Lecture 9 Anticonvulsants

Question 1

partial seizures:
affect one or both hemispheres?
most commonly originate where?

Answer 1

one;

medial temporal lobe

Question 2

partial seizures:
which kind is characterized by sensory disturbances and retained consciousness?
in which kind is consciousness lost?

Answer 2

simple,
complex

both can secondarily generalize

Question 3

generalized seizures:
\_\_\_\_ = stiffening then jerking;
\_\_\_\_ = lapses in awarenesss, 100s per day. 
\_\_\_\_\_ = drops to the floor, falls.
\_\_\_\_ = quick repetitive jerks

Answer 3

tonic-clonic;
absence;
atonic;
myoclonic

status epilepticus = continuous seizures ( > 5 min)

Question 4

MCC seizure by age:
kids =
adults =
elderly =

Answer 4

genetic (or febrile infection);
tumor;
stroke

Question 5

seizures are characterized by ____, _____ neuronal firing

Answer 5

synchronized, high frequency

Question 6

a _____ starts the seizure = excessive neuronal discharge due to imbalance in ratio of excitation/inhibition

Answer 6

paroxysmal depolarization shift

Na influx

Question 7

_____ = repeated stimulation sensitizes an area to become a focus

Answer 7

kindling

Question 8

frequency dependent block:
drug binds more avidly at ___ frequencies. drug (does or does not) dissociate between spikes?
block ____ each spike

Answer 8

higher;
does not;
accumulates

Question 9

voltage dependent block:

drug binds tighter at ____ Channel. ____ percentage of channels are always blocked

Answer 9

more depolarized;

higher

Question 10

phenytoin:

blocks ____ channels and prolongs _____. first line for ____. also used for ____ and ____

Answer 10

Na, inactivation;
status epilepticus (First line);
partial, tonic-clonic

Question 11

phenytoin side effects:
\_\_\_\_ hyperplasia;
2 eye effects ; 
dermatologic effect = 
teratogenic-causes \_\_\_\_ especially

Answer 11

gingival;
diplopia, nystagmus;
hirsutism;
cleft-palate

Question 12

phenytoin:
CYP \_\_\_\_;
cerebellar \_\_\_\_;
fun skin syndrome?
kinetics?

Answer 12

inducer;
ataxia;
SJS;
ZERO order

Question 13

carbamazepine:
blocks ___ channels. prolongs _____.
treats ____ and ____

Answer 13

Na;
inactivation state;
partial, tonic-clonic

Question 14

carbamazepine:
teratogenic
cerebellar \_\_\_\_;
blood problem = 
\_\_\_ toxicity

Answer 14

ataxia;
agranulocytosis/aplastic anemia;
liver

also nausea

Question 15

carbamazepine:
also first line for _____;
CYP ____

Answer 15

trigeminal neuralgia;

inducer

Question 16

ethosuximde:
blocks ____;
first line for _____.

Answer 16

T-Type calcium channels;

absence seizures

Question 17

ethosuximide:
___ and ___ problems;
itching, depression

Answer 17

GI, sleep

Question 18

benzodiazepines:
increase ____ action.
first line for acute _____ and seizure clusters

Answer 18

GABA-A;

status epilepticus

Question 19

phenobarbital:
increase ____ action;
for ____ or ___ seizures

Answer 19

GABA-A;

tonic clonic, partial

Question 20

phenobarbital:
CYP ____:
teratogenic;
cardio respiratory _____

Answer 20

inducer;

depression

Question 21

gabapentin:
primarily blocks _____ channels.
somewhat increases ____ action;
mainly used for ___ seizures

Answer 21

Ca (N type);
GABA;
partial (Also general according to notes)

Question 22

2 side effects of gabapentin:

Answer 22

sedation, ataxia;

also used for neuropathy, post-herpetic neuralgia FYI

Question 23

lamotrigine:
mainly blocks ___ channels, inhibiting release of ____;
3 seizures its used for?

Answer 23

Na (also Ca according to notes);
glutamate;
abscence, partial (myoclonic), tonic-clonic

Question 24

lamotrigine side effects:
2 skin probs:
myclonus;
eye problem =

Answer 24

severe rash, SJS;

diplopia

Question 25

tigabine:
increases ____ by ______;
mainly for ____

Answer 25

GABA, reuptake;
partial seizures

something about GAT1 inhibition in notes

Question 26

tigabine side effects:

somnolence, headache, ____ (psych), and notably _____

Answer 26

depression;

seizures

Question 27

topiramate:
blocks ____ channels, increases ____ action;
used for ____ and ____

Answer 27

Na, GABA (and blocks NMDA according to notes);

partial, tonic-clonic

Question 28

topiramate effects:

mental ___, ____ (kidney effect), weight ____, ____ (eye effect)

Answer 28

dulling/sedation; kidney stones;

loss, glaucoma (and myopia)

Question 29

valporate:
____ channel inactivation, inhibits _____;
first line for ____; also for _____

Answer 29

increased Na;
GABA transaminase –> increased GABA;
tonic clonic;
absence seizures

Question 30

valproate effects:
____ toxicity, weight _____;
teratogenic = ______;
GI probs

Answer 30

liver;
gain;
neural tube defects

Question 31

felbamate:
used for refractory severe generalized and ____ seizures;
fatal ____ or _____

Answer 31

myoclonic;

hepatotoxicity, aplastic anemia

Question 32

levetiracetam:
used for ___ and ____ seuzures;
can cause ____ changes, ataxia, drowsiness

Answer 32

partial, tonic clonic;

personality/behavior

Question 33

vigabatrin:
inhibits _____;
used for refractory _____ seizures. why is not used tho?

Answer 33

GABA transaminase = increased GABA;
partial;
high risk of permanent blindness

Question 34

zonisamide:
used for partial and ____ seizures;
drowsiness, ____ impairment, severe _____

Answer 34

myoclonic;
cognitive;
rash