Pharmacology of Anti-Seizure Drugs

Question 1

What drugs are used as rescue drugs for status epilepticus and may be administered nasally?

Answer 1

Diazepam, Lorazepam, Clonazepam

Question 2

This drug is second-line for status elepticus.

Answer 2

Fosphenytoin

Question 3

What ASMs are broad spectrum enzyme inducers?

Answer 3

Phenytoin, Carbamazepine, Phenobarbital

Question 4

True/False. There is no drug to treat epilepsy.

Answer 4

True. Current drugs treat active seizures and manage symptoms, but cannot cure epilepsy.

Question 5

What ASM blocks NMDA receptors?

Answer 5

Felbamate

Question 6

What ASM is associated with anger and irritability?

Answer 6

Levetiracetam

Question 7

What is the MOA of Tiagabine?

Answer 7

Inhibits pre-synaptic GABA uptake

Question 8

What ASM is associated with weight loss?

Answer 8

Topiramate

Question 9

This drug may be used to treat focal seizures in children and adults, but is not a first line option.

Answer 9

Phenytoin

Question 10

Diplopia and ataxia are ADRs most commonly associated with what ASM?

Answer 10

Carbamazepine

Question 11

What ASM has zero-order kinetics?

Answer 11

Phenytoin

Question 12

ASMs that target Na+ channels should be closely monitored in what patient population?

Answer 12

Patients over 60yo or with cardiac issues

Question 13

Topiramate is used for the treatment of what seizure types?

Answer 13

Monotherapy for focal and generalized seizures and migranes

Question 14

What ASMs act by inhibiting Na+ channels?

Answer 14

Phenytoin, Carbamazepine, Lamotrigine, Topiramate, VPA

Question 15

What is the MOA of Valproate/Valproic Acid?

Answer 15

Blocks Na+ channels and increases K+ permeability

Question 16

What is the first line therapy for absence epilepsy in adults?

Answer 16

Ethosuximide

Question 17

What is the use for Tiagabine?

Answer 17

Adjunct therapy for focal seizures

Question 18

What ASM may exacerbate myoclonic and abscene seizures, if prescribed?

Answer 18

Carbamazepine

Question 19

Infantile spasms and tuberous sclerosis can be treated with what ASM?

Answer 19

Vigabatrin

Question 20

What Na+ channel-targeting ASMs are broad spectrum?

Answer 20

Lamotrigine, Valproate, Topiramate,

Question 21

What is the MOA of Carbamazepine?

Answer 21

Binds to inactivated Na+ channels

Question 22

Benzodiazepines & barbituates both bind the GABAa receptor to enhance Cl- channel function. How do their MOAs differ?

Answer 22

Benzodiazepines increase the duration of channel opening. Barbituates increase the frequency of channel opening. Both cause hyperpolariztion.

Question 23

These ASMs are good for adjunct therapy, but are not used first line for any epilepsy.

Answer 23

Gabapentin, Pregabalin

Question 24

What ASM is a first-line therapy for seizures in neonates?

Answer 24

Phenobarbital

Question 25

Vigabtrin is associated with what irreversible ADR?

Answer 25

Vision deficits and retinopathy

Question 26

What ASM is associated with weight loss?

Answer 26

Ethosuximide & Topiramate

Question 27

How is Levetircetam used in adults?

Answer 27

Adjunct therapy for focal seizures

Question 28

What is the MOA of Levetircetam?

Answer 28

Binds the synaptic vesicle to modify neurotransmitter release

Question 29

What ASMs are associated with behavioral changes?

Answer 29

Levetircetam, Perampanel

Question 30

What ADRs are most associated with Valproate/Valproic Acid?

Answer 30

GI disturbances

Question 31

What ASM can be added as an adjunct therapy to treat generalized tonic-clonic seizures in children?

Answer 31

Levetircetam

Question 32

What serious ADRs are associated with phenytoin?

Answer 32

SJS/TEN, gingival hyperplasia

Question 33

What is the MOA of Lamotrigine?

Answer 33

Bind inactivated Na+ channels

Question 34

What rare ADR is unique to Lamotrigine?

Answer 34

Hemophagocytic Lymphohistiocytosis (HLH)

Question 35

What ASM is contraindicated during pregnancy?

Answer 35

Valproate/Valproic Acid

Question 36

What is the MOA of gabapentin & pregabalin?

Answer 36

Bind Ca2+ channels to decrease Ca2+ influx and thus glutamate release

Question 37

What ASM irreversible inhibits the GABA aminotransferase to prevent degradation of GABA?

Answer 37

Vigabatrin

Question 38

Dependence and tolerance are commonly associated with what class of ASMs?

Answer 38

Benzodiazepines (Diazepam, Lorazepam, Clonazepam)

Question 39

How do ASMs inhibit Na+ channels?

Answer 39

They bind to Na+ channels in the inactivated state to extend the refractory period

Question 40

When is the MOA of Phenytoin and Fosphenytoin?

Answer 40

Bind inactivated Na+ channels

Question 41

Juvenile Myoclonic Epilepsy is effectively treated with this ASM.

Answer 41

Valproate/Valproic Acid

Question 42

What is the most common drug to treat focal seizures?

Answer 42

Carbamazepine

Question 43

What is the first line therapy for absence epilepsy in children?

Answer 43

Ethosuximide

Question 44

What is the MOA of Carbamazepine?

Answer 44

Bind inactivated Na+ channels

Question 45

In utero cardiac malformations are associated with which ASM?

Answer 45

Phenobarbital

Question 46

How does Fosphenytoin differ from Phenytoin?

Answer 46

Fosphenytoin is a phenytoin derivate that may be administered via IM or IV

Question 47

Most ASMs are broad inducers of enzymes. What ASM is a broad INHIBITOR?

Answer 47

Valproate/Valproic Acid

Question 48

What ASM acts on Ca2+ channels on thalamic neurons?

Answer 48

Ethosuximide

Question 49

Cannabidol has been approved for treatment of what seizure disorders?

Answer 49

Lennox-Gastaut Syndrome, Dravet Syndrome, Tuberous Sclerosis

Question 50

What serious ADRs are associated with Felbamate?

Answer 50

Liver failure, aplastic anemia

Question 51

Cognitive slowing is associated with what ASM?

Answer 51

Topiramate