Anticonvulsants

Question 1

Epilepsy

Answer 1

Recurrent attack of involuntary behaviour/experience
Neurologic function caused by electrical activity in brain
Generalized or localized brain activity

Question 2

Generalized seizures

Answer 2

Types (absence, tonic-clonic seizures)
Consciousness lost in both
Aura May occur before onset

Question 3

Seizure phases

Answer 3

Aura
Ictus (seizure)
Postical state (altered state of consciousness, lasts 5-30 minutes)

Question 4

Absence seizures

Answer 4

Petit mal seizures
Little movement
No aura or postical state
Drugs (ethosuximide, valproate, lamotrigine)

Question 5

Tonic-clonic seizures

Answer 5

Grand mal seizure
Body rigid, clonic jerking of face limbs and body, consciousness gradually returns
Drugs (valproic acid, phenytoin, carbamazepine)

Question 6

Partial (focus) seizures

Answer 6

Activation of part of brain
Simple attack=consciousness not impaired
Complex=consciousness impaired
Drugs (carbamazepine, phenytoin, phenobarbital, primidone)

Question 7

Status eilepticus

Answer 7

Continuous tonic-clonic seizures lasting longer than 30 minutes
Medical emergency
Drugs (benzodiazepines-diazepam)

Question 8

Drug therapy

Answer 8

Prevent spread of abnormal electric charges in brain
Cns depressants
Variable efficacy
Drugs used alone or in combination

Question 9

General adverse reactions

Answer 9

Narrow therapeutic index
Can saturate liver microsomal enzymes (abrupt increase in drug level)
Stimulate liver microsomal enzymes
Cns depression (additive affect, tolerance developes)
GI distress (anotexia, nausea, vomiting)

Question 10

Drug interactions

Answer 10

Many possible
Involve stimulation of the liver microsomal enzymes (narrow therapeutic index)
Drug level altered too much results in toxicity (too high) or loss of seizure control (too low)

Question 11

Carbamazepine

Answer 11

Tonic clonic and partial seizures

Question 12

Carbamazepine adverse effects

Answer 12

Cns 
GI
Hematologic (petechia, infection)
Dermatologic
Oral (dry mouth, glossitis, stomatitis)

Question 13

Carbamazepine drug interactions

Answer 13

Stimulate live enzymes
Decrease effects of warfarin, oral contraceptives
Increase effects of calcium channel blockers

Question 14

Valproate

Answer 14

Treat generalized seizures

Question 15

Valproate adverse effects

Answer 15

GI
Cns depression
Hepatoxicity
Prolonged bleeding time

Question 16

Valproate drug interactions

Answer 16

Additive Cns depressant
Inhibits metabolism of phenobarbital
Interaction with phenytoin

Question 17

Phenobarbital

Answer 17

Barbiturate
Tonic clonic seizures, partial seizures
Used alone or combo
Adverse reactions (sedation, hyperactivity in children, confusion/depression in elderly)

Question 18

Phenytoin

Answer 18

Tonic clonic seizures and complex partial seizures 
Status epilepticus (diazepam is #1 option though)

Question 19

Phenytoin adverse effects

Answer 19

GI
Cns depression
Dermatologic
Vitamin deficiency (D and folate-look for mouth ulcerations)
Teratogenic (fetal hydantoin)
Gingival enlargement (oral hygiene important)

Question 20

Ethosuximide

Answer 20

Absence seizures

Gingival enlargement and tongue swelling

Question 21

Benzodiazepines

Answer 21

Adjunct to treat absence seizures not responsive to ethosuximide
Increase salivation, coated tongue, dry mouth, sore gums

Question 22

Felbamate

Answer 22

Only when seizures can’t be control by other agents

Serious toxicities reported

Question 23

Gabapentin

Answer 23

Adjunct for partial and generalized tonic clonic seizures
Not metabolized (does not effect liver or drug interactions)
Tremor and ataxia

Question 24

Lamotrigine

Answer 24

Partial, secondary generalized tonic clonic, adjunct for other types

Question 25

Non seizure uses for anticonvulsants

Answer 25

Trigeminal neuralgia, neurological pain, migraines, psychiatric use