Anti-Seizure Drugs

Question 1

Partial Seizure Drugs (6)

Answer 1

Traditional: Phenytoin, Carbamazepine, Valproate
New: Lamotrigine, Topiramate, Lacosamide

Question 2

Generalized Tonic-Clonic Seizure Drugs

Answer 2

Traditional: Phenytoin, Carbamazepine, Valproate (same as partial)
New: Levitiracetam, Topiramate

Question 3

Absence Seizure Drugs (2)

Answer 3

Traditional: Ethosuximide, Valproate

Question 4

Myclonic Seizure Drugs (2)

Answer 4

Traditional: Phenobarbitol, Valproate
New: Levetiracetam

Question 5

Status Epileptic Drugs

Answer 5

T: Phenobarbitol
N: Lorazepam

Question 6

Major anti-epileptic drug mechanisms (3)

Answer 6

1) diminish glutaminergic excitation
2) Increase GABA for inhibition of excitation
3) Modify ion channels- inhibit Na or Ca channels to hyperpolarize

Question 7

Phenytoin

Answer 7

-alters Na/K/Ca channels, GABA and glutamate
Drug interactions: valproate (both bind albumin), birth control (induces metabolization)
Toxicity: diplopia, nystagmus, gingival hyperplasia, hirsutism
Long term effects: facial features, peripheral neuropathy, osteomalacia

Question 8

Carbamazepine

Answer 8

Mechanism: inhibits Na channels
-treats partial and GTC seizures
-CYP3A4 metabolized
Drug interactions: CYP3A4 inducers (valproate, phenytoin, phenobarbitol), and induces for them
Adverse Effects: Drowsiness, diplopia, headache, dizziness, ataxia, nausea. Interfere with learning. Leukopenia, thrombocytopenia. Rash. Can induce SJS (Steven Johnson Syndrome) in asians.

Question 9

Valproic Acid

Answer 9

Mechanism: inhibits Na/Ca channels, excites GABA
-used for myclonic seizures but works for most
Drug interactions: inhibits metabolism of phenobarbitol, phenytoin, lamotrigine, lorezapam. Can displace others from albumin
Adverse Effects: GI (nausea, vomiting), CNS (sedation, ataxia, tremor), hair thinning, thrombocytopenia, hepatic transaminase elevation/fulminant hepatitis, pancreatitis. TERATOGENIC

Question 10

Ethosuximide

Answer 10

Mechanism: blocks Ca channels
-Used for absence seizures
Drug Interactions: valproic acid can decrease clearance
Side effects: GI, fatigue, headache, skin reactions, SJS, lupus, thrombocytopenia, leukopenia,

Question 11

Phenobarbitol

Answer 11

Mechanism: everything
Interactions:
Adverse: Sedation (unlike phenytoin), nystagmus, ataxia, irritability, rash, osteomalacia

Question 12

Infancy Seizure Drugs (4)

Answer 12

Primidone, phenobarbitol, marijuana, vigabatrin