epilepsy

Question 1

phenytoin/cbz moa

Answer 1

blocks voltage-depd Na+ channels, preventing sodium influx and action potential

Question 2

indication for pht/cbz

Answer 2

all except absence seizures

Question 3

pht cbz strong inducers of

Answer 3

cyp450

Question 4

pk of pht

Answer 4

zero order

Question 5

pht availability

Answer 5

highly albumin bound

Question 6

pht and valp

Answer 6

pregnancy

Question 7

does valp cause weight gain or loss

Answer 7

gain

Question 8

ae of CBZ

Answer 8

sjs/ten

Question 9

what to screen prior to cbz

Answer 9

hlab-1502

Question 10

first line for preg

Answer 10

lamotrigine

Question 11

non dose related side effects of anticonvulsants (valp, pht, cbz)

Answer 11

hirsutism
gingival hyperplasia
folate deficiency
acne
osteomalacia
peripheral neuropathy

Question 12

dose related side effects of anticonvulsants (pht, valp, cbz)

Answer 12

drowsiness
confusion
involuntary eye movement
slurred speech

Question 13

valp moa

Answer 13

Blockade of voltage-dependent Na+ and Ca2+ channels

Inhibits GABA transaminase, increasing GABA

Question 14

valp indication

Answer 14

all seizures

Question 15

pk valp

Answer 15

highly protein bound, displaces other drugs

Question 16

levetiracetam moa

Answer 16

Affinity for binding to synaptic vesicle protein 2A

Question 17

indication of levetiracetam

Answer 17

Adjunct/
Monotherapy

• Partial onset
• Myoclonic
• Primary generalised TC seizures

Question 18

benefit of leve

Answer 18

Low interpersonal variability (no monitoring needed)

Question 19

side effects of leve

Answer 19

Headache
Vertigo
Cough
Depression
Insomnia

(Agranulocytosis, suicide, delirium, dyskinesia)

Question 20

lamotrigine moa

Answer 20

Blocks voltage-depd Na+ channels

Inhibits glutamate release

Question 21

lamotrigine indication

Answer 21

Adjunct/ Monotherapy
- Partial
- Generalised (TC)
- Mono: Absence

Adjunct / initial AED: Lennox-Gastaut syndrome

Question 22

efficacy of lamo reduced with

Answer 22

cbz pht

Question 23

toxicity of lamo increased with

Answer 23

valp

Question 24

side effects of lamo

Answer 24

Headache
Irritability / aggression
Tiredness

(Agranulocytosis, hallucination, EPSE)

Question 25

topiramate moa

Answer 25

Increases GABA activation, enhances GABA induction of Cl- flux, does not increase channel opening time.

Question 26

topiramate uses

Answer 26

Monotherapy:
- Partial
- Generalised TC

Adjunct: Lennox-Gastaut syndrome

Migraine Prophylaxis

Question 27

clearance of topiramate

Answer 27

renal

Question 28

side effects of topiramate

Answer 28

Depression
Somnolence
Fatigue
Nausea
Weight loss

(Neutropenia, mania, SJS/TEN)

Question 29

Barbiturates moa

Answer 29

Potentiate GABAA mediated Cl- currents, at a site distinct from BZD

Question 30

bzd moa

Answer 30

Potentiates influx of Cl- ions → hyperpolarisation → prevents firing of neurons

Question 31

bza antidote

Answer 31

iv flumazenil

Question 32

which anticonvulsant can be used for migraine prophylaxis?

Answer 32

topiramate

Question 33

list three first line choices for status epilepticus

Answer 33

1. IV lorazepam 0.1mg/kg, max 4mg
2. IV diazepam 0.2mg/kg, max 10mg
3. IM Midazolam 10mg if above 40kg

Question 34

for epilepsy, what is the criteria

Answer 34

two seizures at least 24 hours apart