Anticonvulsants

Question 1

Partial Simple Seizure Treatment

Answer 1

Primary: Phenytoin, Carbamazapine, Lamortigine, Levetiracetam

Secondary: Phenobarbitol, Gabapentin

Question 2

Partial Complex Seizure Treatment

Answer 2

Primary: Phenytoin, Carbamazapine, Lamortigine, Levetiracetam

Secondary: Gabapentin

Question 3

Generalized Tonic-Clonic Seizure Treatment

Answer 3

Primary: Phenytoin, Carbamazapine, Lamortigine, Levetiracetam

Secondary: Phenobarbitol, Valproic Acid

Question 4

Generalized Absence Seizure Treatment

Answer 4

Primary: Ethosuximide

Secondary: Clonazepam, Valproic Acid

Question 5

Generalized Myoclonic Seizure Treatment

Answer 5

Primary: Clonazepam, Valproic Acid, Levetiracetam

Secondary: Lamortigine

Question 6

Generalized Febrile Seizure Treatment

Answer 6

Primary: Phenobarbitol

Secondary: Primidone

Question 7

Generalized Status Epilepticus Treatment

Answer 7

Primary: Phenytoin, Diazepam

Secondary: Phenobarbitol

Question 8

Generality: Na Channel Inhibitors

Answer 8

Carbamazepine, Phenytoin, Lamotrigine, Valproic acid

Prolonged refractory state

Question 9

Generality: Ca Channel Inhibitors

Answer 9

Ethosuximide, Valproic acid

Question 10

Generality: Enhanced Inhibitory GABA

Answer 10

Barbiturates (phenobarbital, primidone)

Benzodiazepines (diazepam, lorazepam, clonazepam)

Valproic acid

Also Tiagapine which inhibits GABA reuptake

Question 11

Phenytoin

Answer 11

Drug of choice –> CYP450 saturation can occur

Uses: Partial (simple and complex) and Tonic-Clonic (Oral)

Emergency use in Status Epilepticus (IV)

Fosphenytoin is a prodrug that can be used

Carbamazepine = stimulates breakdown
Chloramphenicol, Sulfonamide = inhibit breakdown

Na channel blocker

Question 12

Carbamazepine

Answer 12

Drug of Choice: Partial (simple + complex) and T-C (Oral)

P450 Inducer = autoinduction of metabolism

Also used for trigeminal neuralgia and bipolar

Na channel blocker

Question 13

Valproic Acid

Answer 13

Drug of Choice: Myoclonic seizures

Divalproex is a combo drug that increases GI tolerance

Blocks Na and Ca channels, increases Gaba

Question 14

Ethosuximide

Answer 14

Drug of Choice: Absence Seizures

Blocks T-type Ca channels, suppresses rhythmic activity

Long half life, oral, pee out 25%

Question 15

Barbiturates (Phenobarbital and Primidone)

Answer 15

Drug of Choice: Simple partial, T-C, Febrile

Facilitate activation of GABA receptors

Question 16

Benzodiazapenes

Answer 16

Drug of Choice: Status Epilepticus (I.V.)

Diazepam and Lorazepam

Question 17

Lamotrigine

Answer 17

Drug of Choice: Partial (S+C), T-C

Inhibits Glutamate release and blocks Na

Question 18

Gabapentin

Answer 18

DOC: Partial (S+C), T-C

Blocks Ca and Glutamate, Enhances GABA

Kidney excretion

Question 19

Pregabalin, Topirimate, Levitiracetam

Answer 19

P: Blocks Ca, Partial Seizures (S+C)

T: Blocks Na, Increased GABA, Partial (S+C) and T-C

L: Regulates glutamate and GABA, Broad Spectrum

Question 20

Side Effects Card

Answer 20

Gingival hyperplasia: phenytoin

Hepatotoxicity: valproic acid, carbamazepine

Megaloblastic anemia: phenytoin, primidone

Thrombocytopenia: valproic acid, pregabalin

Teratogenic effects: phenytoin, carbamazepine, valproic acid, phenobarbital