Exam Two - Antiseizure Drugs

Question 1

tonic-clonic

Answer 1

grand mal

Question 2

absence

Answer 2

petit mal - early childhood onset

Question 3

myoclonic

Answer 3

awake, brief - onset teens/adults

Question 4

clonic

Answer 4

more impaired consciousness vs myoclonic

Question 5

tonic

Answer 5

“tone”

Question 6

Atonic

Answer 6

fainting goat

Question 7

focal

Answer 7

involve a portion of ONE hemisphere, may progress to bilateral tonic clonic though

Question 8

General Antiepileptic drugs side effects

Answer 8

nausea
vomiting
ataxia
sedation
pregnancy (teratogenicity)
rashes
weight changes
mood/psychosis/suicial ideations
Drug interactions may worsen side effects

Question 9

Benzo MOA?

Answer 9

bind GABA inhibitory receptors and decrease firing rate

Question 10

What is the main use for benzo?

Answer 10

urgent/acute injectable use to break a seizure

Question 11

lamotrigine (lamictal) MOA?

Answer 11

multiple:
blocks NA+ and high-voltage depending CA++ channels

Question 12

Lamotrigine uses

Answer 12

• usually a reasonable choice!
  common monotherapy
• absense, focal, generalized and LG SZ
• psych use for bipolar disorder

Question 13

DDI of lamotrigine?

Answer 13

inducers will decrease lamotrigin levels
divalproex (VPA) will increase levels

Question 14

you must titrate _______ slowly

Answer 14

lamotrigine

Question 15

levetiracetam MOA

Answer 15

unique: binds SV2A protein (decrease release of excitatory NT glutamate during high-frequency firing, partially inhibits N-type Ca channels in neuronal cells

Question 16

use of levetracetam

Answer 16

focal and generalized Sz. probably most common monotherapy - reasonable test-taking choice if stuck

Question 17

side effects of levetiracetam

Answer 17

psychiatric/mood changes, depression, nervousness, dizziness

Question 18

How many side effects does levetiracetam have?

Answer 18

few!

Question 19

brivaracetam

Answer 19

use in focal onset sz

Question 20

valproic acid/divalproex MOA

Answer 20

various, block Na channels, inhibit GABA and others?

Question 21

valproic acid/divalproex use?

Answer 21

lots! focal and generalized sz, also used in bipolar

Question 22

valproic acid/divalproex side effects?

Answer 22

GI, tremor, hyperammonemia, pancreatitis, alopecia, thrombocytopenia

Question 23

which drugs causes these risks in pregnancy: cognitive defects (low IQ), neural tube defects, digital abnormalities?

Answer 23

valproic acid/divalproex

Question 24

phenytoin/fosphenytoin MOA?

Answer 24

block Na channels

Question 25

"hydantoins"

Answer 25

phenytoin/fosphenytoin

Question 26

phenytoin/fosphenytoin uses?

Answer 26

focal and generalized tonic-clonic sz

Question 27

phenytoin/fosphenytoin side effects

Answer 27

ataxia nausea vomiting gingical hyperplasia hirsutism nystagmus

Question 28

fetal hydantoin syndrome associated with which drug?

Answer 28

phenytoin/fosphenytoin

Question 29

phenytoin/fosphenytoin has a non-linear PK which means small dose changes = ......

Answer 29

big level changes

Question 30

DDIs of phenytoin/fosphenytoin

Answer 30

inducer of CYP2C and 3A

Question 31

ethosuximide MOA?

Answer 31

inhibits low threshold Ca channels (T-type)

Question 32

ethosuximide uses?

Answer 32

absence SZ!!

Question 33

ethosuximide side effects?

Answer 33

nausea vomiting headache dizziness

Question 34

carbamazepine, oxcarbazepine, eslicarbazepine MOA?

Answer 34

Na channel inhibitor

Question 35

carbamazepine, oxcarbazepine, eslicarbazepine uses?

Answer 35

focal sz, tonic-clonic, trigeminal neuralgia, bipolar disorder

Question 36

carbamazepine, oxcarbazepine, eslicarbazepine side effects?

Answer 36

nausea vomiting dizziness leukopenia hyponatremia rash SJ (high in asians)

Question 37

topiramate MOA?

Answer 37

multiple: inhibit Na channels, inhibit high voltage Ca channels (L type), carbonic anhydrase inhibitor, NMDA actions? GABA?

Question 38

stupormax?

Answer 38

topiramate

Question 39

topiramate uses?

Answer 39

broad-spectrum, focal sz, tonic-clonic, L-G and migraine prophylaxis

Question 40

topiramate side effects??

Answer 40

COGNITIVE SIDE EFFECTS IN OVER 20% OF PATIENTS, risk of cleft palate if used in 1st trimester nausea vomiting dizziness paresthesias

Question 41

phenobarbital MOA?

Answer 41

barbiturate, modulate GABA receptors, reduce excitatory responses

Question 42

phenobarbital uses?

Answer 42

focal, generalized tonic-clonic, myoclonic, neonatal sz

Question 43

phenobarbital side effects?

Answer 43

LOTS nausea vomiting dizziness sedation dependence congenital defects - esp cardiac if used in pregnancy

Question 44

_________ converted to phenobarbital in-vivo!

Answer 44

primidone

Question 45

cenobamate MOA?

Answer 45

block Na channels, modulate GABA

Question 46

cenobamate uses?

Answer 46

focal sz - good efficacy

Question 47

cenobamate side effects?

Answer 47

dizziness fatigue dress - may reduce OCP efficacy!

Question 48

fenfluramine MOA?

Answer 48

increase serotonin

Question 49

fenfluramine uses?

Answer 49

davet and lennox-gastaut

Question 50

fenfluramine side effects?

Answer 50

agitation, insomnia, fatigue, heart valve issues, increased BP

Question 51

which is a repurposed drug? That is, it used to be an appetite suppressant and was pulled from the market due to heart value issues?

Answer 51

fenfluramine

Question 52

Which drugs interact with birth control?

Answer 52

phenytoin phenobarbital primidone topiramate carbamazepine oxcarbazepine cenobamate

Question 53

Which sz drugs cause risk to fetus?

Answer 53

valproic acid/divalproex topiramate phenytoin phenobarbital primidone

Question 54

list of sodium channel blockers

Answer 54

lamotrigine carbamazepine phenytoin/fosphenytoin divalproex/VPA topiramate cenobamate

Question 55

calcium channel blockers list

Answer 55

ethosuximide (T-type) topiramate (L-type) gabapentinoids

Question 56

GABA-related list

Answer 56

benzodiazepine barbiturates/primidone

Question 57

SV2A protein binding list

Answer 57

levetiracetam brivaracetam