AEDs

Question 1

If a woman with sz has been off epilepsy meds for a time before getting pregnant and had sz during pregnancy, what are her best options for AEDs:

Answer 1

Phenytoin

Levetiracetam

Question 2

Percent of major birth defects with LTG plus VPS

Answer 2

12%

Question 3

Percent of major birth defects with LTG

Answer 3

Less than 3%

Question 4

Percent of major birth defects with other AEDs

Answer 4

3-4%

Question 5

Risk of NTDs greatest with

Answer 5

Valproate

Question 6

In utero exposure to Valproate is associated with what effect to children at age 4 compared to LTG

Answer 6

Lower IQ (by 9 pts)

Question 7

Most frequent idiosyncratic rxns to AEDs

Answer 7

Rashes

Question 8

Rashes - most often responsible AEDs

Answer 8

Phenytoin
Carbamazepine
Phenobarbital
Primidone
Lamotrigine

Question 9

High degree of cross reactivity within what AEDs

Answer 9

Phenytoin
Carbamazepine
Phenobarbital
Lamotrigine

Question 10

Rashes are most often seen in _________ month of use

Answer 10

1st

Question 11

Rashes are associated with what certain polymorphisms

Answer 11

HLA B*1502

Question 12

Associated with skin eruptions in Caucasians

Answer 12

HLA A*3101

Question 13

High fever, rash, lymphadenopathy, pharyngitis, eosinophilia, hepatitis

Answer 13

Systemic hypersensitivity syndrome

Question 14

After 2 yrs on a single AED during which no sz had occurred,

Rate of relapse: _____ in 2.5 yrs, _____ in 5 yrs after discontinuation

Answer 14

40%

50%

Question 15

Sz recurrence rate for patients remaining on meds after 2yrs on a single AED and sz-free

Answer 15

20%

Question 16

First line for myoclinic epilepsy in adolescence

Answer 16

Valproate

Question 17

Do not coarsen facial features, do not produce gum hypertrophy or breast enlargement

Answer 17

CBZ

Valproate

Question 18

Rash, fever, lympadenopathy, eosinophilia, other blood dyscrasias, polyarteritis

Answer 18

Idiosyncratic phenytoin hypersensitivity

Question 19

Prolonged use causes hirsutism, gum hypertrophy, facial feature coarsening, peripheral neuropathy, cerebellar degeneration

Answer 19

Phenytoin

Question 20

Overdose causes ataxia, diplopia, stupor

Answer 20

Phenytoin

Question 21

Idiosyncratic SE of phenytoin

Answer 21

Choreoathetosis

Question 22

Mild leukopenia

Answer 22

CBZ

Question 23

Rare SE: pancytopenia, hyponatremia (SIADH), DI

Answer 23

CBZ

Question 24

CBC to be checked regularly

Answer 24

CBZ

Question 25

Marrow toxicity

Answer 25

Oxcarbazepine

Question 26

Weight gain during 1st month of tx (ave 5.8kg)

Answer 26

Valproate

Question 27

Menstrual irregularities, PCOS

Answer 27

Valproate

Question 28

Pancreatitis - rare but important complication

Answer 28

Valproate

Question 29

Maximum IV rate for valproate

Answer 29

3mg/kg/min

Question 30

Drowsiness, mental dullness, nystagmus, staggering

Answer 30

Pb

Question 31

Similar SE as Primidone: behavioral problems in developmentally delayed children

Answer 31

Pb

Question 32

Selectively blocks Na (slow) channel, preventing the release of excitatory transmitters glutamate and aspartate

Answer 32

Lamotrigine

Question 33

First line and adjunctive drug for generalized and focal sz

Answer 33

Lamotrigine

Question 34

If with Valproate, its serum level increases

Answer 34

Lamotrigine

Question 35

Serious rash with LTG

Answer 35

1%

Question 36

Lesser dermatologic eruptions with LTG

Answer 36

12%

Question 37

Concurrent use with phenytoin causes rare reversible chorea

Answer 37

Lamotrigine

Question 38

Alternative to Valproate in young women; does not cause weight gain & ovarian problems

Answer 38

Lamotrigine

Question 39

First line for pxs with organ failure, require numerous meds, with hepatically-metabolized chemotherapy

Answer 39

Levetiracetam

Question 40

Causes sleepiness, dizziness if in high doses

Answer 40

Levetiracetam

Question 41

Irritability and depression

Answer 41

Levetiracetam

Question 42

Chemically similar to GABA

Answer 42

Gabapentin

Question 43

Enhance intrinsic inhibitory system of GABA in brain

Answer 43

Gabapentin | Vigabatrin

Question 44

Apparent effect on Ca channels; anticonvulsant mechanism is not well known

Answer 44

Gabapentin

Question 45

Moderately effective in partial & secondary generalized sz

Answer 45

Gabapentin

Question 46

Not metabolized by liver

Answer 46

Gabapentin

Question 47

SE retinal damage Withdrawn from the market

Answer 47

Vigabatrin

Question 48

Inhibitor of GABA transaminase

Answer 48

Vigabatrin

Question 49

Inhibitor of GABA reuptake

Answer 49

Tiagabine | Topiramate

Question 50

Inhibitor of GABA reuptake but broader effectiveness than Tiagabine

Answer 50

Topiramate

Question 51

Renal stones in 1.5%

Answer 51

Topiramate

Question 52

angle closure glaucoma

Answer 52

Topiramate

Question 53

Hyperchloremic metabolic acidosis

Answer 53

Topiramate

Question 54

Potent drug for focal onset and generalize or remain focal; Mainly as adjunctive tx; MOA is not entirely known; Modulates voltage gated Na channel activity

Answer 54

Lacosamide

Question 55

SE- headache, diplopia, prolonged P-R interval, worsen heart failure

Answer 55

Lacosamide

Question 56

Like Valproate for absence sz; | Fewer cognitive SE

Answer 56

Ethosuximide

Question 57

DOC for benign absence attacks that are associated with photosensitivity, myoclonus, clonic-tonic-clonic sz (including JME)

Answer 57

Valproate Alt- Methsuximide

Question 58

Combination produce Absence status

Answer 58

Valproateb plus Clonazepam

Question 59

Preferred for sz in infancy

Answer 59

Phenobarbital

Question 60

Most difficult to treat in childhood- LGS; No effective combination; What are the AED options?

Answer 60

VPA 900-2400mg/day - reduce frequency of spells in approx 50% Lamotrigine, Topiramate, Vigabatrin - effective in 25%

Question 61

AED which can cause SIADH or DI

Answer 61

Carbamazepine