Seizure medication

Question 1

sodium channel blockers

Answer 1

phenytoin
carbamazepine
valporate

Question 2

calcium channel blockers

Answer 2

gabapentin

Question 3

SV2A receptor blockers

Answer 3

levetiracetam

Question 4

NMDA receptor antagonist

Answer 4

ketamine

Question 5

AMPA receptor antagonist

Answer 5

perampanel

Question 6

1st line monotherapy for general motor (tonic-clonic) seizure

Answer 6

Levetiracetam
lamotrigine
valproic acid/divalproex*

Question 7

1st line monotherapy for myoclonic seizure

Answer 7

levetiracetam
valproic acid/divalproex*

Question 8

1st line monotherapy for general non-motor (absence) seizure

Answer 8

Ethosuximide
Note: not effective in preventing other seizure types such as generalized tonic-clonic seizures and should not be used as monotherapy in children with mixed types.

Question 9

1st line monotherapy for tonic or atonic seizure

Answer 9

valproic acid/divalproex*

Question 10

medication to avoid for myotonic seizure

Answer 10

carbamazepine
gabapentin
oxcarbazepine
phenytoin
Vigabatrin
lamotrigine

Question 11

medication to avoid for tonic- atonic seizure

Answer 11

carbamazepine
gabapentin
oxcarbazepine
vigabatrin

Question 12

medication to avoid for absence seizure

Answer 12

carbamazepine
gabapentin
oxcarbazepine
phenobarbital
phenytoin
vigabatrin

Question 13

1st line monotherapy for focal or unclassified tonic clonic seizure

Answer 13

lamotrigine
levetiracetam
lacosamide
brivaracetam
oxcarbazepine
carbamazepine
valproic acid/divalproex​*
[geriatric population - gabapentin​**]

Question 14

which antidepressant to avoid when patient with seizure?

Answer 14

buproprion
decrease the threshold for seizure

Question 15

what’s Status Epilepticus ?

Answer 15

A seizure with 5 minutes or more of continuous and/or electrographic seizure activity OR recurrent seizure activity without recovery to baseline between seizures.

Question 16

Management of status epilepticus 0-5 minutes

Answer 16

Assessment (Airway, Breathing, Circulation), safety
Stabilization
Easy causes to stabilize
Work up as many VITAMIN CDEs as possible

Question 17

Management of status epilepticus 6-10 minutes

Answer 17

Continue assessment, safety
Manage the easy VITAMIN CDE causes
Get the GABAs on board
Start 2 large-bore IV saline infusion
Consider Intubation to support oxygenation [at 6-10 min hypoxia will be significant and a clear airway to oxygenate is important- ASAP]
Alcohol? Thiamine MI/IV (prior to dextrose)
Hypoglycemic? Dextrose 50% IV (give is unknown BS or if low)

Get the BZD started
Lorazepam 4 mg IV OR
If not IV access:
Midazolam 10 mg IM/intranasal/buccal OR
Diazepam 20 mg rectal gel or IV

Question 18

Management of status epilepticus 11-30 minutes

Answer 18

Continued assessment and safety
Keep managing any VITAMIN CDEs causes
Keep the GABAs going
Load with other AEDs
Generalize tonic/clonic
Levetiracetam OR
Phenytoin OR
Valproic acid OR
Lacosamide OR
Brivaracetam
Prepare for ICU and intubation

Question 19

what are five basic mechanism of actions for anti-seizure medications

Answer 19

1. sodium channel blockers
2. calcium channel blockers
3. promote potassium efflux
4. block glutamate receptors (AMPA and NMDA receptor blockers)
5. increase GABA