Anticonvulsants

Question 1

Focal, brief (20-90 seconds), no LOC

Answer 1

simple partial seizure

Question 2

Longer (<2 mins); Altered or LOC; hallucination

Originate from temporal lobe

Answer 2

Complex partial seizure

Question 3

Initial tonic rigidity (15-30s) –> tremor –> clonic jerking (60-120s)
LOC, stuporous/confused

Answer 3

Tonic-clonic

Question 4

Sudden onset; brief (10-30 s), loss of awareness (not consciousness), mild clonic movements

Answer 4

absence

Question 5

Brief spasm or rigidity; often secondary to other seizure disorder

Answer 5

Myoclonic generalized seizures

Question 6

Sudden loss of postural tone –> falls

Answer 6

Atonic

Question 7

Goal of anticonvulsant medication

Answer 7

Increase GABA activity, decrease glutamate activity

Question 8

Mechanism for increasing GABA activity

Answer 8

1. Block GABA reuptake, 2. Inhibit GABA metabolism, 3. Stimulate GABA(a) receptors, 4. Binds synaptic vesicular protein SV2A

Question 9

Mechanism for decreasing glutamate activity

Answer 9

1. Inhibit sodium channels, 2. inhibit T-type Ca2+ channels , 3. SV2A, 4. K+ channel, 5. NMDA and 6. AMPA receptors

Question 10

Induces CYP450

Answer 10

Phenytoin, carbamzepine, phenobarbital, lamotrigine

Question 11

Most anticonvulsants are metabolized by

Answer 11

CYP450s

Question 12

Common side effects of anticonvulsants

Answer 12

GI, CNS disturbances, teratogenic, hypersensitivty (SJS!)

Question 13

Drugs causing SJS

Answer 13

Carbamazepine, phenytoin, phenobarbital, Iamotrigine, valproic acid

Question 14

IM Injectable form: phenytoin or fosphenytoin

Answer 14

Fosphenytoin

Question 15

Elimination of phenytoin/ fosphenytoin

Answer 15

Low doses: 1st order

Higher dose: zero order

Question 16

SE: Gingival hyperplasia

Answer 16

Phenytoin

Question 17

DOC for partial seizure

Answer 17

Carbamazepine

Question 18

Inhibit CYP450

Answer 18

cimetidine, fluoxetine, valproic acid

Question 19

SE: acute myopia/glaucoma

Answer 19

Topiramate

Question 20

Drug preventing migranes

Answer 20

Topiramate

Question 21

Drug excreted unchanged by kidney

Answer 21

Gabapentin

Question 22

Pt w/ seizures came in w/ a long ass list of meds, which med should you use to treat the seizure

Answer 22

Gabapentin, pregabalin, Tiagabine (adjunct)

(few or neglibile drug interaction)

Question 23

Irreversibly inhibits GABA transminase (GABA-T)

Answer 23

Vigabatrin

Question 24

drug for refractory complex partial seizure

Answer 24

Vigabatrin

Question 25

SE: visual field problems/ retinal damage

Answer 25

Vigabatrin

Question 26

DOC for absence seizures

Answer 26

Ethosuximide

Question 27

SE: Hiccup

Answer 27

Ethosuximide

Question 28

Increase risk of spina bifida

Answer 28

Valproic acid

Question 29

What do you avoid if you have an anticonvulsant overdose

Answer 29

CNS stimulants

Question 30

SJS syndrome caused by drugs w/ what MOA

Answer 30

Block Na+ channels

Question 31

If you’re taking a drug that induces CYP450, educate your pt on increase metabolism of

Answer 31

multiple anticonvulsants, haloperidol, and oral contraceptions

Question 32

Adjunct tx for partial seizure

Answer 32

Tiagabine

Question 33

Drug for infantile spasm (West’s syndrome)

Answer 33

Vigabatrin, clonazepam

Question 34

Absence seizure drugs

Answer 34

Ethosuximide, valproic acid, clonazepam

Question 35

Most common anticonvulsant SE from high dose

Answer 35

Respiratory depression

Question 36

Petit mal

Answer 36

Absence seizure

Question 37

Grand mal

Answer 37

Tonic-clonic