antiseizure meds

Question 1

partial complex seizure tx

Answer 1

• phenytoin, carbamazepine, lamortigine, levetiracetam

- gabapentin

Question 2

generalized tonic clonic tx

Answer 2

• phenytoin, carbamazepine, lamortigine, levetiracetam

- phenobarbital, valproic acid

Question 3

generalized absence tx

Answer 3

• ethosuximide

- clonazepam, valproic acid

Question 4

generalized myoclonic

Answer 4

• clonazepam, levetiracetam, valproic acid

- lamortigine

Question 5

generalized febrile

Answer 5

-phenobarbital, primidone

Question 6

generalized status E

Answer 6

-phenytoin, diazepam, phenobarbital

Question 7

phenytoin

Answer 7

blocks voltaged gated Na and Ca channels
drug of choice for epilepsy in adults
-partial simple
-partial complex
-tonic clonic
-emergency status E
not for absence seizures (may precipitate)
high plasma protein binding
CYP2c9 and 2c19
-dose saturation 
-drug interactions
AE
-gingival hyperplasia
-megablastic anemia
-teratogen

Question 8

phenytoin drug interaction

Answer 8

cyp2c9 and cyp2c19
increases metabolism of doxycycline and cyclosporine
phenytoin’s metabolism increased by carbamazepine
phenytoin’s metabolism decreased by chloramphemicol and sulfonamide

Question 9

carbamazepine

Answer 9

voltage gated Na channels
tx
-partial simple
-partial complex
-tonic clonic
-trigeminal neuralgia
-bipolar
induces own metabolism and phenytoins
high plasma protein binding
AE hepatotoxicity, teratogen

Question 10

valproic acid

Answer 10

blocks voltage gated Na and Ca channels, facilitates GABAinergic
tx
-drug of choice for myoclonic
-2nd line for tonic clonic and absence
p450 metabolism
high plasma protein binding
AE hepatotoxic, thrombocytopenia, teratogen

Question 11

ethosuximide, methuximide, phensuximide

Answer 11

blocks voltage gated type T Ca channels
drug of choice for absence seizure
long half life (30-60 hours)
75% p450, 25% renal excretion

Question 12

phenbarbital, primidone

Answer 12

barbiturates
GABAinergic
tx
-simple partial
-tonic clonic
-febrile 
-anxiety
combined with carbamazepine and phenytoin
75% hepatic microsomal system
AE drowsiness, megablastic anemia, teratogen

Question 13

diazepam, lorazepam, clonazepam

Answer 13

benzodiazepine 
GABAinergic
tx
-stat E
-anxiety
-myoclonic
-absence (clonazepam)
tolerance in 1-6 months

Question 14

lamotrigine

Answer 14

blocks voltage Na, inhibits GLU release
tx
-partial simple
-partial complex
-tonic clonic
metabolized by liver
-metabolism increased by carbamazepine, phenytoin
-metabolism decreased by valproic acid

Question 15

gabapentin

Answer 15

blocks Ca (alpha2-delta) and GLU release
tx
-partial simple
-partial complex
-tonic clonic
-peripheral neuropathy
no interaction with liver
short 1/2 life 5-8 hours

Question 16

pregabalin

Answer 16

blocks voltage gated Ca channels (alpha2-delta) and GLU release
tx
-partial simple 
-partial complex
AE- thrombocytopenia

Question 17

topiramate

Answer 17

blocks Na, increases post synaptic GABA receptor activity
tx
-partial simple 
-partial complex
-tonic clonic

Question 18

levetiracetam

Answer 18

mech unclear- GLU, GABA via synapic SV2A binding
tx
-broad spectrum for generalized or partial
-tonic clonic
-myoclonic

Question 19

partial simple seizure medications

Answer 19

• phenytoin, carbamazepine, lamortigine, levetiracetam

- phenobarbital, gabapentin