Anti-convulsants

Question 1

____ are short term alteration in behavior due to
disordered, synchronous, rhythmic firing of brain
neurons.

Answer 1

Seizures

Question 2

What distinguished partial (focal) seizures from generalized seizures?

Answer 2

Partial seizures start at a single site in the cortex while generalized involve both hemispheres

Question 3

How can you distinguish simple versus complex partial seizures?

Answer 3

In simple partial seizures, you do not lose consciousness. In complex partial seizures you have a gradual LOC and strong emotions, lip-smacking, or hand wringing are features

Question 4

3 spikes/sec on an EEG suggests someone is having a ___ seizure

Answer 4

Absence Seizure

Question 5

Which type of generalized seizure is associated with 3Hz spikes, sudden, impaired consciousness, staring, blinking. Cause?

Answer 5

Absence Seizures

Cause: thalmic T-type Ca
channels

Question 6

Which type of generalized seizures is characterized as sudden impaired
consciousness, 20 sec muscle rigidity then 1-2 min
violent rhythmic body and limb movements

Answer 6

Tonic-clonic

Question 7

Which type of generalized seizures is characterized as shock-like single (< 1 sec) contraction of
muscle in whole body or an extremity

Answer 7

Myoclonic

Question 8

What types are seizures begin as partial seizure and then transform into generalized?

Answer 8

Secondarily Generalized Seizure (focal to bilateral
tonic clonic)

Question 9

What four anti-convulsant drugs inhibit voltage-gated sodium channels and prolong inactive state of channel?

Answer 9

Cabamazepine
Oxycarbazepine
Phenytoin
Valproic Acid

Question 10

Which two drugs act on T-type Ca2+ channels to treat absence seizures?

Answer 10

1) Valproic Acid
2) Ethosuximide

Question 11

Barbituates like (___, ____) and benzodiazepines like (_____) enhance effect of GABA on GABAa receptors

Answer 11

phenobarbital, primidone

diazepam

Question 12

What anti-convulsant inhibits the reuptake of GABA?

Answer 12

Tiagabine

Question 13

Vigabatrin prolongs the effect of ____

Answer 13

GABA

Question 14

Which anti-convulsant drug can treat absence, myoclonic, partial, and tonic/clonic seizures?

Answer 14

Valproic Acid

Question 15

Carbamazepine can induce its own metabolism (autoinduce) while ____ cannot

Answer 15

Oxcarbazepine

Question 16

What three anti-convulsants are good monotherapy treatments for myoclonic seizures?

Answer 16

-Valproic Acid
-Phenytoin
-Carbamazepine

Question 17

What two drugs are good for treating partial seizures (secondarily generalized)?

Answer 17

-Phenytoin
-Carbamazepine

Question 18

Phenobarbital is a monotherapy for generalize ____ and partial seizures

Answer 18

tonic-clonic

Question 19

How does phenobarbital act?

Answer 19

GABAa-receptor (potentiation of synaptic inhibition)

Question 20

Minor drug allergies occur in 1-2% of patients taking ____

Answer 20

phenobarbital

Question 21

Common side effect of anti-epileptic drugs?

Answer 21

Ataxia

Question 22

Phenytoin could have drug-drug interactions with which drug?

Answer 22

Warfarin

Question 23

Gingival hyperplasia is common with taking which anti-convulsant?

Answer 23

Phenytoin

Question 24

SJS is a side-effect with use of ____ or ____

Answer 24

Ethosuximide or Phenytoin

Question 25

Which drug can be used as a monotherapy/adjunct treatment for partial seizure?

Answer 25

Oxcarbazepine

Question 26

Which drug inhibits T type calcium channels, prolongs inactivation of sodium channels, and increases GABA synthesis (in vitro)

Answer 26

Valproic Acid

Question 27

Which drug has side effects of increase in hepatic blood enzymes and hepatic toxicity in kids 2 and under on multiple AED?

Answer 27

Valproic acid

Question 28

Which drug inhibits CYP2C0, result in increased concentrations of phenytoin, phenobarbital, also displaces phenytoin from plasma binding proteins?

Answer 28

Valproic Acid

Question 29

Benzodiazepines are adjunctive treatment for ___ and juvenile _____ seizures

Answer 29

absence; juvenile myoclonic seizures

Question 30

True or False: In general newer anti-epileptic drugs lack serious side effects, do not induce liver enzymes (less drug-drug interactions) and are approved for mostly adjunctive treatment

Answer 30

True

Question 31

____ is a newer anti-epileptic drug used as an adjunctive treatment for partial secondary seizures and for neuropathy/fibromyalgia. It is NOT metabolized, excreted unchanged in the urine.

Answer 31

Gabapentin

Question 32

Which drug is used to treat Lennox-Gustaut Syndrome?

Answer 32

Felbamate

Question 33

Which anti-epileptic drug has no drug-drug interactions and is used as an adjunctive treatment for partial and tonic/clonic seizures in adults and myoclonic seizures in kids

Answer 33

Keppra (Levetiracetam)

Question 34

What drug is a monotherapy and an adjunctive treatment for partial and generalized tonic clonic seizures?

Answer 34

Topiramate/Lamotrigine

Question 35

How does Topiramate work?

Answer 35

Inhibits sodium channels/AMPA kaonate receptors that enhance GABA receptors

Question 36

Which newer anti-epileptic drug is most apt to have drug-drug interactions?

Answer 36

Lamotrigine

Question 37

Clonazepam is a good alternative/adjunctive for treating _____

Answer 37

generalized absence seizures

Question 38

What two drugs are good adjunctive treatment to partial, secondarily generalized seizures?

Answer 38

Lamotrigine/Valproic acid

Question 39

______ _____ is a series of seizures where full recovery

Answer 39

Status epilepticus

Question 40

How is status epilepticus treated?

Answer 40

1) Sedate with benzodiazepine (lorazepam IV) 2) Once seizures are controlled, give fosphenytoin/keppra/ph

Question 41

Drug concentration increases disproportionately as dosage is increased for what drug?

Answer 41

Phenytoin

Question 42

AED's can alter vitamin D metabolism in liver, which can lead to ___-

Answer 42

osteoporosis

Question 43

Failure rate of ___ ____ is 3X more in women taking AEDs

Answer 43

oral contraceptives

Question 44

Facial and cranial deformities associated with ___, but all AEDs can cause fetal hydantoin syndrome

Answer 44

phenytoin

Question 45

How do manage anti-convulsants in pregnant mother

Answer 45

-If on combo therapy, change to mono -Give folate to reduce risk of neural tube birth defects -