seizure drug confusion

Question 1

four drugs used to tx partial seizures? (COLL)

Answer 1

carbamazepine(decrease Na+ channels)

Oxacarbezepine (decrease Na+ channels and CA2+ effects; increase K+)

Lamotirgine (decrease Na+ channels)

levetiracetam (UNKNOWN)

Question 2

drugs used to treat BOTH GRAND MAL(tonic clonic seizures) and Atypical absence atopic seizures?

3 (VLL)

Answer 2

Valproate (increase GABA activity; decrease Na+ channels)

Lamotrigine(decrease Na+ channels)

Levetiracetam (UNKNOWN)

Question 3

2 drugs used to tx Absence seizures (EV)

Answer 3

Ethosuximide (decrease T-type ca2+ channels)

Valproate (decrease Na+channels and increase GABA)

Question 4

which drug is the DOC for the Tx of status epilepticus and WHY?

Answer 4

IV lorazepam b/c benzodiazepines can be given via RAPID IV (unlike phenytoin or valproate)

Question 5

TERATOGENS:

which drugs is only Cat C

the 5 CATD drugs:(3 major CYP inducers(CPP), a benzo w/a C and a Tdrug )

the one Cat X drug:

Answer 5

cat C: lamotrigine

Cat D: Carbamazepine, Clonazepam, Phenobarbital + Topiramate

Cat X: valproate

Question 6

jacksonian march characteristic of which type of seizure?

Answer 6

simple partial

Question 7

the 3Hz spike wave is characteristic of which seizures?

Answer 7

ABSENCE

Question 8

does valproate inhibit drug metabolism?

Answer 8

yes- major inhibitor

Question 9

peripheral neuropathy including diminished deep tendon reflexes in the lower extremities = ADE of which drug?

Answer 9

PHENYTOIN

Question 10

GI distress, hepatotoxicity, weight gain and CATX labelling = ADE of which drug?

Answer 10

valproic acid

Question 11

kinetics of pheytoin

Answer 11

zero-order so must monitor plasmsa concentration

Question 12

t/f. b/c of zero order kinetics, (dose-dependent elimination), some toxicities of phenytoin may occur only with a small increment in dose

Answer 12

true

Question 13

which allele predisposes Asians to SJS?

which two drugs is SJS not reported with?

Answer 13

Asians - HLA-B*1502

SJS NOT WITH: CLONAZEPAM and LACOSAMIDE

Question 14

which 3 drugs have blood toxicities (CFV)?

Answer 14

carbamazepoine

felbamate

valproate

Question 15

which drug is first line for Status epilepticus?

Answer 15

Lorazepam IV

Question 16

three MOA’s of AED drugs?

Answer 16

1. work on Na+ channel
2. Ca2+ T-type channel
3. Reinforce GABA’s actions

Question 17

major BBW for these all AED drugs?

Answer 17

increased suicidial ideation

Question 18

which two AEDs have extensive protein binding?

Answer 18

pheytoin and valproate

Question 19

which drug accumulates in erythrocytes?

Answer 19

Zonisamide

Question 20

t/f/ drugs to tx AEDs have long serum t1/2.

Answer 20

true

Question 21

must monior serum drug levels for which three drugs?

Answer 21

carbamazpein(induces own metabolism), phenytoin(zero-order), valproate

Question 22

what are two eak carbonic anyhydrase inhibitors tat promote renal bicarbonate loss–>stone formation by reducing urinary citrate excretion and by increaing urinary pH therefore MUST monitor serum bicarb levels

Answer 22

topiramate(inhibits Na+ and glutamate channels; increases K+ and GABA)/zonisamide (decreases Na+ and T-type Ca2+)

Question 23

why would you not discontinue AEDs drugs quickly

Answer 23

discontineu –> status epilepticus

Question 24

MC ADE for phenytoin

Answer 24

NYSTAGMUS

other prominent: gingivial hyperplasia and Hypertrichosis or hirsuitis. (also, headache, ataxia and incooridation)

Question 25

BBW for carbamazepine?

Answer 25

AGRANULOCYTOSIS

CNS

Question 26

which drug (s) would you sue HLA-B 1502 genotyping to determine risk of developing SJS or TEN?

Answer 26

CARBAMAZEPINE

pheytoin, fosphenytoin

Question 27

BBW = aplastic anemia, BM suppression, hepatic disease

Answer 27

felbamate (decrease NMDA and increase GABA)

Question 28

BBW = serious rash (TEN/SJS)

Answer 28

lamotrigine