Anti-Epileptic Drugs

Question 0

Generalized Seizures

Answer 0

• LOC
• Febrile seizures
• Tonic/Clonic seizures

Question 1

Partial Seizures

Answer 1

• No LOC

- Simple & complex

Question 2

Phenytoin

Answer 2

• Na+ channel blocker (prevent abnormal changes in ion conductance)
• Secondary Ca+2 channel blocker @ therapeutic doses
• Delays onset of neuron firing

Question 3

Phenytoin therapeutic uses:

Answer 3

• All generalized partial & tonic-clonic seizures

- DO NOT use for Juvenile Myoclonic Seizures

Question 4

Adverse side effects of Phenytoin:

Answer 4

• Gingival hyperplasia

- Hirsutism

Question 5

Oxcarbazepine

Answer 5

• Na+ channel blocker
• Preferred for children
• Delay onset of neuron firing

Question 6

Felbamate

Answer 6

• Glutamate receptor antagonist (block excitatory activity)
• Inhibits NMDA channel
• Binds to NR2B & NR1 subunits
• Delays recovery of desensitized NMDA channels

Question 7

Felbamate therapeutic use:

Answer 7

1. Lennox-Gastaut Syndrome

2. In patients highly refractory to other drugs

Question 8

Gabapentin

Answer 8

• GABA regulating drug (increase inhibitory transmission by increasing GABA)
• Does not bind to GABA analog GABA-A receptor

Question 9

Tiagabine

Answer 9

• GABA regulating drug (increase inhibitory transmission by increasing GABA)
• Inhibits re uptake of GABA by GABA transporter (GAR-1)

Question 10

Vigabatrin

Answer 10

• GABA regulating drug (increase inhibitory transmission by increasing GABA)
• Inhibits metabolism of GABA by GABA transaminase ( GABA-T)

Question 11

Gabapentin therapeutic use:

Answer 11

• Neuropathic pain
• Migraine
• Not effective for controlling seizures

Question 12

Tiagabine therapeutic use:

Answer 12

-Contrils tonic-clonic seizures for kids <12 y.o.

Question 13

Vigabatrin therapeutic use:

Answer 13

-Infantile spasm & Refractory complex partial seizures not controlled by usual Tx

Question 14

Vigabatrin adverse side effects:

Answer 14

-Liver failure, psychotic disorder, SI & visual field defect

Question 15

Valproic Acid

Answer 15

• Blocks Na+ channel
• Blocks Ca+2 channel
• Deceases GABA metabolism

Question 16

Valproic Acid therapeutic use:

Answer 16

Juvenile Myoclonic Seizure Tx

Question 17

Valproic Acid side effects

Answer 17

• Hepatotoxic
• Spina bifida in offspring of pregnancy (folic acid deficiency)
• If juvenile and pregnant, give with folic acid
• Controlling seizure more important than baby

Question 18

Ethosuximide therapeutic use:

Answer 18

Tx for Absence Seizures

Question 19

Ethosuximide

Answer 19

• Blocks alpha subunit of T-type Ca+2 channel
• Inhibits GABA-T
• Blocking Ca+2 blocks excitation

Question 20

Lorazepam

Answer 20

GABA-AR agonists 
Tx for Status Epilepticus seizures
Benzo (safer than Phenobarbital)
-low lipid solubility
-action delayed
-effects lasts 6-12 hours
-half life = 10-20 hours
-respiratory depression is less

Question 21

Diazepam

Answer 21

GABA-AR agonists 
Tx for Status Epilepticus seizures
Benzo
-high lipid solubility
-rapid action
-effects last 15-30 mins
-half life = 20-100 hours
-respiratory depression & hypotension

Question 22

Benzos

Answer 22

• Increases Cl- ion influx causing hyperpolarization preventing repetitive neuron firing
• Positive allosteric effector to GABA receptor