Komiskey Anticonvulsants

Question 1

Phenytoin

Answer 1

Alters Na, Ca, and K conductances, membrane potentials, and aa concentration
Inhibits high freq firing
Toxicity: hirsutism, gingival hyperplasia, exacerbates absence seizures, coarse facial features, decerebrate rigidity

Question 2

Carbamazepine

Answer 2

Works on all partial seizures, effective in tonic clinic
Rx for Trigeminal and other neuralgia
Inhibits high freq firing-Na channels
Inhibits uptake and release of NE, but not GABA
Potentiates post synaptic effects of GABA
SE: aplastic anemia, exacerbates absence seizure, granulocyte suppression

Question 3

Oxcarbazepine

Answer 3

Like carbamazepine but with less toxicity
First choice for partial-generalized adjunct therapy
Alters Na conductance and inhibits high freq firing
SE: hyponatremia
Can aggravate myoclonic and absence

Question 4

Lamotrigine

Answer 4

Blocks firing of Na channel
DOC in myoclonic,atonic, and generalized seizures, absence
SE: life threatening rash
T1/2=24hrs

Question 5

Levetiracetam

Answer 5

Broad spectrum
Binds to synaptic vesicular protein SV2A
DOC: myoclonic, atonic, generalized seizures and atypical absence
SE:decrease in RBC, ataxia

Question 6

Phenobarbital

Answer 6

50% response to simple partial seizures, febrile, unresponsive tonic-colonic
Not for complex partial
Prolongs opening of Cl channels
Blocks excitatory GLU and CA channel
Inhibits high freq repetitive firing
SE: induction of liver enzymes, worsens absence and atonic

Question 7

Ezogabine

Answer 7

For partial and refractory partial epilepsy
Open voltage gated potassium channels -hyperpolarizes
Can enhance GABA A currents
SE: urinary retention

Question 8

Gabapentin

Answer 8

Partial and generalized tonic clonic
Low potency, no drug interactions
Decrease Ca currents by binding alpha 2 delta subunit of VG Calcium channel

Question 9

Topiramate

Answer 9

Blocks voltage dependent Na channels
Potentiates GABA
Depresses excitatory kainate on AMPA receptors
SE: cognitive slowing, paresthesias, weak carbonic anhydrase inhibitor
Bioavailability is 80%

Question 10

Tiagabine

Answer 10

Partial seizures at least 12 y/o -100% bio
GABA uptake inhibitor by neurons and glial
SE: abdominal pain, emotional liability, psychosis, skin rash

Question 11

Zonisamide

Answer 11

Partial and tonic clonic 
Adjunctive for adults 
Inactivation of sodium channels 
Inhibition of Ca T channels 
Binds GABA receptor 
Facilitates 5ht and DA neurotransmission 
SE: renal stones, anorexia

Question 12

Worst drugs for rash

Answer 12

Phenytoin, Lamotrigine, zonisamide

Question 13

Pregabalin

Answer 13

Binds alpha 2 delta subunit of the Ca channel
Increases GABA and glutamic acid decarboxylase
For: partial seizures, shingles and neuropathic, fibromyalgia

Question 14

Meds for absence seizures

Answer 14

Ethosuximide, valproate maybe Lamotrigine

Question 15

Ethosuximide

Answer 15

DOC for absence seizures, high efficacy and safety
Reduces low threshold Ca channel current (t type)
At high concentrates: inhibit na/k atpase, GABA aminotransferase, depress cerebral metabolic
Toxicity: GI distress, hiccups, euphoria, skin rash, lupus

Question 16

Valproate

Answer 16

Increase GABA in brain
Facilitates glutamic acid decarboxylase
Inhibits GABA transporter in neurons and glia
DOC myoclonic, atonic seizures
SE: elevated liver enzymes, hair loss, weight gain, hepatotoxity,
Teratogen: spins bifida, congenital impairment

Question 17

Myoclonic seizures, atypical absence, atonic

Answer 17

Valproate, levetiracetam , colonazepam

Question 18

Benzodiazepine

Answer 18

Safest drug
Clonazepam- suppress seizure spread, absence and myoclonic
Increases freq of Cl channel
Clorazepate- effective in partial

Question 19

Midazolam, lorazepam, diazepam

Answer 19

Lorazepam- longer acting
Primary for treating epilepticus
All obstetric modulator of GABA receptor, increases opening
SE: sedation and tolerance

Question 20

Worst drugs for pregnancy

Answer 20

Topiramate, phenobarbital, valproate

Question 21

Best for focal onset

Answer 21

Carbamazepine, phenytoin, levetiracetam, zonisamide