Atonic.

Answer 7

1. Tonic clonic

2. Absence

Question 8

Partial seizures can be _____ (unimpaired consciousness) or _____ (impaired consciousness).

Answer 8

1. simple

2. complex

Question 9

_________ is a serious form of seizure (5 or more mins of seizure before recovery and enters another episode of seizure right away (medical emergency).

Answer 9

Status epilepticus

Question 10

The rationale of antiepileptics is to ______ by altering Na+ and Ca2+ conductance during action potentials. This is done by enhancing effects of _________ neurotransmitters. We must note that not all compounds are effective against all types of seizures.

Answer 10

1. decrease membrane excitability

2. inhibitory GABA (mainly GABA-A)

Question 11

Phenytoin is suitable for all types of seizures except ______seizures. It exerts its effect via Blockade of ________ channels.

Answer 11

1. absence

2. voltage-dependent Na+

Question 12

Phenytoin has a relative narrow therapeutic range (plasma concentration 40-100μM) shows _____ kinetics and is contraindicated in _____ women.

Answer 12

1. saturation

2. pregnant (teratogenic)

Question 13

Carbamazepine is suitable for all types of seizures except ______seizures. It exerts its effect via Blockade of ________ channels.

Answer 13

1. absence

2. voltage-dependent Na+

Question 14

Carbamazepine is a CYP450 _____ , T½ shortens with repeated doses, accelerating elimination of other drugs. One potentially fatal side effect is ______

Answer 14

1. inducer

2. Aplastic anemia

Question 15

Valproate is suitable for all types of seizures except ______seizures. It exerts its effect via Blockade of ________ channels.

Answer 15

1. (none), works for all seizures, including Absence

2. voltage-dependent Na+ and Ca2+

Question 16

Valproate inhibits ______ , increasing GABA levels. It is Strongly bound to plasma proteins which allows it to ________________.

Answer 16

1. GABA transaminase

2. displace other antiepileptics

Question 17

Some dose related side effects of antiepileptics include: drowsiness, confusion, _______, _____, slurred speech, nausea, unusual behavior, mental changes, coma.

Answer 17

1. nystagmus

2. ataxia

Question 18

Some non- dose related side effects of antiepileptics include _____, acne, gingival hyperplasia, _____deficiency, osteomalacia, _______ reactions (including Stevens-Johnson syndrome)

Answer 18

1. hirsutism
2. folate
3. hypersensitivity

Question 19

BZDs can be used to treat epilepsy via _____ inhibitory GABA neurotransmitters.

Answer 19

potentiating effects of

Question 20

Long acting BZDs have a duration of ____ but are not 1st line in treating epilepsy as they have ______.

Answer 20

1. 1 - 3 days

2. high addictive potential

Question 21

Intermediate acting BZDs have a duration of ____.

Answer 21

10-20hrs

Question 22

Short acting BZDs have a duration of ____ but are usually not used for chronic antiepileptic use as multiple doses = more ______ and _______.

Answer 22

1. 3 - 8hrs
2. side effects
3. addiction

Question 23

Antiepileptic drug treatment strategy should be individualized according to the seizure ____, _______ syndrome, co-medication, comorbidity and the individual’s ______ (and/or those of their family and/or carers as appropriate).

Answer 23

1. type
2. epilepsy
3. lifestyle and preferences

Question 24

Patients should be commenced on _______ initially. Should the patient develop an adverse reaction or if the initial __________ is unsuccessful, _______________ should be tried.

Answer 24

1. monotherapy
2. monotherapy
3. monotherapy using another drug

Question 25

We want to start at _____ dose and ______ as epilepsy is a chronic lifelong condition. (prevent long term adverse effects from chronic dosing)

Answer 25

1. lowest

2. monotherapy

Question 26

All antiepileptic drugs licensed for monotherapy have _____ in newly diagnosed epilepsy. For this reason, the medicine the prescribing physicians are most familiar with can be used.

Answer 26

similar efficacy

Question 27

Carbamazepine, phenytoin and sodium valproate can be considered first line treatments for newly diagnosed _______ and ___________ seizures.

Answer 27

1. partial

2. generalized tonic clonic

Question 28

Routine checking of antiepileptic drug levels without _______ is not required, and is ______.

Answer 28

1. a clear clinical indication

2. not cost effective

Question 29

Antiepileptic drug levels may help clinical management under the following clinical indications:

(1) Assessment of ________ to drug treatment for patients with refractory epilepsy
(2) Assessment of ______ due to possible antiepileptic drug toxicity
(3) _______ of phenytoin dose.

Answer 29

1. compliance
2. symptoms
3. Titration

Question 30

The following present increased risk for breakthrough seizures:
– ________ to antiepileptic medication or drug
– Interactions with antiepileptic medications lowering blood levels of antiepileptic drugs. (i.e. ______)
– _____ abuse
– _____ deprivation
– Concurrent illness

Answer 30

1. Non-compliance
2. Valproate
3. Alcohol
4. Sleep

Question 31

Plan for a 35 year old female presenting with a Single seizure, CT normal and EEG normal?

Answer 31

Observe as 60-70% chance of unnecessary treatment/side effects, 30-40% chance of recurrence.
Treatment unlikely to alter long term prognosis.

Question 32

Plan for a 29 year old newly married female. Newly diagnosed epilepsy. Which 1st line antiepileptic should we give and what are things to consider?

– Phenytoin
– Carbamazepine
– Valproate

Answer 32

Phenytoin is teratogenic.
Consider Efficacy, safety, cost effectiveness (1st line meds are cheaper).
Use lowest dose of C or V (both 1st line) which control seizures.

Question 33

When it comes to epilepsy, we must “Treat the _____, NOT the ______”.

Answer 33

1. patient

2. numbers