Anti-Epileptic Drugs

Question 1

Ethosuximide: what type of seizure? Mechanism?

Answer 1

First line for Absence. Blocks thalamic T-type Calcium channels “Sucks to have Silent Seizures”

Question 2

Side Effects of Ethosuximide?

Answer 2

EFGHIJ: Ethosuximide causes Fatigue, GI distress, Headache, Itching, Steven-Johnson

Question 3

Benzodiazepines (Diazepam=valium, lorazepam): type of seizure? Mechanism?

Answer 3

First line for acute status epilepticus. Increases action of GABA at GABAa receptors.

Question 4

Side effects of Benzodiazepines (Diazepam/valium, lorazepam)?

Answer 4

sedation, tolerance, dependence, respiratory depression.

Question 5

Phenytoin: type of seizure? Mechanism?

Answer 5

First line for tonic-clonic seizures; first line for status epilepticus prophylaxis. Also can treat simple and complex focal seizures. Acts via use-dependent Na+ Channel block.
Also it has zero-order kinetics (PK).

Question 6

Phenytoin: Side effects

Answer 6

A ton! Nystagmus, diplopia. ataxia, sedation, gingival hyperplasia, magaloblastic anemia, teratogenesis, peripheral neuropathy, SLE-like syndrome, SJS, lymphadenopathy

Question 7

Carbamazepime: type of seizure? mechanism?

Answer 7

First line for simple, complex and tonic-clonic. Acts via use-dependent Na+ Channel block.

Question 8

Carbamazepime: side effects? fun fact?

Answer 8

A ton! Diplopia, ataxia, liver toxicity, teratogenesis, SIADH, SJS. Also first line for trigeminal neuralgia.

Question 9

Valproate: type of seizure? mechanism?

Answer 9

First line clonic-tonic; also simple and complex focal. and absence. Acts via increased Na+ channel inactiation and Calcium block

Question 10

Valproate: side effects, fun fact?

Answer 10

Lots! GI distress, rare (fatal) hepatotoxicity, neural tube defects, tremor, weight gain (dont take if pregnant). Also used for bipolar disorder and migraine prophylaxis.

Question 11

Gabapentin: type of seizure? mechanism?

Answer 11

Simple and complex focal seizures; GABA Analog– increases GABA levels; mechanism not fully known.

Question 12

Gabapentin: side effects?

Answer 12

Sedation, ataxia, weight gain

Question 13

Phenobarbitol: type of seizure? mechanism?

Answer 13

Used for focal seizures (simple and complex); and tonic-clonic. Increases action of at GABAa receptor.

Question 14

Phenobarbitol: side effects? Fun fact?

Answer 14

Sedation, hypersensitivity, dependence, teratogenicity, megaloblastic anemia. First line in neonates.

Question 15

Topiramate: type of seizure? mechanism?

Answer 15

Used for focal seizures (simple and complex); and tonic-clonic. Inactivates Na+ channels and Increases action of at GABAa receptor.

Question 16

Topiramate: side effects? Fun Fact?

Answer 16

Weight loss, kidney stones, mental dulling/ sedation. Oligohydrosis (children), Rare acute myopia with angle closure glaucoma. Also used to prevent migraines and alcoholism.

Question 17

Lamotrigine: type of seizure? mechanism?

Answer 17

Used for focal seizures (simple and complex); tonic-clonic an absence. Blocks VG-Na+ channels.

Question 18

Lamotrigine: side effects?

Answer 18

SJS; diplopia and sedation

Question 19

Levatiracetam: type of seizure? mechanism?

Answer 19

Used for focal seizures (simple and complex); and tonic-clonic. Unknown; maybe inhibits Ca channels.

Question 20

Levatiracetam: side effects?

Answer 20

Anesthesia, ID, SJS

Question 21

Tiagabine: type of seizure? mechanism?

Answer 21

Focal– simple and complex; Inhibits GABA reuptake

Question 22

Tiagabine: side effects?

Answer 22

CNS: dizziness, nervousness, drowsiness. Seizure-induction when used off-label

Question 23

Vigabatrin: type of seizure? mechanism?

Answer 23

Focal– simple and complex; Inhibits GABA reuptake via binding GABA transaminase.

Question 24

What is the difference b/w simple and complex focal seizure?

Answer 24

Simple: no impaired consciousness (can have sensory, autonomic and psych symptoms).
Complex: impaired concsiousness

Question 25

What would you use the benzo clonazepam (klonipin) for?

Answer 25

Chronic use. Seizures, panic disorder, anxiety.

Question 26

Does Gabapentin bioavailability increase or decrease with increased dose?

Answer 26

Decrease.

Question 27

Which anti-epileptics bind to plasma proteins?

Answer 27

Phenytoin, valproate, tiagabine, clonazepam-- can cause MD error if they think plasma levels have decreased and increase dose.

Question 28

Which drugs undergo renal elimination?

Answer 28

Gabapentin (95%), topoiramate, leviteracetam (65%)

Question 29

Treatment course for status epilepticus?

Answer 29

1. Benzos: lorazepam, diazepam 2. Phenytoin: add for prophylaxis/ prevention 3. If this doesnt work: Phenobarbitol or valproate 4. General anesthesia after 1 hr.

Question 30

Which anti-epileptics treat BPD?

Answer 30

valproate, carbamazepime, lamotregine

Question 31

Which anti-epileptics treat neuropathic pain?

Answer 31

carbamazepime (Trigem neuralgia), gabapentin (post-herpetic neuralgia)

Question 32

Which anti-epileptics treat Headache?

Answer 32

topiramate, valproate

Question 33

Which anti-epileptics treat alcoholism?

Answer 33

topiramate (off-label)

Question 34

Which anti-epileptics can cause SJS?

Answer 34

Ethosuximide, phenytoin, carbamazepine, lamotrigine