Seizures

Question 1

Carbamazepine brand name

Answer 1

Tegretol

Question 2

Carbamazepine MOA

Answer 2

limits influx of Na+ ions across cell membrane, stimulates release of ADH

Question 3

Carbamazepine dosing

Answer 3

2 divided doses
initial 400 mg/day
max 1600 mg/day

Question 4

Precautions of carbamazepine

Answer 4

caution in hepatic

renal adjust to 75% of dose when CrCl < 10

Question 5

Carbamazepine levels

Answer 5

4-12 mcg/mL

toxic > 15

Question 6

Black box warning for carbamazepine

Answer 6

dermatologic reactions

aplastic anemia/ agranulocytosis

Question 7

carbamazepine preg cat

Answer 7

D

Question 8

Clobazam brand name

Answer 8

Onfi

Question 9

Clobazam MOA

Answer 9

BZD binds to postsynaptic GABA neuron; enhances GABA -> hyperpolarization

Question 10

Clobazam dosing

Answer 10

5 mg BID x 1 week -> 10 BID x 1 week -> 20 mg BID

Question 11

Clobazam drug interactions to avoid

Answer 11

CNS depressants
strong CYP 2C19 inhibitors
CYP3A4 inducers
estrogen contraceptives
other BZDs

Question 12

Precautions with clobazam

Answer 12

CrCl<30

caution in severe hepatic impairment

Question 13

schedule of clobazam

Answer 13

IV

Question 14

safety alert for clobazam

Answer 14

SJS

TEN

Question 15

Clobazam in pregnancy

Answer 15

1st trimester avoid

Question 16

Clonazepam MOA

Answer 16

enhances GABA, suppresses spike and wave discharge by depressing nerve transmission

Question 17

Clonazepam dosing

Answer 17

2-8 mg QD in 1-2 divided doses

max 20 mg daily

Question 18

Clonazepam preg cat

Answer 18

D

Question 19

Eslicarbazepine brand name

Answer 19

Aptiom

Question 20

Eslicarbazepine MOA

Answer 20

inhibit voltage gated sodium channels

Question 21

Eslicarbazepine brand name

Answer 21

400 mg daily x 1 week -> 800 mg daily

max 1200 mg daily

Question 22

Avoid eslicarbazepine with what

Answer 22

strong 3A4 inducers

Question 23

Eslicarbazepine induces what

Answer 23

2C19

Question 24

Precautions with eslicarbazepine

Answer 24

renally dose

avoid in severe hepatic impairment

Question 25

dose dependent AEs with eslicarbazepine

Answer 25

CNS related - dizziness, drowsiness, HA

Question 26

Eslicarbazepine preg cat

Answer 26

C

Question 27

Ethosuximide brand name

Answer 27

Zarontin

Question 28

ethosuximide MOA

Answer 28

diminish T-type calcium currents in thalamic neurons

Question 29

Ethosuximide dose

Answer 29

500 mg/day increase 250 mg x 4-7 days up to 1500 mg/day in divided doses

Question 30

Therapeutic level of ethosuximide

Answer 30

40-100 mcg/mL

Question 31

AEs of ethosuximide

Answer 31

N/V sleep disturbances drowsiness hyperactivity

Question 32

Ezogabine brand name

Answer 32

Potiga

Question 33

Ezogabine MOA

Answer 33

voltage gated potassium channels -> stabilization -> regulated excitability

Question 34

Ezogabine dosing

Answer 34

100 mg TID increase weekly by 150 mg to 200-400 mg TID | max 1200 mg/day

Question 35

precautions with ezogabine

Answer 35

renally dose hepatic dose for moderate-severe QT prolongation

Question 36

ezogabine drug interactions to avoid

Answer 36

QTC prolonging

Question 37

ezogabine black box warning

Answer 37

retinal abnormalities | potential vision loss

Question 38

Felbamate brand name

Answer 38

Felbatol

Question 39

Felbamate MOA

Answer 39

inhibitory effects GABA receptor binding and BZD receptor binding

Question 40

Felbamate dosing as monotherapy

Answer 40

1200 mg/day in divided doses 3-4 x/day increase by 600 mg x 2 weeks to 2400 mg/day max 3600 mg/day

