MIDTERMS: Anti-Seizures Flashcards
What is the primary goal of antiseizure medications in the treatment of epilepsy?
a) To increase neuronal excitation
b) To suppress the excitability of neurons that initiate seizures
c) To promote the release of monoamines
d) To inhibit GABA receptors
b) To suppress the excitability of neurons that initiate seizures
Which class of anti-epileptic drugs is commonly used for the treatment of absence (petit mal) seizures?
a) Benzodiazepines
b) Hydantoins
c) Succinimides
d) Valproates
c) Succinimides
Which anti-epileptic drug is known for causing gingival hyperplasia as an adverse effect?
a) Valproic acid
b) Phenytoin
c) Diazepam
d) Ethosuximide
b) Phenytoin
True or False: Benzodiazepines are primarily used for the long-term management of epilepsy.
False
Explanation: Benzodiazepines are typically used as adjunct therapy or for acute management, such as status epilepticus, rather than long-term management.
Which of the following drugs is classified as a hydantoin?
a) Diazepam
b) Phenytoin
c) Carbamazepine
d) Ethosuximide
b) Phenytoin
Valproic acid is used off-label for all of the following conditions EXCEPT:
a) Bipolar disorder
b) Migraine headaches
c) Trigeminal neuralgia
d) Fibromyalgia
c) Trigeminal neuralgia
True or False: Barbiturates can enhance the inhibitory effects of GABA by increasing the duration of chloride channel opening.
True
True or False: Valproic acid has a wide therapeutic window and is considered non-toxic.
False
Explanation: Valproic acid has a narrow therapeutic window and can be very toxic if not monitored properly.
__________ are anti-epileptic drugs that stabilize neuronal membranes by decreasing sodium entry into neurons.
Hydantoins
__________ is an anti-epileptic drug used specifically for absence seizures by decreasing calcium influx in thalamic neurons.
Ethosuximide
True or False: Phenytoin is effective in treating absence seizures.
False
Explanation: Phenytoin is primarily used for partial and generalized tonic-clonic seizures, not absence seizures.
Describe the mechanism of action of benzodiazepines in the treatment of epilepsy.
Benzodiazepines enhance the effects of GABA at the GABA
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receptor, increasing the frequency of chloride channel opening. This leads to hyperpolarization of neurons, thereby reducing neuronal excitability and preventing seizures.
One of the common adverse effects of benzodiazepines is __________, which refers to a lack of muscle coordination.
Ataxia
Match the anti-epileptic drug to its corresponding class:
Drug Class
a) Diazepam 1. Hydantoins
b) Phenytoin 2. Succinimides
c) Ethosuximide 3. Benzodiazepines
d) Carbamazepine 4. Iminostilbenes
e) Valproic acid 5. Valproates
a) Diazepam → 3. Benzodiazepines
b) Phenytoin → 1. Hydantoins
c) Ethosuximide → 2. Succinimides
d) Carbamazepine → 4. Iminostilbenes
e) Valproic acid → 5. Valproates
True or False: Succinimides decrease calcium influx in thalamic neurons to exert their anticonvulsant effect.
True
A patient being treated for absence seizures with Ethosuximide develops severe GI distress and a skin rash. What should be the immediate course of action?
The immediate course of action should be to discontinue Ethosuximide and consult a healthcare provider. The patient may need to switch to an alternative anti-epileptic medication and manage the adverse effects accordingly.
________ is a benzodiazepine derivative used as an antagonist to reverse the effects of benzodiazepine overdose.
Flumazenil
The drug __________ is used off-label for bipolar disorder and migraine headaches and works by increasing GABA levels.
Valproic acid
List three common adverse side effects of hydantoin anti-epileptic drugs like Phenytoin.
Gastric irritation
Gingival hyperplasia
Hirsutism
A 30-year-old patient with a history of epilepsy is experiencing frequent partial seizures despite being on Phenytoin. The patient also reports developing gum overgrowth. Which anti-epileptic drug should be considered as an alternative?
Carbamazepine or Oxcarbazepine (Iminostilbenes) could be considered as alternatives to Phenytoin to manage partial seizures and avoid gingival hyperplasia.
