Epilepsy Drugs

Question 1

Ethosuximide Use:

Answer 1

1st line Absence

Question 2

Ethosuximide mech:

Answer 2

Blocks thalamic T-type Ca++ channels

Question 3

Ethosuxmide SE:

Answer 3

GI, Fatigue, headache, urticaria, Steven-Johnson syndrome. EFGHIJ

Question 4

Benzodiazepines (diazepam, lorazepam) clinical use?

Answer 4

1st line for acute Status epilepticus; Also for eclampsia seizures (MgSO4 is first line)

Question 5

Benzodiazepine mech

Answer 5

Increase GABA(A) action

Question 6

Benzodiazepine SE

Answer 6

Sedation, Tolerance, Dependence, Respiratory Depression

Question 7

Phenytoin clinical Use:

Answer 7

First Line Tonic-Clinic. First Line-prophylaxis for Status Epilepticus. Also Treats Simple and Complex Seizures

Question 8

Phenytoin mech

Answer 8

Increase Na+ channel inactivation; zero-order kinetics

Question 9

Phenytoin SE:

Answer 9

Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome) SLE-Like syndrome, induction of CYP-450, lymphadenopathy, Stevens-Johnson Syndrome, Osteopenia

Question 10

What do you use for parenteral Use?

Answer 10

Fosphenytoin

Question 11

Carbamazepine Clinical use?

Answer 11

First line for Simple, Complex, and Tonic-clonic. Also first line for trigeminal neuralgia

Question 12

Carbamazepine mech

Answer 12

increase Na channel inactivation

Question 13

Carbamazepine SE

Answer 13

Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of CYP 450-, SIADH, Stevens-Johnson syndrome.

Question 14

Valproic Acid clinical use?

Answer 14

First line Tonic-Clonic. Also used to treat Simplex, Complex, Tonic-Clonic, Absense. Also used for myoclonic seizures and bipolar disorder.

Question 15

Valproic Acid Mech:

Answer 15

Increase Na+ channel inactivation, Increase GABA concentration by inhibiting GABA transaminase

Question 16

Valproic Acid SE:

Answer 16

GI, distress, rare but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus (spina bifida), tremor, weight gain, contraindicated in pregnancy.

Question 17

Gabapentin Clinical use?

Answer 17

Simple, Complex, Tonic-Clonic Seizures. Also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder.

Question 18

Gabapentin Mech:

Answer 18

Primarily inhibits high voltage activated Ca++ channels; designed as GABA analog

Question 19

Gabapentin SE:

Answer 19

Sedation, Ataxia

Question 20

Phenobarbital clinical use:

Answer 20

Simple, Complex, Tonic-Clonic

Question 21

Phenobarbital Mech:

Answer 21

Increase GABA (A) action

Question 22

Phenobarbital SE:

Answer 22

Sedation, tolerance, dependence, induction of CYP450, cardiorespiratory depression.

Question 23

What drug is 1t line for neonates?

Answer 23

Phenobarbital

Question 24

Topiramate Clinical use:

Answer 24

Simple, Complex, Tonic-Clonic. Also used for migraine prevention.

Question 25

Topiramate SE:

Answer 25

sedation, mental dulling, kidney stones, weight loss

Question 26

Topiramate mech:

Answer 26

blocks Na+ channels, increase GABA action

Question 27

Lamotrigine clinical use:

Answer 27

Simple, Complex, Tonic-Clonic, Absence

Question 28

Lamotrigine mech:

Answer 28

Blocks voltage-gated Na+ channels

Question 29

Lamotrigine SE:

Answer 29

Stevens-Johnson syndrome (must be titrated slowly)

Question 30

Levetiracetam clinical use:

Answer 30

Simple, Complex, Tonic-Clonic

Question 31

levetiracetam mech

Answer 31

Unknown; may modulate GABA and glutamate release

Question 32

Tiagabine clinical use:

Answer 32

Simple and Complex

Question 33

Tiagabine mech

Answer 33

increase GABA by inhibiting re-uptake

Question 34

Vigabatrin clinical use:

Answer 34

Simple and Complex

Question 35

Vigabatrin mech

Answer 35

Increase GABA by irreversibly inhibiting GABA transamination.

Question 36

What is the presentation of Stevens-Johnson syndrome?

Answer 36

Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal and sloughing.

Question 37

What is the first line prophylaxis for Status Elipticus?

Answer 37

Phenytoin

Question 38

What is the first line for for Simple?

Answer 38

Carbamazepine

Question 39

What is the first line for acute status epilepticus?

Answer 39

Benzos (diazepam, lorazepam)

Question 40

First line for Tonic - Clonic?

Answer 40

Phenytoin, Carbamazepine, Valproic Acid

Question 41

First line for complex?

Answer 41

Carbamazepine

Question 42

What are the barbiturates?

Answer 42

Phenobarbital, Pentobarbital, Thiopental, Secobarbital

Question 43

What is the mech of Barbiturates?

Answer 43

Facilitate GABA(A) action by increasing duration of Cl- channel opening, thus decrease neuron firing (barbiDURATES increase duration).

Question 44

Barbiturates are contraindicated in what?

Answer 44

Porphyria

Question 45

What is the clinical use of Barbiturates?

Answer 45

Sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)

Question 46

Toxicity of barbiturates?

Answer 46

Respiratory and cardiovascular depression (can be fatal); CNS dperession (can be exacerbated by EtOH use); dependence; drug interactions (induces CYP450). Overdose treatment is supportive (Assist respiration and maintain BP).

Question 47

Benzodiazepines

Answer 47

Diazepam, lorazepam, triazolam, temazepam, oxacepam, midazolam, chlordiazepoxide, alprazolam.

Question 48

mech of benzos?

Answer 48

Faciliate GABA(A) action by increasing (FREQUENCY) of Cl- channel opening. Decrease REM sleep. Most have long half-lives and active metabolites

Question 49

most have long half lifes, what are the exceptions? what does this indicate?

Answer 49

Triazolam, oxazepam, and midazolam: short acting and therefore have a higher addictive potential.

Question 50

Clinical use of benzos

Answer 50

Anxiety, spaticity, status epilepticus (lorazepam and diazepam), detoxification (especially alcohol withdrawal -DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia)

Question 51

Benzo Toxicity

Answer 51

Dependence, additive CNS depression effects with alcohol. less risk of respiratory depression and coma than with barbiturates.

Question 52

What is the antidote for benzo toxicity?

Answer 52

Flumazenil (competitive antagonist at GABA benzodiazepine receptor)

Question 53

What are the nonbenzodiazepine hypnotics?

Answer 53

Zolpidem, Zaleplon, esZopiclone. (All ZZZs put you to sleep)

Question 54

Nonbenzodiazepine mech

Answer 54

Act via the BZ1 subtype of the GABA receptor. Effects reversed by flumazenil.

Question 55

Nonbenzodiazepine clinical use:

Answer 55

Insomnia

Question 56

Nonbenzodiazepine Toxicity

Answer 56

Ataxia, headaches, confusion. Short duration because of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnestic effects. Decrease dependence risk than benzos