Antiepileptics

Question 0

How do you distinguish between a partial and a generalized seizure?

Answer 0

Partial: starts focally and can evolve into tonic-clonic with loss of consciousness

Generalized: immediate loss of consciousness, doesn’t evolve

Question 1

How do you distinguish between a simple partial and a complex partial seizure?

Answer 1

Simple: no loss of consciousness - abnormal movement of single limb

Complex: loss of consciousness - can urinate

Question 2

Describe the difference between grand mal and petite mal seizures

Answer 2

Both generalized
Grand mal: tonic-clonic
Petit mal: absence seizure - pt stares with rapid eye blinking (loss of consciousness)

Question 4

Two mechanisms that can cause seizures (general ideas)

Answer 4

Loss of inhibition
Over excitement

Think in terms of GABA and glutamate
GABA antagonists and glutamate agonists can cause seizures

Question 5

Name the four drugs used in epilepsy who’s main method of action is blocking voltage-gated sodium channels

Answer 5

Phenytoin
Carbamazepine
Lamotrigine
Zonisamide

Question 6

name the two drugs effective in treating absence seizures. what channels do they act on?

Answer 6

Ethosuximide and Valproate

Block T-type Calcium channels

Question 7

Name the drug that treats epilepsy by inhibiting the reuptake of GABA

Answer 7

Tiagabine

Question 8

Name the drug that treats epilepsy by inhibiting the degradation of GABA

Answer 8

Vigabatrin

Question 9

Name the two drugs that treat epilepsy by increasing GABA release AND blocking glutamate release

Answer 9

Gabapentin and Pregabalin

Question 10

Name two drugs that treat epilepsy by blocking glutamate receptors

Answer 10

Phenobarbital and topiramate

Question 11

DOC simple and complex generalized tonic-clonic seizures

Answer 11

Carbamazepine
Oxcarbazepine
Lamotrigine
Phenytoin

Question 12

Which drug is used to treat generalized tonic-clonic as well as myclonic seizures, but is now second line due to adverse effects?

Answer 12

Phenobarbital

Question 13

DOC generalized tonic-clonic seizures

Answer 13

Valproate
Carbamazepine
Phenytoin

Question 14

DOC atypical absence seizures

Answer 14

Valproate

Question 15

DOC myoclonic seizures

Answer 15

Valproate

Question 16

What is important to remember about atonic seizures? what two drugs can help?

Answer 16

they are often refractory of all drugs

Valproate and Lamotrigine

Question 17

Name three drugs used to treat infantile spasms

Answer 17

Corticotropin
Glucocorticoids
Vigabatrin

Question 18

What is the time frame for treatment of febrile convulsions? How do you treat?

Answer 18

If seizures less than 15 minutes, just supportive care

If they are longer than 15 minutes, treat with Diazepam given IV or rectally

Question 19

For Status Epilepticus give the first (1), second (2), third (1), and final drugs of choice (3) to treat if seizures continue

Answer 19

IV Lorazepam
IV Penytoin or Fosphenytoin
IV Phenobarbital
General anesthesia with IV Midazolam, Propofol, or barbiturates

Question 20

Name the three drugs used to treat drug-induced seizures in nonepileptic patients

Answer 20

Diazepam
Lorazepam
Phenobarbital

Question 21

What is the drug of choice for breakthrough seizures and how is it administered?

Answer 21

Diazepam via rectal gel

Question 22

which three antiepileptics are CYP inducers?

Answer 22

Phenytoin
Carbamazepine
Phenobarbital

Question 23

Which anti-epileptic causes hepatotoxicity and actually inhibits its own metabolism through CYP inhibition?

Answer 23

Valproate

Question 24

Which anti-epileptic drug causes nystagmus, hirsutism and gingival hyperplasia?

Answer 24

Phenytoin

Question 25

Adverse effects of Carbamazepine?

Answer 25

aplastic anemia, agranulocytosis, rash

Question 26

Adverse effects of Vigabatrin?

Answer 26

irreversible visual field defects in 1/3 of patients

Question 27

How long does a patient have to be seizure free to consider withdrawing treatment? How do you withdraw treatment?

Answer 27

3-5 years

gradual tapering (very gradual for benzos and barbituates to avoid withdrawal) and if on several, remove one at a time

Question 28

An epileptic patient is tired of shitting himself and takes the rest of the pills in his almost full bottle of antiepileptic meds. What is the most important concern for overdose? How likely is he to be successful at suicide?

Answer 28

respiratory depression

not very, anti-seizure drugs are rarely lethal in overdose

Question 29

Which anti-epilepsy drug has the highest rate of fetal malformations?

Answer 29

Valproate

Question 30

What is an important complication in the newborn if the mother was taking anti-epilepsy drugs during pregnancy? Why? Prevention?

Answer 30

Bleeding

some anti-epileptics can increase degradation of vitamin K in the newborn

mother should take vitamin K supplementation during final month of pregnancy and also given to newborn

Question 31

Many epilepsy drugs can be used for other things, what is another use for: Carbamazepine (2)

Answer 31

neuropathic pain and bipolar disorder

Question 32

Many epilepsy drugs can be used for other things, what is another use for: Gabapentin

Answer 32

neuropathic pain

Question 33

Many epilepsy drugs can be used for other things, what is another use for: Lamotrigine

Answer 33

Bipolar disorder

Question 34

Many epilepsy drugs can be used for other things, what is another use for: Pregabalin

Answer 34

neuropathic pain

Question 35

Many epilepsy drugs can be used for other things, what is another use for: Topiramate

Answer 35

Migraine

Question 36

Many epilepsy drugs can be used for other things, what is another use for: Valproate (2)

Answer 36

Bipolar disorder and migraine

Question 37

Almost 1/3 of patients being treated for epilepsy still continue to have seizures. Name 3 nonpharmacologic approaches to treat these patients

Answer 37

Surgery
Ketogenic Diet (high fat diet and low carbs -> ketosis which has a direct antiseizure effect)
Vagus nerve stimulation via implanted pacemaker that the patient can activate when they feel a seizure coming