Pharmacology - Pharmacology of epilepsies Flashcards
predisposition to generate recurrent unprovoked epileptic seizures ( due to excessive electrical discharges in the brain) and the associated cognitive, psychological and social consequences
epilepsy
what percentage of people with epilepsy have pharmacoresistant epilepsy
a.50%
b.20%
c.30%
d.40%
c.30%
what are the 3 types of epilepsy
focal onset
generalised onset - absence (rapid blinking, few seconds staring into space)
tonic clonic ( cry out, lose consciousness, muscle jerks and tiredness)
myoclonic (brief muscle spasms)
which type of seizure starts in the mesial temporal lobe (limbic region) leading to hallucinations of smell, taste a funny feeling in the tummy, and memory disturbances plus psychiatric dysfunction
a.focal onset
b.generalised onset
c.motor onset
a.focal
which type of seizure has electrical misactivity all over the brain
a.focal onset
b.generalised onset
c.motor onset
b.generalised onset
what is the key excitatory neurotransmitter
a.dopamine
b.serotonin
c.glutamate
d.GABA
e.Ach
c.glutamate
what is the key inhibitory neurotransmitter
a.dopamine
b.serotonin
c.glutamate
d.GABA
e.Ach
d.GABA
activation of sodium channels on the presynaptic neuron has what effect on neurotransmitter release
a.increased
b.decreased
a.increased
opening of the GABA a receptor allows which substance to move into the post synaptic neuron
a.sodium
b.magnesium
c.potassium
d.chloride
d.chloride
what effect does chloride moving into the post synaptic neuron have
..
a.excitation
b.inhibiton
b.inhibiton
which group of drugs act on the GABA receptor to promote inhibition (likely question )
a.topiramate, benozodiazepines .valproate
b.phenytoin, carbamazepine, lamotrigine, levetiracetam
a.topiramate, benozodiazepines .valproate
which of these groups of drugs reduce excitation by acting on glutamate receptors (likely question)
a.topiramate, benozodiazepines .valproate
b.phenytoin, carbamazepine, lamotrigine, levetiracetam
b.phenytoin, carbamazepine, lamotrigine, levetiracetam
what presynaptic channel do carbamazepine and phenytoin work on
a.calcium
b.sodium
c.potassium
b.sodium
which of these drugs can exacerbate absence and myoclonic seizures
a.carbamazepine
b.sodium valproate
c.torpiramate
d.lamotrigrine
e.levetiracetam
a.carbamazepine
which of these drugs can exacerbate absence and myoclonic seizures
a.phenytoin
b.sodium valproate
c.torpiramate
d.lamotrigrine
e.levetiracetam
a.phenytoin
if someone presents with focal/ generalised epilepsy which drug is first choice
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
interacts the least and has the least side effects
d.lamotrigine
e.levitiracetam
effective against all seizure types
what seizure type is the most effective against generalised seizure types
a.carbamazepine
b.phenytoin
c.sodium valporate
d.lamotrigine
e.leveriracetam
c.sodium valporate
but has side effects so not the best to start with especially for women
what is the mode of action of carbamazepine
a.calcium channel blocker
b.sodium channel blocker
c. potassium channel blocker
b.sodium channel blocker
what is the main side effect of carbamazepine
a.strong hepatic enzyme disturbance
b.kidney failure
c.nausea
a.strong hepatic enzyme disturbance
so has lots of interactions
and can disturb liver function so has ro be monitored
induces enzymes to metabolise itself over wks / months so may need dose increase
RASH - Steven johnson syndrome
what has to be monitored in patients taking carbamazepine
a.wbc
b. fluid levels
c. bilirubin
d.lft
e.thyroid function
d.lft
function can be disturbed
plus major side effect of inducing liver enzymes
which side effects of carbamazepine are dose dependent
a.liver enzyme induction
b.diplopia,ataxia, fatigue
c.hyponatraemia
d.bone marrow surpression, hepatic derangement
b.diplopia,ataxia, fatigue
c.hyponatraemia
d.bone marrow surpression, hepatic derangement
what effect does carbamazepine have on bone marrow
a.surpression
b.activation
a.surpression
changes in platelet function, anaemia, hb
patient has a rash following taking carbamazepine what syndrome does this indicate
a.steven johnson
b.eaton Lambert
c.cushings
d. brown squared
a.steven johnson
organ failure
what side effect of carbamazepine should the patient be advised to stop the drug and phone doctor immediately
a.diplopia
b.ataxia
cfatigue
d.rash
e.hyperensitivity
d.rash
Steven johnson syndorome
what side effect of carbamazepine should the patient be advised to stop the drug and phone doctor immediately
a.diplopia
b.ataxia
cfatigue
d.rash
e.hyperensitivity
d.rash
