anti seizure drugs

Question 1

what is the mechanism for Bilateral tonic-clonic (aka primary generalized onset seizures)

Answer 1

Initiation occurs locally with loss of GABA inhibitory tone, propagation due to decreased GABA tone over large area / increased response to glutamate / Na+-channel excitation

Question 2

what is the mechanism for absence seizures

Answer 2

Related to oscillatory stimulation of thalamic-cortical circuitry; inappropriate activation of low-threshold T-type Ca++ channels

Question 3

what are the 3 primary drugs to treat Primary Generalized Tonic-Clonic seizures

Answer 3

Valproate OR Lamotrigine OR Levetiracetam

Question 4

what are the 2 primary drugs for absence seizures

Answer 4

Ethosuximide OR Valproate

Question 5

what are the 3 drugs for Myoclonic seizures

Answer 5

Valproate
Lamotrigine
Clonazepam

Question 6

what drugs can make myoclonic seizures worse

Answer 6

gabapentin and carbamazepine

Question 7

what 4 AED’s block voltage dependent sodium channels and reduce repetitive firing, thus better at controlling tonic-clonic seizures

Answer 7

Phenytoin,
carbamazepine,
lamotrigine,
topiramate

Question 8

what does ethosuximide do?

Answer 8

Decreases low-threshold Ca++ (T-type) current (oscillatory responses in thalamic neurons). These Abnormal currents are involved in absence seizures;

Question 9

Levetiracetam binds to and inhibits function of synaptic vesicle protein ______ in Ca++-mediated neurotransmitter release. Relation to antiseizure action is uncertain

Answer 9

SV2A

Question 10

Rash & gingival hyperplasia are side effects of which drug?

Answer 10

Phenytoin

Question 11

Levetiracetam has no ______ drug metabolism, and minimal drug interactions

Answer 11

P450

Question 12

•Levetiracetam is First-line drug in treatment of generalized ______ seizures and partial onset seizures

Answer 12

tonic-clonic

Question 13

Topiramate is Used as adjunctive therapy in _______ seizures

Answer 13

partial

Question 14

in which drug is Renal stones possible (due to mild carbonic anhydrase inhibitor).

Answer 14

Zonisamide

Question 15

________ Inhibits Na+ channel function via enhancement of slow inactivation without blocking channel directly in contrast to other AEDs that prolong fast inactivation

Answer 15

Lacosamide

Question 16

Drug of choice in absence (petit mal) seizures is ______

Answer 16

Ethosuximide

Question 17

Valproic acid Limits activity of _______

Answer 17

T-type Ca++-channels

Question 18

Valproic Acid has drug interactions with Aspirin / warfarin that can _____.

Answer 18

inhibit platelet aggregation

Question 19

which drug is Designed as a lipid-soluble GABA analog to cross blood brain barrier, but does not act directly at GABA receptors. Binds to α2δ subunit of voltage-sensitive Ca++ channels, may act to decrease synaptic release of glutamate producing its anticonvulsant activity

Answer 19

GABApentin

Question 20

define Status Epilepticus

Answer 20

state of recurrent major motor seizures between which a patient does not regain consciousness

Question 21

describe the Initial therapy for status epilepticus

Answer 21

IV lorazepam, until seizures stop or 20 mg given, then start phenytoin or fosphenytoin NTE 50 mg/min (20 mg/kg IV push or infusion), slow infusion if hypotensive

Question 22

Which 2 anti-seizure drugs may have the highest risk for fetal malformations.

Answer 22

Valproate and phenobarbital

Question 23

Risk of birth defects (cleft palates, skeletal abnormalities, CNS/cardiac problems) _____ higher if mother on anticonvulsants, but ______ deliver normal babies

Answer 23

2-3-fold ,

> 90%

Question 24

what are the main side effects of Phenobarbital

Answer 24

Irritability and overactivity in many children,
sedative effects in others (tolerance can develop).
May interfere with learning (cognitive deficits)

Question 25

the Most common dose-related side effects of Valproic acid are _________

Answer 25

GI complaints (nausea, vomiting, pain, “heartburn”)