Epilepsy: AEDs continuum

Question 1

Phenobarbital:

MOA and half-life

Answer 1

GABA-A agonist and prolonging opening of Cl channel. 80-100 hours

Question 2

P450 enzyme inducers

Answer 2

phenobarbital, carbamazepine,

Question 3

Phenobarbital:

Normal levels

Answer 3

15-40

Question 4

Phenobarbital:

Adverse reactions

Answer 4

Teratogenic (cardiac/psych), decrease bone density and MSK (Dupuytrens,plantar fibromatosis, frozen shoulder.

Question 5

Cheapest AED in the developing world.

Answer 5

Phenobarbital

Question 6

Only AED that is NOT effective for focal seizures

Answer 6

ethosuximide (clobazam and rufinamide are not FDA approved)

Question 7

AEDs best (Class 1 trials) for GTC

Answer 7

Lamotrigine (LTG), topiramate, levetiracetam, perampanel

Question 8

AEDs for Absence

Answer 8

ETX > VPA = LTG

Question 9

Best AED for Generalized myoclonic seizures

Answer 9

Keppra

Question 10

AEDs with low or intermediate bio-availability

Answer 10

Neurontin, Ezogabine

Question 11

AEDs with high protein binding (>85%)

Answer 11

PHT,CBZ,VPA,Clobazam, Tiagabine, Perampanel

Question 12

AEDs with absent or minimal interactions

Answer 12

Gabapentin,Pregabalin, Topiramate, Keppra, Lacosamide, Vigabatrin

Question 13

AEDs with long half lives (>30 hours)

Answer 13

PB, ETX, Zonisamide, Perampanel

Question 14

Primidone:

MOA

Answer 14

25% converted to PB

Question 15

Hepatic Enzyme inducers (5)

Answer 15

PHT, CBZ, Barbituates OXC TP, (PC BOT)

Question 16

AEDs that are mainly renal excreted (3)

Answer 16

Gabapenting, Keppra, TP

Question 17

AEDs with weight loss (2)

Answer 17

TP, Zonisamide

Question 18

AEDs with migraine indication (3)

Answer 18

TP, Gabapentin, VPA

Question 19

AEDs with IV form available (4)

Answer 19

PHT(fospht), CPA, Barbituates, BZD

Question 20

AEDs with once daily dosing (4)

Answer 20

PHT, Zonisamide, VPA, PB

Question 21

Two AEDs to definitely avoid in women

Answer 21

VPA, PHT

Question 22

What things (4) reduce bioavailability of PHT

Answer 22

calcium,antacids,NG feedings,

Question 23

What meds can cause the accumulation (4) of PHT ?

Answer 23

Fluoxetine, azoles, amiodarone, isoniazid

Question 24

5 situations which will increase the protein free fraction.

Answer 24

hepatic and renal failure

malnutrition, pregnancy, old age

Question 25

At what dosage is there a disproportionate increase in serum PHT

Answer 25

300mg

Question 26

Two side effects of IV PHT

Answer 26

hypotension and aarhythmias

Question 27

CBZ: What you have to check in the asian population before giving.

Answer 27

HLA-B1502

Question 28

Unique thing about CBZ metabolism.

Answer 28

auto-induction for 2-4 weeks

Question 29

The one side effect that OXC has more than CBZ

Answer 29

hyponatremia (CI with diuretic)

Question 30

AED associated with hyperammonemia and reversible parkinsonism

Answer 30

VPA

Question 31

When does bioavailability of gabapentin

Answer 31

above 300mg

Question 32

Keppra: MOA

Answer 32

binding to synaptic vesicle protein SV2A decreaseing NT release

Question 33

Which AED is related to sulfonamides ?

Answer 33

Zonisamide

Question 34

AED for infantile spasms esp with tuberous sclerosis

Answer 34

Vigabatrin

Question 35

Major side effect of vigabatrin

Answer 35

retinal toxicity, requires close monitoring and d/c if not effective in 3 months