Antiepileptics

Question 1

Broad spectrum antiepileptics

Answer 1

1) Valproate
2) Lamotrigine
3) Topiramat
4) Levetiracetam

Question 2

Grand mal traditional antiepileptics

Answer 2

1) Carbamazepine
2) Phenytoin
3) Phenobarbital
4) Tiagabin
5) Gabapentin
6) Pregabalin
7) Vigabatrin

Question 3

Grand mal new antiepileptics

Answer 3

1) Felbamat
2) Zonisamide
3) Lacosamide
4) Rufinamide
5) Perampanel
6) Retigabin
7) Stiripentol

Question 4

Petit mal antiepileptics (absence seizures)

Answer 4

1) Ethosuxamid
2) Phensuximid
3) Metsuximid

Question 5

Status epilepticus treatment

Answer 5

1) Benzodiazepines
2) I.v antiepileptics: Phenytoin, Phenobarbital, Valproate
3) General anesthesia

Question 6

Primarily Na+ channel blocker antiepileptics

Answer 6

1) Phenytoin & Fosphenytoin
2) Carbamazepine
3) Primidone
4) Lamotrigine

Question 7

Primarily GABAergic antiepileptics

Answer 7

1) Benzodiazepines
2) Phenobarbital
3) Vigabatrin
4) Tiagabin
5) Gabapentin
6) Pregabalin

Question 8

Primarily T-type Ca2+ channel inhibitor antiepileptics

Answer 8

1) Ethosuximid
2) Phensuximid (?)
3) Metsuximid (?)

Question 9

Antiepileptics with multiple or unknown mechanisms

Answer 9

1) Valproate
2) Topiramate
3) Levetiracetam

Question 10

Valproate

Answer 10

Broad spectrum antiepileptic, w/unknown mechanism

• Possible mechanisms:
  
  • Block VGSC, T-Ca2+ or GABA transaminase.
  • Activate Glutamate decarboxylate
• Uses: lithium-resistant mania & migraine prophylaxis
• Enzyme inducer & blocker (drug interactions)

Question 11

Topiramate

Answer 11

Broad spectrum antiepileptic, with unknown mechanism
- Possible mechanisms:
*Block Na+, high-voltage Ca2+, AMPA R, carbonic
anhydrase
*Give non-BZD-like potentiation of GABA

Question 12

Levetiracetam

Answer 12

Broad spectrum antiepileptic, with unknown mechanism

• Modifies glutamate and GABA release
• Possibly modifies N-type Ca2+ channels
• Renal elimination (good for use in liver patients)

Question 13

Ethosuximid, phensuximid, metsuximid

Answer 13

Petit mal (absence seizure) treatment
- T-type Ca2+ channel inhibitors

Question 14

Benzodiazepines as antiepileptics

Answer 14

Status epilepticus treatment, GABAa receptor potentiation (frequency)

• Also inhibit VGSC
• Can develop tolerance and addiction
• Clonazepam can be used in absence seizures

Question 15

Phenobarbital as antiepileptic

Answer 15

I.v for Status epilepticus, GABAa receptor potentiation (duration)

• Higher conc: may block AMPA & Ca2+ channels
• Extremely sedative!
• Strong enzyme inducers (CYP3A4) - drug interaction

Question 16

Vigabatrin

Answer 16

Grand mal treatment,