Antiepileptics - session 22

Question 1

What is the most common cause of recurrent seizures in dogs?

Answer 1

Idiopathic epilepsy

Question 2

What is the most common cause of seizures in cats?

Answer 2

intracranial

Question 3

If a dog/cat presents with cluster seizures. There is no history of seizures previously. What class of seizures should you consider?

Answer 3

intracranial

Question 4

How is phenobarbital metabolized?

Answer 4

Liver

Question 5

List the most common persistent AE associated with Phenobarbital

Answer 5

PU/PD

polyphagia

Question 6

What steps should be taken when rapid elevation of ALT is noted in a dog taking phenobarbital?

Answer 6

Stop PB immediately, switch to alternative anti-epileptic drug

Question 7

What AED is a risk factor for superficial necrolytic dermatitis in dogs?

Answer 7

Phenobarbital

Question 8

Clinical signs of anprexia, sedation, ascites, and icterus are associated with what process?

Answer 8

Hepatotoxicity

Question 9

At what frequency should animals receiving chronic PB therapy be evaluated?

Answer 9

every 6 months

Question 10

What is a risk of administering Phenobarbital with a tetracycline?

Answer 10

P450 inhibitors can inhibit hepatic metabolism causing inc in serum conc and PB toxicity

P450 drugs: Chloramphenicol, tetracyclines, cimetidine, ranitidine, enilconazole

Question 11

What drugs are P450 inhibitors?

Answer 11

H2 blockers:

• cimetidine
• ranitidine

antibiotics:

• chloramphenicol
• fluoroquinolones (enrofloxacin, marbofloxacin)

azole antifungals:

• ketoconazole
• enilconazole

Question 12

What is the initial AED of choice in dogs with hepatic dysfunction?

Answer 12

potassium bromide

Question 13

What AE does Potassium bromide have in cats that makes it contraindicated?

Answer 13

Fatal Progressive bronchitis

Question 14

What are the dietary Chloride requirements when on KBr?

Answer 14

Keep normal Cl

Question 15

What adverse effects are associated with KBr?

Answer 15

PU/PD, polyphagia - less dramatic then with PB

Question 16

Which AED does not cause sedation?

Answer 16

Felbamate

Question 17

Which AEDs are a structural analog in GABA?

Answer 17

Gabapentin, Pregabalin

Question 18

Which AED can cause KCS?

Answer 18

Felbamate

Question 19

Which AED do patients rapidly develop tolerance to anticonvulsant effects?

Answer 19

Diazepam

Question 20

What is the preferred choice for chronic AED therapy in cats?

Answer 20

Phenobarbital

Diazepam = hepatotoxicity

Question 21

What AED’s are metabolized by the liver?

Answer 21

Phenobarbital
Zonisamide
Diazepam
Gabapentin (minor)
Felbamate

Question 22

Which AED is associated with dec tear production?

Answer 22

Zonisamide

Question 23

Which AED is contraindicated in cats due to its association with potentially fatal drug-induced bronchitis?

Answer 23

Potassium Bromide

Question 24

Which anti-epileptic drug can be used as an at-home, rectally administered emergency treatment for cluster seizures?

Answer 24

Diazepam

Question 25

What is the criteria for starting an antiepileptic?

Answer 25

• 3+ seizures in 24 hr
• seizures >5min
• 2+ seizures in 6 months
• protracted severe or unusual

Question 26

What AED is recommended as a second line AED with little evidence supporting its use as monotherapy?

Answer 26

Levetiracetam

Question 27

What AED’s can be used as monotherapy?

Answer 27

Phenobarbital, Potassium Bromide

Question 28

Which AED causes acute fatal hepatic necrosis when administered orally to cats?

Answer 28

Diazepam

Question 29

What 2 drugs have significant side effects in cats?

Answer 29

Potassium bromide - allergic bronchitis

Diazepam - hepatic necrosis

Question 30

In dogs and cats, what is the most effective antiepileptic drug?

Answer 30

Phenobarbital

Question 31

What class of AEDs is recommended as first line therapy to stop seizure activity with status epilepticus?

Answer 31

Benzodiazapines (Midazolam)

Question 32

What is the goal of emergent anticonvulsant therapy?

Answer 32

stop all seizure activity immediately and prevent additional seizures for 24hr period

Question 33

Which Benzodiazepine can be given IM?

Answer 33

Midazolam