Pharma-Antiepileptic Drugs

Question 0

1) Clozapine
2) Olanzapine
3) Risperidone
4) Ziprasidone
5) Amisulpride

Answer 0

Atypical antipsychotics (Second generation)

Question 1

1) Chlorpromazine

2) Haloperidol

Answer 1

Typical antipsychotics (First generation)

Question 2

MOA of typical antipsychotics

Answer 2

Block D2 receptors in brain’s dopamine pathways

Question 3

MOA of atypical antipsychotics

Answer 3

Block D2 receptors in brain’s dopamine pathways with additional to serotonin receptors

Question 4

Seizures?

Answer 4

Abnormal excessive neuroactivity in the brain

Question 5

Convulsions?

Answer 5

1) Contraction and relaxation of skeletal muscle (Repeated and rapid)
2) Due to head injury, drug overdose or toxins

Question 6

Epilepsy?

Answer 6

Seizures with or without convulsions with no immediate underlying cause

Question 7

Classifications of seizures

Answer 7

1) Partial “focal” seizures
2) Generalised seizures
3) Status epilepticus

Question 8

Aim of treatment of anti-epileptic drugs

Answer 8

1) Drugs/pharmacological

2) Vagus nerve stimulation

Question 9

MOA of anti-epileptic drugs

Answer 9

1) Inhibit voltage-gated sodium channels
2) Reduce GABA-ergic transmission
3) Calcium channel inhibitors

Question 10

1) Phenytoin
2) Carbamazepine
3) Lamotrigine
4) Valproic acid

Answer 10

Inhibit voltage-gated sodium channels

Question 11

1) Ethosuximide

2) Lamotrigine

Answer 11

Ca2+ channel inhibitors

Question 12

1) Benzodiazepines
2) Phenobarbital
3) Valproic acid
4) Galbapentin, Pregabalin
5) Felbamate

Answer 12

Reduce GABA-ergic transmission

Question 13

1) Grand mal, Complex Partial
2) Not indicated for absence seizures
3) Antiarrythmic drug (Digoxin toxicity)
4) Enhance inactive form of Na2+ channels

Answer 13

Phenytoin (Dilantin)

Question 14

1) Nystagmus, double vision, tremor, ataxia, sedation (CNS-related)
2) Megaloblastic anemia due to low folate production
3) Teratogenic
4) Drug-induced lupus
5) Gingival hyperplasia
6) Induction of liver enzymes
7) Interacts with Warfarin and Trimethoprim

Answer 14

Side effects of phenytoin

Question 15

Fosphenytoin?

Answer 15

Prodrug of phenytoin

Question 16

1) Grand mal, Complex Partial
2) Not indicated for absence seizures
3) Trigeminal neuralgia; neuropathic pain
4) Long half life (~30 hours)

Answer 16

Carbamazepine (Tegretol)

Question 17

1) Aplastic anemia
2) Teratogenic: Spina Bifida
3) Drowsiness, dizziness, headache, nausea (CNS)
4) Enhance liver enzymes

Answer 17

Side effects of carbamazepine

Question 18

Oxycarbazepine

Answer 18

Prodrug of carbamazepine

Question 19

Drug of choice for absence seizures

Answer 19

Ethosuximide

Question 20

1) CNS-related side effects

2) GI-related side effects

Answer 20

Ethosuximide

Question 21

1) Absence seizures
2) Tonic-clonic (Grand mal)
3) Status epilepticus

Answer 21

Valproic acid

Question 22

Mood stabiliser for bipolar mania?

Answer 22

Valproic acid

Question 23

1) CNS-related
2) Diarrhea, liver toxicity (GI-related)
3) Hyperandrogenism (Female)
4) Low liver enzyme production
5) Blood protein-bound
6) Teratogenic

Answer 23

Side effects of valproic acid

Question 24

Drug of choice for status epilepticus

Answer 24

Benzodiazepines, Phenobarbital

Question 25

MOA of Phenobarbital and Benzodiazepines

Answer 25

Potentiate GABA function

Question 26

1) Diazepam | 2) Lorazepam

Answer 26

Benzodiazepines, Phenobarbital

Question 27

Special precaution for Benzodiazepines and Phenobarbital

Answer 27

Low therapeutic index

Question 28

Side effect of Benzodiazepines and Phenobarbital

Answer 28

Sedation

Question 29

1) Partial, Generalised, Atypical Absence seizures 2) Metabolised in liver 3) Indication for bipolar and neuropathic pain

Answer 29

Lamotrigine

Question 30

Side effect of lamotrigine

Answer 30

Severe skin reaction (serious side effect)

Question 31

Lamotrigine + Phenytoin?

Answer 31

Increase lamotrigine dose

Question 32

Lamotrigine + Valproate

Answer 32

Reduce lamotrigine dose

Question 33

1) Euphoria | 2) Sedation

Answer 33

Side effects of Gabapentin, Pregabalin

Question 34

1) Fatal 2) Aplastic anemia 3) Hepatic failure

Answer 34

Side effects of felbamate

Question 35

1) Used for refractory epilepsies | 2) Multiple mechanisms (Na+, Ca2+, GABA, NMDA)

Answer 35

Felbamate

Question 36

1) Dizziness | 2) Somnolence

Answer 36

Side effects of Levetiracetam (Keppra)

Question 37

1) Partial seizures 2) Adjunct for Generalised epilepsy 3) Unknown MOA

Answer 37

Levetiracetam (Keppra)

Question 38

TT of status epilepticus

Answer 38

1) IV Diazepam or lorazepam 2) IV Phenytoin or Fosphenytoin 3) IV Phenobarbitone

Question 39

TT of severe refractory epilepsy

Answer 39

1) GA 2) Artificial respiration 3) Neuromuscular blocker

Question 40

1) Monotherapy 2) Lowest possible dose 3) Lamotrigine, oxcarbazepine, gabapentin are indicated 4) Valproate, phenobarbital, others are contraindicated

Answer 40

Pregnancy

Question 41

No or minimal effect to hepatic enzymes

Answer 41

1) Topiramate | 2) Oxcarbazepine