Anti-Epileptics and Anti-Depressants

Question 1

ethosuximide

Answer 1

absence seizure; block T-type Ca channels in the thalamus, preventing spike-wave; side fx: fatigue, GI, headache

Question 2

phenytoin

Answer 2

partial and TC; prolong refractory period of voltage-gated Na channels in a use-dependent manner; 1st order –> 0 order metabolism; drug interactions, gingival hyperplasia, excessive hair growth

Question 3

carbamezipine

Answer 3

partial and TC; prolong refractory period of voltage-gated Na channels in a use-dependent manner; + mood effects

Question 4

gabapentin

Answer 4

partial and TC; alpha-2-delta Ca channels

Question 5

valproaic acid

Answer 5

all seizures; mechanism unclear; + mood effects; side fx: GI, liver, pancreas; TERATOGEN

Question 6

lamotrigine

Answer 6

all seizures, prolong refractory period of voltage-gated Na channels; side fx: rash (10% SJS)

Question 7

levetiracetam

Answer 7

all seizures; SV2A synaptic vesicle protein

Question 8

lorazepam

Answer 8

status epilepticus; increase GABAnergic neuron, short-acting; side fx: sedation, tolerance, dependence

Question 9

diazepam

Answer 9

status epilepticus; increase GABAnergic neuron activity, long-acting; side fx: sedation, tolerance, dependence

Question 10

non-pharmalogical therapies

Answer 10

1) ketogenic diet 2) surgical resection (focal seizures) 3) vagus nerve stimulator 4) deep brain stimulator (anterior nucleus of the thalamus) 5) response neurostimulator

Question 11

fluoxetine

Answer 11

SSRI (non-pure), long half-life, active metabolite, CYP2D6 inhibitor, aka Prozac

Question 12

sertraline

Answer 12

SSRI (non-pure), aka Zoloft

Question 13

citalopram

Answer 13

SSRI (pure)

Question 14

escitalopram

Answer 14

SSRI (pure)

Question 15

duloxetine

Answer 15

balanced combination NE and serotonin reuptake inhibitor

Question 16

venlafaxine

Answer 16

primarily SSRI at low dose, becomes SNRI at high dose, comes in IR/XR side fx: high BP

Question 17

mirtazapine

Answer 17

5-HT2A receptor blocker; side fx: weight gain, sedation

Question 18

buproprion

Answer 18

NDRI, can be used for smoking cessation, side fx: increased seizure risk, irritability

Question 19

phenelzine

Answer 19

MAOI, drug interaction w/ SSRI, meperidine (HTN crisis)

Question 20

tranylcypromine

Answer 20

MAOI, drug interaction w/ SSRI, meperidine (HTN crisis)

Question 21

serotonergic side effects

Answer 21

sexual dysfunction, sleep disturbance, GI upset

Question 22

noradrenergic side effects

Answer 22

tachycardia, tremor, constipation, dry mouth

Question 23

dopaminergic side effects

Answer 23

psychomotor activation

Question 24

tricyclic antidepressants

Answer 24

NRI

Question 25

phases of tx for depression

Answer 25

acute: 10-12 weeks; maintenance: 6-12m sx-free; continuation: years- life

Question 26

lithium

Answer 26

tx for mania; anti-suicidal; narrow therapeutic window; kidney excretion; side fx: tremor, delirium, ataxia

Question 27

quetiapine

Answer 27

atypical antipsychotic, receptor blocker

Question 28

treatment for mania

Answer 28

lithium, anti-epileptics, antipsychotics in COMBO