Question 41

felbamate dosing as adjunct

Answer 41

incremental increase is by 1200 mg

Question 42

avoid felbamate with what

Answer 42

drugs metabolized by CYP3A4

Question 43

Precautions with felbamate

Answer 43

``` transaminase and hematologic renally dose (50%) Avoid in hepatic impairment ```

Question 44

Felbamate black box warning

Answer 44

aplastic anemia | hepatic failure

Question 45

Felbamate preg cat

Answer 45

C

Question 46

Fosphenytoin brand name

Answer 46

Cerebryx

Question 47

Fosphenytoin MOA

Answer 47

increased efflux or decreased influx of sodium ions

Question 48

Fosphenytoin interactions by strongly inducing

Answer 48

``` CYP2B6 CYP2C19 CYP2C8 CYP3A4 p-glycoprotein ```

Question 49

fosphenytoin black box warning

Answer 49

CV risk with rapid infusion (>150 PE/min)

Question 50

fosphenytoin preg cat

Answer 50

D

Question 51

fosphenytoin therapeutic level

Answer 51

10-20 mcg/mL toxic >30 lethal > 100

Question 52

fosphenytoin precautions

Answer 52

``` dermatologic reactions local toxicity (purple glove) ```

Question 53

Gabapentin brand name

Answer 53

neurontin

Question 54

gabapentin MOA

Answer 54

voltage gated calcium channels

Question 55

gabapentin dosing

Answer 55

300 mg TID up to 1800 mg/day

Question 56

avoid gabapentin with what

Answer 56

CNS depressants

Question 57

gabapentin precautions

Answer 57

renally dose

Question 58

gabapentin preg cat

Answer 58

C

Question 59

AEs of gabapentin

Answer 59

dizziness drowsiness fatigue

Question 60

Lacosamide brand name

Answer 60

Vimpat

Question 61

Lacosamide MOA

Answer 61

slow inactivation of sodium channels

Question 62

lacosamide dosing monotherapy

Answer 62

100 mg BID increase weekly by 50 mg BID

Question 63

lacosamide dosing adjunct

Answer 63

50 mg BID

Question 64

lacosamide precautions

Answer 64

prolong PR interval

Question 65

lacosamide interactions

Answer 65

CYP3A4 inhibitors may decrease elimination

Question 66

lacosamide preg cat

Answer 66

C

Question 67

Lacosamide AEs

Answer 67

dizziness ataxia fatigue HA

Question 68

Lamotrigine brand name

Answer 68

Lamictal

Question 69

Lamotrigine MOA

Answer 69

inhibits release of glutamate, inhibits voltage sensitive sodium channels

Question 70

Lamotrigine precautions

Answer 70

renal dosing, hepatic dosing for moderate/severe +/- ascites

Question 71

Lamotrigine black box warning

Answer 71

dermatologic rashes - SJS

Question 72

Lamotrigine Preg Cat

Answer 72

C

Question 73

Lamotrigine AE

Answer 73

nausea

Question 74

Levetiracetam brand name

Answer 74

Keppra

Question 75

Levetiracetam MOA

Answer 75

voltage dependent N type calcium channels an facilitate GABA inhibition and reduce potassium current

Question 76

Levetiracetam dosing

Answer 76

500 mg BID + 500 mg x 2 weeks to 1500 mg BID

Question 77

Levetiracetam preg cat

Answer 77

C

Question 78

Oxcarbazepine brand name

Answer 78

Trileptal

Question 79

Oxcarbazepine MOA

Answer 79

blocks voltage sensitive sodium channels and increase potassium conduction modulate high voltage calcium channels

Question 80

oxcarbazepine dosing

Answer 80

600 mg daily in 2 divided doses + 600 mg/day x week to 1200 mg/day max 2400 mg/day

Question 81

oxcarbazepine strongly induces

Answer 81

CYP3A4

Question 82

AEs of oxcarbazepine

Answer 82

hyponatemia CNS effects blood dyscrasias

Question 83

oxcarbazepine preg cat

Answer 83

C

Question 84

oxcarbazepine precautions

Answer 84

renally dose

Question 85

Perampanel brand name

Answer 85

Fycompa