Drugs to treat epilepsy

Question 1

moa of carbamazepine

Answer 1

↓Na+ channels

Question 2

AE of carbamazepine

Answer 2

∙ CNS (dizziness/drowsiness, ataxia, vision)
∙ BBW for agranulocytosis
∙ Derm effects rare
∙ constipation or dry mouth, n/v
Screen for HLA-B 1502 in ASIANS (↑risk SJS)

Question 3

metabolism of carbamazepine

Answer 3

HEP (CYP3A4) - inducer

Question 4

clonazepam MOA

Answer 4

GABA allosteric agonist

Question 5

clonazepam AE

Answer 5

somnolence, ataxia, dizziness, fatigue

Question 6

metabolism of clonazepam

Answer 6

HEP (CYP3A4), no induction/inhibition

Question 7

ethosuximide MOA

Answer 7

↓T-type Ca2+ channels

Question 8

ethosuximide AE

Answer 8

somnolence, dizziness, headache, n/v, diarrhea, GI upset

Question 9

metabolism of ethosuximide

Answer 9

HEP (CYP3A4), no induction/inhibition

Question 10

felbamate MOA

Answer 10

∙ ↓NMDA

∙ ↑GABA

Question 11

AE of felbamate

Answer 11

AE: BBW aplastic anemia, BM suppression, hepatic disease

∙ n/v, constipation

Question 12

metabolism of felbamate

Answer 12

M: HEP, CYP inducer & inhibitor

Question 13

gabapentin MOA

Answer 13

∙ ↓alpha-2 delta-1 of Ca2+ channel

Question 14

gabapentin AE

Answer 14

somnolence, dizziness, ataxia, fatigue

Question 15

metabolism of gabapentin

Answer 15

M: NONE, No induction/inhibition

Question 16

lacosamide MOA

Answer 16

∙ ↓Na+ channels

Question 17

AE of lacosamide

Answer 17

dizziness, headache, diplopia, n/v

Question 18

metabolism of lacosamide

Answer 18

M: HEP, CYP (inhibitor)

E: UR DRUG

Question 19

lamotrigine MOA

Answer 19

∙ ↓Na+ channels

Question 20

lamotrigine AE

Answer 20

AE: BBW rash (TEN/SJS), dizziness, diplopia, ataxia, blurred vision, rhinitis

Question 21

lamotrigine metabolism

Answer 21

M: HEP, UGT inducer (no CYP)

Question 22

levetiracetam MOA

Answer 22

unknown

Question 23

AE of levetiracetam

Answer 23

HA, URTI, somnolence

Question 24

metabolism of levetiracetam

Answer 24

M: None, no induction/inhibition
E: UR D & M

Question 25

oxycarbazepine MOA

Answer 25

∙ ↓Na+ channels | ∙ ↑K+ & ↓Ca2+ channels (possibly)

Question 26

AE of oxycarbzaepine

Answer 26

AE: dizziness, diplopia, headache, n/v, nystagmus/somnolence/ataxia

Question 27

Metabolism of oxycarbazepine

Answer 27

M: HEP, conjugation ∙ induce & inhibitor E: UR D & M

Question 28

phenytoin MOA

Answer 28

∙ ↓Na+ channels Fosphenytoin is a pro-drug dose in phenytoin equivalents

Question 29

phenytoin AE

Answer 29

∙ CNS (nystagmus, headache, ataxia) ∙ Gingival hyperplasia ∙ Derm effects rare ∙ Hematologic changes (dyscrasias)

Question 30

phenytoin DME

Answer 30

D: Highly protein bound M: HEP, CYP (inducer) E: Stool, ZERO ORDER ELIMINATION

Question 31

pregabalin MOA

Answer 31

∙ ↓alpha-2 delta-1 of Ca2+ channel

Question 32

pregabalin AE

Answer 32

dizziness, somnolence, peripheral edema

Question 33

pregabalin metabolism

Answer 33

M: none, no induction/inhibition E: UR DRUG

Question 34

topiramate MOA

Answer 34

∙ ↓Na+ channels ∙ ↑K+ current, ↑GABA, ↓glutamate Weak carbonic anhydrase inhibitor, routine monitoring of serum bicarb required;

Question 35

topiramate AE

Answer 35

dizziness, fatigue, ataxia, paresthesias, abnormal vision, psychomotor slowing

Question 36

topiramate metabolism

Answer 36

M: minor, no induction/inhibition E: UR DRUG

Question 37

valproate moa

Answer 37

∙ ↑GABA | ∙ ↓Na+ channels

Question 38

valproate AE

Answer 38

∙ CNS related to infusion rate (dizziness) ∙ Heme = thrombocytopenia, ↑BT ∙ Derm effects are rare ∙ n/v, hepatic tox (KIDS)

Question 39

valproate metabolism

Answer 39

M: HEP,CYP & UGT (inhibitor)

Question 40

zonisamide MOA

Answer 40

∙ ↓Na+ channels ∙ ↓T-type Ca2+ channels Weak carbonic anhydrase inhibitor, routine monitoring of serum bicarb required

Question 41

zonisamide AE

Answer 41

somnolence, anorexia, dizziness

Question 42

zonisamide DME

Answer 42

D: accumulates in RBCs M: HEP, CYP and UGT ∙ No induction/inhibition E: UR D & M

Question 43

which drugs are category C

Answer 43

lamotrigine

Question 44

which drugs are category D

Answer 44

carbamazepine, clonazepam, phenytoin, topiramate

Question 45

which drugs are category X

Answer 45

valproate

Question 46

describe fetal hydantoin syndrome

Answer 46

craniofacial abnormalities, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects, clefts

Question 47

3 general MOA for AEDs

Answer 47

1. promote inactive state of Na channel 2. pre/post enhancement of GABA 3. inhibition of Ca channels

Question 48

partial & secondarily generalized siezures

Answer 48

∙ Lamotrigine ∙ Carbamazepine ∙ Levetiracetam ∙ Oxcarbazepine

Question 49

primary generalized tonic-clonic seizures

Answer 49

∙ Valproate ∙ Lamotrigine ∙ Levetiracetam

Question 50

absence seizures

Answer 50

∙ Ethosuximide | ∙ Valproate

Question 51

atypical absence, myoclonic, atonic seizures

Answer 51

∙ Valproate ∙ Lamotrigine ∙ Levatiracetam

Question 52

treatment of SE

Answer 52

First - Benzo (IV lorazepam > IM Midazolam) | SEcond - IV AED (valproate)