Seizures and epilepsy

Question 1

Carbamazepine MoA

Answer 1

Inhibits glutamate transmission by voltage dependent blockade of Na+ channels

Question 2

Carbamazepine uses

Answer 2

Partial seizures

Question 3

Carbamazepine AE

Answer 3

Drowsiness, dizziness, blurring of vision, ataxia, mental dulling, rash

Question 4

Phenytoin MoA

Answer 4

Inhibits glutamate transmission by voltage dependent blockade of Na+ channels

Different pharmacokinetics to carbamazepine (0 order)

Question 5

Phenytoin uses

Answer 5

Partial seizures

Question 6

Phenytoin AE

Answer 6

Gum hyperplasia, acne, hirsutism, ataxia, diplopia, nystagmus, drowsiness, slowed mentation, rash, lymphadenopathy

Question 7

Ethosuximide MoA

Answer 7

Inhibition of glutamate transmission causing blockade of T-type Ca2+ channels

Question 8

Ethosuximide uses

Answer 8

Absence seizures (these are associated with T-type Ca2+ channel activation)

Question 9

Ethosuximide AE

Answer 9

Gastric pain, nausea, vomiting, lethargy, headache, dizziness, hiccups, euphoria

Question 10

Valproate MoA

Answer 10

Inhibits GABA transaminase which metabolises GABA after reuptake into pre-synaptic neuron -> causes increased levels of GABA -> causes increased neuronal inhibition

Secondarily blocks high frequency Na+ channels

Question 11

Valproate AE

Answer 11

Nausea, vomiting, weight gain, increased appetite, hair loss, alopecia, spina bifida

Question 12

Tigabine MoA

Answer 12

Inhibits GABA transaminase -> increased levels of GABA -> increased neuronal inhibition

Question 13

Tigabine AE

Answer 13

Nausea, vomiting, weight gain, increased appetite, hair loss, alopecia, spina bifida

Question 14

Clonazepam MoA

Answer 14

Increased potentiation of GABA effects at receptors - it increased Cl- permeability -> causes hyperpolarisation + enhanced neuronal inhibition -> depresses nerve transmission

Question 15

Clonazepam uses

Answer 15

Status epilepticus, absence seizures, refractory epilepsy

Question 16

Clonazepam AE

Answer 16

Sedation, behavioural changes, salivary + bronchial hypersecretion, hypotension, respiratory depression, ataxia, confusion (in elderly)

Question 17

Phenobarbitone MoA

Answer 17

Increased GABA effects due to increased Cl- permeability -> enhanced neuronal inhibition

Question 18

Phenobarbitone AE

Answer 18

Sedation, behavioural changes, salivary + bronchial hypersecretion, hypotension, respiratory depression, ataxia, confusion (in elderly)

Question 19

First line treatment for partial seizures

Answer 19

Carbamazepine

Valproate

Question 20

First line treatment for generalised tonic-clonic seizures

Answer 20

Valproate

Question 21

First line treatment for absence seizures

Answer 21

Ethosuximide

Valproate

Question 22

First line treatment for infantile spasms/refractory seizures

Answer 22

Vigabatrin