Steven johnson syndorome
what contraception does carbamazepine interact with
a.progesterone only
b.combined
a.progesterone only
key drugs that carbamazepine interacts with
CARDIAC
ANTIBIOTICS
STEROIDS
which age group should not be prescribed carbamazepine
a.young adults
b.elderly
b.elderly
bone effects
what IS THE MECHANISM OF ACTION OF PHENYTOIN
a.calcium channel blocker
b.sodium channel blocker
c. potassium channel blocker
b.sodium channel blocker
dizziness, fatigue, diplopia, nystagmus , rash and sedation teratogens effects are acute side effects of which drug
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
b.phenytoin
what is important to monitor when giving a loading dose of phenytoin
a.lft
b.thyroid
c.cardiac
d.resp rate
c.cardiac
can cause arrhythmias
gum thickening, coarse face, bone thinning, low folate and peripheral neuropathy FEVER, RASH, LYMPAHDENOPATHY are side effects of which drug over decades
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
b.phenytoin
stop drug is idiosyncratic reaction suspected
in compliance checking / ICU the closer the therapeutic range of phenytoin is to ……… the more effective it is
a.10 ug
b.20 ug
c.30 ug
d.40 ug
b.20 ug
the elimination of phenytoin goes from …………. to ……….
a.first to second order
b.first to zero order
c.zero order to first order
b.first to zero order
pharmacokinetics
phenytoin is a hepatic enzyme……
a.inhibitor
b.inducer
b.inducer
which drug can increase the phenytoin level
a.valproate
b.lamotrigrine
c.carbamazepine
a.valproate
which of these drugs acts on sodium channels and GABA and glutamate receptors
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
c.sodium valproate
what is the major issue of valproate
a.rash
b.cardiac arrhythmias
c. teratogenic
c. teratogenic
DO NOT START DRUG ON YOUNG WOMEN - LEGALLY
what effect does valproate have on lamotrigine
a.increase dose
b.decreases dose
a.increase dose
which drug has few side effects and no significant interactions
a.carbamzepine
b.phenytoin
c.valproate
d. levetiracetam
d. levetiracetam
what is the main side effect of levetiraceteam
a. irritability
b. rash
c. gum thickening
d.heart arrhythmias
e.teratogenic
a. irritability
rarely psychosis
one of the safest in terms of teratogens
which drug acts via the sv2a ligand to block synaptic vesicle release
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
e.levitiracetam
what does lamotrigine work on
a.sodium channel
b.potassium channel
c.gaba and glutamate receptors
d.sv2a ligand
a.sodium channel
which drugs are the safest in terms of teratogenicity
2 Ls
lamotrigine
leviteraciteam
which syndrome that needs emergency treatment can be caused by lamotrigine
a.agranulocytosis
b.brown sequard
c.guillian barre
d.steven johnson
d.steven johnson
idiosyncratic rash
must call and stop drug same day
drug built up slowly
which drug is a mood stabilising drug so a good option for someone with depression
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
d.lamotrigine
which 2 drugs can cause Steven johnson syndrome
a.carbamezipine and phenytoin
b.carbamazepine and lamotrigine
c.lamotrigine and leviteracetam
b.carbamazepine and lamotrigine
lamotrigine interacts with which contraception
a.pop
b.combined
b.combined
cause lamotrigine levels to drop and seizure risk to increase
which other anti epileptic does lamotrigine interact with
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
c.sodium valproate
which drug has multiple modes of action and is helpful for migraine
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
f.toparimate
f.toparimate
sedation and weight loss are the key side effects of which drug
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
f.toparimate
f.toparimate
torparimate should be avoided in…
a.elderly
b. young women
b. young women
comorbidities
mental health
weight gain
bone health - co prescribe vitamin d with carbamazepine
which vitamin should be co prescribed with carbamazepine
a.vit a
b.vit b12
c.vit c
d.vit d
d.vit d
which drug that is used for neuropathic pain can be abused
a.carbamazepine
b.gabapentin
c.pregablin
c.pregablin
what drugs are particular good for bipolar
cccarbamazepine
lamotrigine
what drugs can be used in migraine first line
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
f.toparimate
f.toparimate
what is the first line treatment for trigeminal neuralgia
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
f.toparimate
a.carbamazepine
what is the anti epileptic used in obesity
a.carbamazepine
b.phenytoin
c.sodium valproate
d.lamotrigine
e.levitiracetam
f.toparimate
f.toparimate