Explain why valproic acid requires careful monitoring during treatment.
Valproic acid has a very narrow therapeutic window, making it highly toxic if levels become too high. Adverse effects such as GI distress, temporary hair loss, weight changes, and impaired platelet function necessitate close monitoring of drug levels and patient symptoms.
What are the primary uses of succinimide anti-epileptic drugs?
Succinimides, such as Ethosuximide, are primarily used for the treatment of absence (petit mal) seizures.
Barbiturates enhance the inhibitory effects of GABA by increasing the __________ of chloride channels.
Duration
Why are succinimides like Ethosuximide not effective for generalized tonic-clonic seizures?
Succinimides specifically target absence seizures by decreasing calcium influx in thalamic neurons. They do not effectively stabilize neuronal membranes involved in generalized tonic-clonic seizures, making them ineffective for that seizure type.
Match the anti-epileptic drug to its primary adverse effect:
Drug Adverse Effect
a) Valproic acid 1. Gingival hyperplasia
b) Phenytoin 2. Weight gain or loss
c) Carbamazepine 3. Anemia
d) Ethosuximide 4. Sedation
e) Phenobarbital 5. Cognitive impairment
a) Valproic acid → 2. Weight gain or loss
b) Phenytoin → 1. Gingival hyperplasia
c) Carbamazepine → 3. Anemia
d) Ethosuximide → 4. Sedation
e) Phenobarbital → 5. Cognitive impairment
Explain the rationale behind using benzodiazepines in the treatment of status epilepticus.
Benzodiazepines are used in status epilepticus due to their rapid onset of action and potent anticonvulsant properties. They enhance GABA
Common causes of seizures
Infections, hypoglycemia, hypoxia, CNS injuries, congenital abnormalities, genetic factors.
Common Benzodiazepines used for epilepsy
Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin), Clorazepate (Tranxene)
Iminostilbene anti-epileptic drugs stabilize neuronal membranes by __________ sodium channel recovery.
Slowing
Chronic neurological disorder with recurrent seizures due to hyperexcitable neurons.
Epilepsy
Mechanism of Action of Hydantoins
Stabilize neuronal membranes by decreasing sodium entry into neurons.
Adverse Effects of Iminostilbenes
Dizziness, drowsiness, ataxia, blurred vision, anemia, water retention.
Factors for successful AED withdrawal
Seizure-free for 2+ years, good seizure control within 1 year of onset, normal neuro exam, childhood onset.
Use of Succinimides
Treatment of absence (petit mal) seizures.
Mechanism of Action of Valproates
Increase GABA levels, inhibit sodium and calcium influx.
Mechanism of Action of Gabapentin
Inhibits calcium channels in presynaptic terminals, decreasing excitatory neurotransmitter release.
Side Effects of Levetiracetam
Sedation, dizziness, weakness.
Common Barbiturates for epilepsy
Phenobarbital, Primidone (Mysoline).
Common use of Felbamate
Partial seizures, Lennox-Gastaut syndrome.
Risks of AED use during pregnancy
Increased risk of congenital malformations such as cleft palate, cardiac defects, and neural tube defects.
Management strategy for pregnant women on AEDs
Use monotherapy at the lowest effective dose; avoid valproates if possible.
Mechanism of Action of Topiramate
Inhibits sodium channels, enhances GABA activity, blocks glutamate receptors.
Common use of Pregabalin
Partial seizures, fibromyalgia, neuropathic pain.
Adverse Effects of Vigabatrin
Visual field defects, drowsiness, dizziness.
AED withdrawal process
Gradual tapering over 3-6 months under medical supervision.
Follow-up medication for Status Epilepticus
IV phenytoin or fosphenytoin.
Initial emergency procedures for Status Epilepticus
Maintain airway, administer oxygen, monitor blood pressure, assess for injury, start IV line for drug administration.
What to do if seizures persist after initial treatment
Administer IV phenobarbital or valproic acid; if all fails, use general anesthesia.
First-line medication for Status Epilepticus
IV benzodiazepines: Lorazepam (Ativan), Diazepam (Valium).
