Pharm 8 Anticonvulsants

Question 1

Boobs

Answer 1

BOOBS

Question 2

Group 1 mechanism

Answer 2

Enhance GABA

Question 3

Group 2 mechanism

Answer 3

Inhibit Glutamate

Question 4

Group 3 mechanism

Answer 4

Ion channel blocker

Reduce neuronal excitability

Question 5

Theory behind most seizure control

Answer 5

• Decrease Na conductance (prolong refractory period)

- Facilitate GABA

Question 6

Absence seizure Tx theory

Answer 6

• Reduce Ca current

- Other drugs might exacerbate

Question 7

-Phenytoin-

MOA

Answer 7

Prolong Na channel inactivation, reduce neuronal firing

Question 8

-Phenytoin-
Metabolism
Serum levels
Interactions

Answer 8

• Liver
• Slow unless IV, doesn’t work IM
• Oral contraceptives

Question 9

-Phenytoin-

Toxicity (acute, chronic, IV)

Answer 9

Acute - Nystagmus, Diplopia, Ataxia
         - Cerebellar atrophy sometimes
Chronic - Gingival hyperplasia & hirsutism
            - Agranulocytosis, Rash
IV - arrhythmia, CNS depression

Question 10

-Phenytoin-
Good aspects
Alternative

Answer 10

• Minimal sedation

- Fosphenytoin (pro-drug)

Question 11

-Carbamazepine-

MOA

Answer 11

Non-sedating Tricyclic

Prolong Na channel inactivation

Question 12

-Carbamazepine-

Metabolism

Answer 12

• Induces microsomal enzymes -> enhances metabolism of other anti-convulsants
• Active metabolite

Question 13

-Carbamazepine-

Toxicity

Answer 13

Acute - Stupor, Coma, Convulsion, Rash
Chronic - Diplopia, Ataxia
- Agranulocytosis
- Stevens-Johnson in Asians (test)

Question 14

-Phenobarbitol-
Indication
MOA

Answer 14

• Young children, Status Epilepticus

- Na inactivation, GABA stimulation

Question 15

-Phenobarbitol-

SE

Answer 15

-Sedation, Respiratory depression, Tolerance

Question 16

-Lamotrigine-

Answer 16

• Adjunct

- May cause life threatening rash in children

Question 17

-Feldamine-

Answer 17

• Adjunct

- Severe hepatitis and Aplastic Anemia

Question 18

-Gabapentin-

Answer 18

• Adjunct (GABA)

- May exacerbate myoclonic seizures

Question 19

-Topiramate-

Answer 19

• Adjunct

- Typical mental SE

Question 20

-Tiagabine-

Answer 20

• Adjunct (GABA)

- Typical mental SE

Question 21

-Pregabalin-

Answer 21

• Adjunct (GABA)
• Good for neuropathic pain
• Euphoria SE

Question 22

-Ethosuximide-
Indication
MOA

Answer 22

• Absence seizures

- Ca channel inhibition (thalamic)

Question 23

-Ethosuximide-

Metabolism

Answer 23

Liver

Question 24

-Ethosuximide-
SE
Toxicity

Answer 24

• GI side effects

- Rash and bone marrow depletion

Question 25

-Valproic Acid- Indication MOA

Answer 25

- Absence seizures, Generalized Tonic-Clonic | - Inhibit Na and Ca channels and GABA

Question 26

-Valproic Acid- Metabolism Interactions

Answer 26

- Liver | - Blocks metabolism of other anti-convulsants (phenytoin, carbamazepine, phenobarbital)

Question 27

-Valproic Acid- SE Toxicity

Answer 27

- GI side effects, birth defects | - Hepatotoxicity in infants and patients on too many medications

Question 28

-Diazepam- Indication MOA

Answer 28

- Status Epilepticus | - Benzo

Question 29

-Clonazepam- Indication MOA

Answer 29

-Infantile spasms, Absence/myclonic seizures

Question 30

Anticonvulsant interaction with: Oral contraceptives Pregnancy

Answer 30

- Reduce efficacy (phenytoin, carbamazepine, phenobarbital) | - Vitamin K deficiency -> Coagulation problems

Question 31

Most teratogenic anticonvulsant

Answer 31

Valproic acid