AED second line meds

Question 1

indication for Zonisamide

Answer 1

adjunct treatment for focal seizures in adults

Question 2

CI for Zonisamide

Answer 2

sulfonamide allergies

Question 3

3 examples of Zonisamide warnings

Answer 3

SJS, blood dyscrasias, kidney stones

Question 4

why are Zonisamide and Toperimiate similar?

Answer 4

both carbonic anhydrase inhibitors

Question 5

MOA lacosamide

Answer 5

enhances slow inactivation of NA+ channels

Question 6

lacosamide indications 3

Answer 6

focal seizures, neuropathy, fibromyalgia

Question 7

3 warnings for lacosamide

Answer 7

DRESS, syncope, afib/aflutter

Question 8

ADR of lacosamide

Answer 8

diplopia, HA, dizziness

Question 9

MOA perampanel

Answer 9

noncompetitive glutamate receptor antagonists

Question 10

is Perampanel a controlled substance?

Answer 10

YES CIII - potential for addiction

Question 11

2 key drug interactions for perampanel

Answer 11

OCP less effective

additive effect with alcohol

Question 12

what are 2 GABA barbiturate drugs?

Answer 12

phenobarbital, primidone

Question 13

MOA of phenobarbital

Answer 13

prolongs GABA mediated choloride channel openings

some blockade of kainite receptors

Question 14

phenobarbital anticonvulsant powers are _____ but many ____

Answer 14

strong , but many ADRs

Question 15

3 warnings phenobarbital

Answer 15

pregnancy, alcohol use, respiratory depression

Question 16

3 drug interactions of phenobarbital

Answer 16

corticosteroids - enhances metabolism
anticoagulants - decreases efficacy
CNS depressants - additive effects

Question 17

Primidone is metabolized to ___ in the liver

Answer 17

phenobarbital

Question 18

2 indications of primidone

Answer 18

generalized tonic clonic seizures and psychomotor seizures

Question 19

benzodiazepines increase_____

Answer 19

frequency of GABA mediated chloride channel openings

Question 20

3 examples of benzodiazepines

Answer 20

clonazepam, diazepam, lorazepam

Question 21

diazepam’s long half life causes you to have _____

Answer 21

a long post icterus hangover.. so we use midazolam nad lorazepam for status epilepticus instead

Question 22

Gabapentin indication

Answer 22

post herpetic neuralgia and focal seizures

Question 23

how is gabapentin eliminated?

Answer 23

renal so dose adjust!

Question 24

2 additional uses for gabapentin

Answer 24

peripheral neuropathy and bipolar disorder

Question 25

pregabalin is indicated for..

Answer 25

``` DM peripheral neuropathy postherpetic neuralgia adjunctive therapy for adult pts with focal seizures fibromyalgia neuropathic pain with spinal cord injury ```

Question 26

pregabalin is ___eliminated

Answer 26

renal - dose adjust

Question 27

ADR of pregabalin

Answer 27

angioedema, peripheral edema, weight gain,

Question 28

tiagabine MOA

Answer 28

interferes with GABA reuptake by binding to reuptake carrier

Question 29

4 uses for tiagabine

Answer 29

anxiety, bruxism, migraine, neuropathic pain

Question 30

tiagabine can cause...

Answer 30

new onset of seizure in pts without prior history of epilepsy

Question 31

Tiagabine adr

Answer 31

depression dizzy nervousness tremor

Question 32

vigabatrin

Answer 32

indicated for infantile spasms up to age 2

Question 33

___ is associated with permannt vision loss

Answer 33

vigabatrin

Question 34

what drugs are first line for status epilepticus

Answer 34

Diazepam lorazepam IV or Midazolam IV ..usually midazolam or lorazepam are used because diazepam gives you longer post ictus state

Question 35

clonazepam is second line for

Answer 35

absence seizures

Question 36

what are 4 main uses of gabapentin (Neurontin)

Answer 36

focal seizures, post herpetic neuralgia, peripheral neuropathy, and bipolar disorder

Question 37

what are 2 warnings with gabapentin use?

Answer 37

pancreatic cancer - seen in rats | DRESS

Question 38

what are some common gabapentin ADR?

Answer 38

sedation, dizzy, weight gain

Question 39

what is brand of pergabalin

Answer 39

Lyrica

Question 40

what did Switzerland study reveal about pregabalin

Answer 40

higher risk of birth defects and possible higher rate of miscarriage

Question 41

what drug is a structural derivative of gaba and the son of gabapentin?

Answer 41

pregabapentin (lyrica_

Question 42

tiagabine moa

Answer 42

interferes with GABA reuptake by binding uptake carrier

Question 43

what drug can treat west syndrome aka infantile spasms up to age 2?

Answer 43

vigabatrin

Question 44

how does ezogabine work?

Answer 44

opens potassium channels

Question 45

ezogabine is similar to ___ in indication

Answer 45

lacosamide - both add ons for focal seizure in adults

Question 46

3 weird ezogabine ADR

Answer 46

blue skin discoloration retinal pigment changes urinary retention

Question 47

2 drug interactions of ezogabine

Answer 47

alcohol and dignoxin

Question 48

ezogabine is a C--

Answer 48

5 substance

Question 49

why is felbamate last line?

Answer 49

due to risk of aplastic anemia and acute liver failure

Question 50

2 indications felbamate

Answer 50

refractory partial seizures, lennox-gaustaut syndrome

Question 51

eslicarbazepine approved for __

Answer 51

mono or add on therapy for partial onset seizures

Question 52

p450 and exlicarbazepine

Answer 52

3A4 inducer and 21C9 inhibitor: OCP, warfarin and statins

Question 53

brivaracetam indicated __

Answer 53

partial onset seizures pts over 15 - new drug as of 2016!

Question 54

ADR brivaracteam

Answer 54

sedation, dizzy, fatigue, N/V

Question 55

5 examples of acute AED adr

Answer 55

Neuro: sedation/fatigue, diplopia, mood change Gi: N/ heart burn Lab: increases LFTs, leukopenia, thrombocytopenia Weight loss Weight gain: valproic, gaba pre gaa and vigabatrin

Question 56

SJS more common in ____ pts that are also receiving ___ or aggressively titrated

Answer 56

lamotrigine | valproate

Question 57

early sx of SJS

Answer 57

abdominal pain, jaundice, vomit

Question 58

examples of long term AED us ADR

Answer 58

osteomalacia, osteoporosis, teratogenesis, altered connective tissue sexual dysfunction: polycystic ovaries etc.

Question 59

what are 2 AED safe with pregnancy

Answer 59

lamotrigine or levetiracetam

Question 60

what AED had shown lower IQ fetal rates

Answer 60

valproate