Antiepileptics

Question 1

Drugs that Enhance Na+ Channel mediated inhibition. - promote Na channel inactivation conformation.

Answer 1

Phenytoin, Carbamazepine, Valproic Acid, Lamotrigine, and Lacosamide

Question 2

Strong specificity for FOCAL and SECONDARILY GENERALIZED seizures, not absence seizures

Answer 2

Phenytoin, Carbamazepine, Lamotrigine, and Lacosamide

Question 3

Major drug of use in FOCAL and TONIC-CLONIC seizures. Use dependent slows recovery of Na channel to resting state.

Answer 3

Phenytoin

Question 4

metabolized by liver P450. P450 inhibitors – cimetidine, isoniazid, disulfiram – increase serum levels and toxicity

Answer 4

Phenytoin

Question 5

Order of DOC for ABSENCE seizures.

Answer 5

Ethosuximide, Valproic Acid, Lamotrigine, then Clonazepam.

Question 6

Most teratogenic AEDs

Answer 6

Valproic Acid, then Carbamazepine

Question 7

AEDs and pregnancy recommendations

Answer 7

single agent at lowest possible dose. 90% normal pregnancies.

Question 8

Tx of Status Epilepticus

Answer 8

ABCs (airway and vascular access) then Lorazepam or Diazepam, Fosphenytoin and if unsuccessful an additional dose, then phenobarbital and transfer to ICU.

Question 9

Potent agent with lack of sedative effects. Inhibits NMDA-NR2B. Use restricted to REFRACTIVE EPILEPSY. - associated with aplastic anemia and liver failure.

Answer 9

Felbamate

Question 10

Tx of FOCAL seizures and Lennox-Gastaut syndrome (refractive epilepsy). Na channel inhibition.

Answer 10

Rufinamide

Question 11

drugs that inhibit glutamate receptors. Neither is routinely used.

Answer 11

Felbamate and Rufinamide

Question 12

DOC for FOCAL seizures. Better option to phenytoin in patients with potential drug interactions.

Answer 12

Carbamazepine

Question 13

Na+ channel drug that is contraindicated in children – Stevens-Johnsons Syndrome, Toxic epidermal necrosis.

Answer 13

Lamotrigine

Question 14

Adjunctive therapy to FOCAL seizures and alternate to Phenytoin and Carbamazepine with fewer drug interactions.

Answer 14

Lacosamide

Question 15

Drugs that block T-type Ca2+ channels. Specific to ABSENCE seizures.

Answer 15

Ethosuximide and Valproic Acid…..Clonazepam

Question 16

Most effective for Generalized epilepsy with mixed seizure types. Alternate to Phenytoin and Carbamazepine in FOCAL seizure Tx.

Answer 16

Valproic Acid

Question 17

Most serious side effect of Valproic Acid.

Answer 17

Hepatotoxicity

Question 18

Drugs that block High Voltage Ca channels. Impedes transmitter release – pleiotrophic effects.

Answer 18

Gabapentin and Pregabalin

Question 19

Primarily for FOCAL seizures with or w/out secondary generalization and GENERALIZED seizures other than absence.

Answer 19

Gabapentin and Pregabalin

Question 20

Structural analogue of GABA. Not generally first line – not as effective. Very few drug interactions

Answer 20

Gabapentin

Question 21

Pt with Hepatic impairment. Adjunct to FOCAL seizures and supresses just about everything. Preferable to Gabapentin.

Answer 21

Pregabalin

Question 22

Drugs that enhance GABA mediated inhibition.

Answer 22

Benzodiazepines, Phenobarbital, Vigabatrin, Tiagabine

Question 23

Used to abort seizures acutely – dizziness, ataxia, drowsiness. Suited for FOCAL and TONIC-CLONIC seizures.

Answer 23

Benzodiazepines – Diazepam, Lorazepam, and Midazolam

Question 24

Can exacerbate absense seisure. Tx – of FOCAL, TONIC-CLONIC, and acute, resistant seizures of all types. Use falling out of favor.

Answer 24

Phenobarbital

Question 25

Inhibits GABA-transaminase – increasing brain GABA.

Answer 25

Vigabatrin

Question 26

Infantile spasms and refractory focal epilepsy. Pts in treatment should undergo baseline and routine visual field testing.

Answer 26

Vigabatrin

Question 27

Potentiates actions of GABA modulators – BZ Barbs and EtOH

Answer 27

Tiagabine