Antiepileptics

Question 1

What are the 4 voltage-gated Na channel stabilizers used for the treatment of epilepsy?

Answer 1

Phenytoin
Carbamazepine
Oxcarbamazepine
Lamotrigine

Question 2

What 2 Na channel stabilizers are more effective for complex partial seizures and are also used for bipolar disorder and neuropathic pain?

Answer 2

Carbamazepine

Oxcarbamazepine

Question 3

Which voltage gated Na channel stabilizer is used for primary generalized epilepsies and can also be used for bipolar disorder and neuropathic pain

Answer 3

Lamotrigine

Question 4

What are the side effects of phenytoin?

Answer 4

Rash
Gingival hyperplasia 
Hirsutism
Lupus-like rxn
Can cause contraceptive failure 

Mild myelosuppression
Increased LFTs
Long-term:
-Cerebellar degeneration
-Peripheral neuropathy
-Osteoporosis

Question 5

What are the side effects of carbamazepine and oxcarbamazepine?

Answer 5

Rash–rarely stevens-johnson
Mild myelosuppression
Mild LFT elevation
Can cause contraceptive failure

Question 6

What are the side effects of lamotrigine

Answer 6

Rash–rarely stevens-johnson
Slow initial titration is important
May lead to contraceptive failure

Question 7

Broad spectrum anti epileptic that can be used IV for status epileptics and used for treatment of bipolar disorder and migraine and long-term cluster HA prophylaxis

Answer 7

Valproate

Question 8

What are the side effects of Valproate

Answer 8

Weight gain
Hair turnover
Hyperammonemia
Tetratogenicity
Blood dyscarasias
Pancreatitis

Question 9

GABAergic anti-epileptic used for status epilepticus

Answer 9

Benzodiazapines–Lorazepam and diazepam

Question 10

GABA analogs that block presynaptic influx of Ca used as adjunct for partial complex epilepsy and more commonly used for neuropathic pain

Answer 10

Gabapentin

Pregabalin

Question 11

Glutamate receptor blocker that is partial AMPA, Ca receptor blocke, secondary effect at voltage gated Na channel and GABA system –anti-epileptic

Answer 11

Topiramate

Question 12

Besides anti-epileptic use, what else is topiramate used for?

Answer 12

Migraine and long-term cluster headache prevention

Question 13

What are the side effects of topiramate?

Answer 13

Metabolic acidosis–> respiratory compensation–> mild alkalosis–> Ca ionization–> tingling—TREAT with Vit C

Kidney stones–carbonic anhydrase activity

Modest weight loss

Word-finding

Question 14

Glutamate receptor blocker that works through NMDA receptor blockade and has secondary effect at voltage gated Na and Ca channels — used for partial onset seizures

Answer 14

Felbamate

Question 15

Why does felbamate require monitoring

Answer 15

It potentially fatal and can cause aplastic anemia and acute hepatic failure

Question 16

Works as anti-epileptic med by binding synaptic vesicle protein 2, which leads to less NT release

Answer 16

Levetiracetam

Question 17

Voltage-gated Ca channel blocker (specific T-type Ca channels in thalamocortical circuits) that is used exclusively for absence seizures and can be effective for neuropathic pain?

Answer 17

Ethosuximide