Epilepsy And Migraine

Question 1

Effect of Na channel blockade and agents with this mechanism

Answer 1

Decrease repetivive firing of neurons
Phenytoin, Carbamazepine, lamotrigine and topiramate, valproate

Question 2

Effect of Ca++ T channel blockade and agents with this mechanism

Answer 2

Dec brain rhythmic activity
Ethosuximide, valproate

Question 3

Effect of presynaptic voltage gated Ca++ channel blockade and agents with this mechanism

Answer 3

Dec glutamate release
Lamotrigine, pregabalin gabapentin

Question 4

….acts on VS2A,…. acts on NMDA receptor

Answer 4

Levetiracetam
Valproate

Question 5

Mention drugs with an effect of GABA with specifying the effect

Answer 5

Facilitate GABA action: phenobarbital, benzodiazepines, topiramate
Inc GABA level: valproate inc turnover

Question 6

Mention first line treatment of:
1. Partial
2. Tonic-clonic
3. Absence
4. Myoclonic

Answer 6

1. Carbamazepine, lamotrigine
2. Valproate, lamotrigine
3. Ethosoxidime, valproate
4. Valproate

Question 7

Phenytoin is used in…….

Answer 7

Generalized tonic-clonic and partial

Question 8

Mention advantages of the following over their prototype drug:
1. Fosphenytoin
2. Oxcarbazepine

Answer 8

1. Can be given IV or IM, less phlebitis and cardiac side effects, better bioavailability, used in s.e.
2. Less potent, less enzyme induction and blood dysacrias

Question 9

Phenobarbital and BZD are used mainly in……due to…..

Answer 9

SE and acute fits
Sedation amd tolerance

Question 10

………are CI in absence and myoclonic seizures

Answer 10

Phenytoin, carbamazeine, oxycarbazepine

Question 11

……..may worsen myoclonic seizures

Answer 11

Gabapetine, pergabaline, lamotrigine

Question 12

Mention hypersensitivity and GIT side effects of the classic antiepileptics

Answer 12

Skin rash, stop drug
Nausea, vomiting, epigastric pain esp val, give small dose after meals

Question 13

Mention neurological side effects of classic AE agenta

Answer 13

P, nystagmus diplopia, dec learning in children drowsiness
C, diplopia, drowsiness
V, less sedatibe, fine hand tremors
ALL cause ataxia

Question 14

Mention microsomal enz side effects of classic AE agents

Answer 14

P, inducer inc AE, vit D metabolism (osteomalacia, supplement vit D and Ca++)
C, induce AE and warfarin metabolism
V, induce AE metabolism

Question 15

Mention hematological side effects of classic AE agents

Answer 15

P, megaloblastic anemia (spp folate) and lymphadenopathy
C, leukopenia amd agranulocytosis
V, thrombocytopenia

Question 16

Mention teratogenic effects of classic AE

Answer 16

P, cleft palate and lip, cardiac abnormalities
C, less teratogenic
V, spina bifida, neural tube defect

Question 17

……causes hirsutism while…..causes hair loss.

Answer 17

Phenytoin
Valproate

Question 18

A specific hormonal imbalance caused by carbamazepine is….

Answer 18

Water intoxication and dilutional hyponatremia potentiate ADH

Question 19

Fatal Hepatotoxicity may occur with…..

Answer 19

Valproate

Question 20

….causes polycytic ovaries

Answer 20

Valproate

Question 21

Mention side effects of:
1. Topiramate
2. Lamotrigine

Answer 21

1. Renal stones, myopia, weight loss, hypohydrosis
2. Rash —>fatal dermatitis (stevens johnson syndrome)

Question 22

Mention drug interactions of lamotirgine

Answer 22

Valproate inhibits its metabolism
OCP & carbamazepine increase its metabolism

Question 23

Treatment is terminated if epilepsy stops for……, & drug withdrawal occurs over…..months

Answer 23

2 years
6 months

Question 24

GR: Phenytoin level is unpredictable

Answer 24

A. Irregular bioavailability
B. Staturation kinetics
C. Drug interactions withs other AE

Question 25

Mention management of status epilepticus

Answer 25

1. Lorazepam, midazolam, diazepam, for rapid control
2. Fosphenytoin or phenytoin to maintain control
3. Phenobarbital (2nd choice to phenytoin)
4. IV antiepileptics (valproate, levetiracetam)
5. IV anesthesia (resistant cases)

Question 26

Mention the AE used in the following:
1. Mood stabilizers
2. Neuropathic pain

Answer 26

1. Lamotrigine valproate, cabamazepine
2. Carbamazepine, gabapentin, pregabalin

Question 27

Mechanism of action of triptans

Answer 27

Selective 5HT 1B/1D
1. Activate 5HT 1B/1D receptors on presynaptic trigeminal nerve endings to inhibit release of VD neuropeptides
2. VC of dural vessels, prevent stetching of pain nerve endings

Question 28

Mention adverse effects & CI of sumatriptan

Answer 28

AD: 1. Injection site reaction or unpleasant taste
2. Chest pressure (resolves spontaneously wiyhin 30 min)
3. With serotoninergic drugs: SSRIsnor within 24 hrs

Question 29

Mechanism of action & adverse effects of ergots

Answer 29

MOA: similar to triptans
AD: GIT upset, chest pressure, vasospasm (gangrene), CI pregnancy, should not be used long term

Question 30

Mention drugs of migraine prophylaxis

Answer 30

1. Beta-blockers, propranolol, timolol
2. Antidepressants, amitrityline
3. Anticonvulsants, valproate & topiramate
4. CCB, nefidine, verapamil

Question 31

Mention most common tumours in adults & children in dexcreasing order of frequency

Answer 31

A, metastases, glioma, meningioma, schwannoma
C, pilocytic astrocytoma, medulloblastoma, ependymoma

Question 32

GR: Anantomic site of the neoplasm can influence outcome regardless of histologicak grading

Answer 32

Due to local effects (a benign meningioma may cause cardiorespiratory arrest from medullary compression) or non-resectability (brain stem gliomas)

Question 33

GR: Complete surgical resection of diffuse glioma is ususally not possible

Answer 33

Due to Single-cell infiltration of normal brain tissue by tumour cells beyond the tumour core is distrinction to other neuroepithelial tumors.