B7.053 Prework 2: Drugs for Seizure Disorders

Question 1

classification of AEDs

Answer 1

mechanism of action
OR
type of seizure for which they are effective

Question 2

side effects common to many AEDs that hinders effective pharmacotherapy

Answer 2

sedation, ataxia, diplopia, rashes
dispositional drug interactions
teratogenic potential

Question 3

major mechanisms of action of AEDs

Answer 3

1. prolong inactivation of Na+ channels
2. enhance GABAergic activity
3. inhibit T-type Ca+ channels
4. decrease glutamatergic activity
5. decrease activity of Ca2+ channels

Question 4

purpose of inactivating Na+ channels

Answer 4

reduces ability of neurons to fire at high frequencies

Question 5

drugs that inactivate Na+ channels

Answer 5

phenytoin
carbamazepine
valproic acid (also enhances GABA)
lamotrigine (also inhibits T-type Ca2+)
topiramate (also enhances GABA and decreases glutamatergic)

Question 6

purpose of enhancing GABAergic activity

Answer 6

increases neuronal inhibition

Question 7

2 ways to enhance GABAergic activity

Answer 7

increase receptor response to neurotransmitter

increase synaptic availability of GABA

Question 8

drugs that increase receptor response to GABA

Answer 8

barbiturates
-phenobarbital
-primidone
benzodiazepines
-diazepam
-clonazepam

Question 9

drugs that increase synaptic availability of GABA

Answer 9

tiagabine- inhibits GABA reuptake
vigabatrin- inhibits catabolism
levetiracetam- modifies synaptic release by binding to synaptic vesicular protein SV2A

Question 10

drugs that inhibit the T-type Ca2+ channels

Answer 10

ethosuximide
valproic acid (also enhances GABA)

Question 11

purpose of inhibition of T-type Ca2+ channels

Answer 11

these channels are normally active during sleep

tends to be efficacious for absence seizures

Question 12

how can glutamatergic activity be decreased

Answer 12

decrease release or act as a competitive or noncompetitive antagonist at NMDA, AMPA, or kainite receptors

Question 13

drugs that decrease glutamatergic activity

Answer 13

carbamazepine
topiramate
phenobarbital
phenytoin

Question 14

mechanism of gabapentin

Answer 14

decrease excitatory neurotransmission by binding to a2d1 subunit of voltage gated Ca2+ channels within the CNS
enhances GABA release

Question 15

route of admin of AEDs

Answer 15

all have an oral form
IV and parenteral routes exist
IV for status epilepticus

Question 16

drugs used to treat tonic-clonic, partial, and status epilepticus

Answer 16

benzos (diazepam, clonazepam)
barbiturates (phenobarbital)
primidone
hydantoins (phenytoin)
valproic acid
carbamazepine

Question 17

drugs used to treat tonic-clonic, partial, and status epilepticus that can be an add on or monotherapy

Answer 17

lamotrigine
topiramate
levetiracetam

Question 18

drugs used to treat tonic-clonic, partial, and status epilepticus that can be an add on ONLY

Answer 18

gabapentin
tiagabine
vigabatrin

Question 19

drugs used to treat absence seizures

Answer 19

ethosuximide
valproic acid
lamotrigine (less)
clonazepam (less)

Question 20

AEDs with use in mood stabilization

Answer 20

carbamazepine
valproic acid
lamotrigine

Question 21

AEDs with use in migraine prophylaxis

Answer 21

valproic acid

topiramate

Question 22

AEDs with use in neuropathic pain

Answer 22

gabapentin

Question 23

important caution with use of AEDs

Answer 23

increased risk of suicidal behavior or ideation

regardless of condition being treated