Anti-seizure

Question 1

3 mechanisms of current antiepileptic drug action

Answer 1

modulate voltage dependent ion channels; enhance GABA mediated inhibition; suppress excitatory AAs

Question 2

Carbamazepine

Answer 2

Voltage dep. Na+ channel inactivator (inhibit rep. firing AP), generalized tonic-clonic, focal to bilateral tonic clonic, focal aware or impaired awareness

Question 3

Valproate

Answer 3

tonic clonic, absence, myoclonic, focal aware & impaired, focal to bilat tonic clonic; Na+ channel inactivator & T-type Ca++ channel modulator, and works to increase gaba availability for synaptic transmission

Question 4

T-type Ca++ channel

Answer 4

supply pacemaker current underlying thalamic rythym in spikes and waves seen in generalized absence seizures

Question 5

ethosuximide

Answer 5

Ca2+ (t-type) inactivator; generalized absence

Question 6

Phenytoin

Answer 6

Na+ channel inactivator; generalized tonic-clonic, focal aware and impaired; focal to bilateraltonic clonic; can elicit absence seizure; also STATUS EPILEPTICUS

Question 7

Lamotrigine

Answer 7

Na+ channel inactivator; back-up & adjunctive; myoclonic; also GLU inhibitor

Question 8

Topirimate

Answer 8

Na+ channel inactivator; back-up and adjunctive; also Glutaminergic (NDMA AMPA)

Question 9

Zonisamide

Answer 9

Na+ channel inactivator, Back up, adjunct

Question 10

Benzodiazepines

Answer 10

Enhance Gaba a post synaptic inhibitory potential (Cl–)

Question 11

Phenobarbitol

Answer 11

Glutaminergic (NMDA AMPA) block; status epilepticus

Question 12

Flumazenil

Answer 12

Benzo antagonist

Question 13

Zolpidem

Answer 13

acts like a benzo; Gaba A post synaptic enhancer

Question 14

Vigabatrin

Answer 14

enhanced Gaba synaptic transmission, can cause blindness

Question 15

Tigabine

Answer 15

interferes with gat-1 transporter of GABA (inhibits reuptake)

Question 16

Felbamate

Answer 16

NMDA and AMPA glutaminergic block

Question 17

Perampanel

Answer 17

NMDA and AMPA glutaminergic block; new back up drug - don’t need to know

Question 18

Phenobarbital

Answer 18

NMDA and AMPA glutaminergic block; status epilepticus

Question 19

Lorazepam

Answer 19

Status Epilepticus

Question 20

Fosphenytoin

Answer 20

Status Epilepticus

Question 21

Diazepam

Answer 21

Status Epilepticus

Question 22

Phenytoin dosage

Answer 22

10 therapeutic, 20 toxic - narrow window of use. go from 1st order pharmacokinetics to 0 order within the therapeutic dose range (metabolize constant amt instead of constant percentage in given time)