Anticonvulsant Drugs - Kinder

Question 1

epilepsy

Answer 1

2 unprovoked seizures - separated 24 hours

Question 2

path of epilepsy

Answer 2

hyperexcitable and hypersynchronous neurons

Question 3

partial seizures

Answer 3

focal - localized onset

Question 4

simple partial seizure

Answer 4

patient retains awareness

Question 5

complex partial seizure

Answer 5

patient lose consciousness

Question 6

secondary generalized seizure

Answer 6

from partial - to both hemispheres

Question 7

generalized seizure

Answer 7

both brain hemispheres

Question 8

tonic clonic seizure

Answer 8

generalized - grand mal

Question 9

absence seizure

Answer 9

generalized - blank stare

young children and adolescents

Question 10

myoclonic jerking

Answer 10

brief shock-like movement - wide variety of seizurs

Question 11

atonic seizures

Answer 11

loss of postural control - slumping

Question 12

anti-epileptic drugs

Answer 12

suppress seizures

-do not cure or prevent epilepsy

Question 13

tx of epilepsy

Answer 13

monotherapy preferred

increase dose gradually
monitor treatment regularly

compliance essential - warn patient not to stop taking med

Question 14

AED MOAs

Answer 14

1 affect ion channel kinetic - delay Na channel recovery

2 augment inhibitor neurotransmission - GABA increase

3 modulate excitatory neurotransmission - decreased glutamate

Question 15

AEDs protein bound

Answer 15

all - except

phenytoin
tigabine
valproic acid

Question 16

adverse of AEDs

Answer 16

neurotoxic - sedation, dizzy, double vission

Question 17

phenytoin MOA

Answer 17

bind and prolong inactivated state of Na channel

also decreased glutamate and increased GABA

Question 18

phenytoin PK

Answer 18

don’t give IM - may precipitate

can give fosphenytoin (prodrug) IV or IM

Question 19

phenytoin DDI

Answer 19

inhibits affects of warfarin

Question 20

phenytoin ADR

Answer 20

diplopia, ataxia, nystagmus, sedation

gingival hyperplasia**
osteomalacia

hypotension, bradycardia, arrhythmia - so give slowly

Question 21

gingival hyperplasia

Answer 21

ADR of phenytoin

Question 22

carbamazepine MOA

Answer 22

prolong inactivation state of Na channels

inhibit high frequency firing rate

Question 23

autoinduction

Answer 23

with carbamazepine

induces own metabolism

half life decreases over time - so levels fall

need to increase dose

Question 24

asian patient with HLA V1502 allele

Answer 24

10x higher steven johnson syndrome with carbamazepine

Question 25

gabapentin MOA

Answer 25

analog of GABA -modify synaptic and non-synaptic release of GABA bind alpha2delta subunit of voltage Na channels - decrease Ca entry - and decrease glutamate release

Question 26

gabapentin ADR

Answer 26

HA and tremor

Question 27

lamotrigine MOA

Answer 27

prolong inactivation state of Na channel suppress rapid firing

Question 28

lamotrigine ADR

Answer 28

skin rash, HA, dizzy, ataxia

Question 29

lamotrigine DDI

Answer 29

concentration decrease with use of OCP can also lead to contraceptive faliure

Question 30

levetiracetam MOA

Answer 30

bind synaptic vesicle protein SV2A | -modified release of glutamate and GABA

Question 31

levetiracetam ADR

Answer 31

serious mood and behavior change

Question 32

topiramate MOA

Answer 32

block voltage Na channels, increase Cl opening by binding GABA receptors, reduce Ca currents

Question 33

tipiramate ADR

Answer 33

paresthesia, weight loss

Question 34

migrain tx

Answer 34

topiramate

Question 35

ethosuximide MOA

Answer 35

reduce Ca threshold - T type current | -this current provide pacemaker current in thalamus for absence attacks

Question 36

lennes-gestaut syndrome

Answer 36

childhood onset epilepsy | -frequent seizures of different types

Question 37

ethosuximide ADR

Answer 37

gastric distress - so can't do 1x/day

Question 38

valproic acid MOA

Answer 38

prolong Na channel inactiviation block NMDA increased GABA

Question 39

high level valproic acid

Answer 39

see tremor

Question 40

valproic acid ADR

Answer 40

hepatotoxicity need to monitor liver function when initiating valproic acid

Question 41

diazepam MOA

Answer 41

bind GABA receptor - enhanced Cl influx stimulate inhibitor membrane potentials

Question 42

lorazepam vs. diazepam

Answer 42

lorazepam - less lipophilic | -longer duration of action

Question 43

tx status epilepticus

Answer 43

diazepam and lorazepam

Question 44

DOC for partial seizures and secondary generalized

Answer 44

carbamazepine lamotrigine oxcarbazepine levetiracetam

Question 45

DOC for primary generalized tonic-clonic seizures

Answer 45

valproate lamotrigine levetiracetam

Question 46

DOC for absence seizures

Answer 46

ethosuximide | valproate

Question 47

DOC for atypical absence, myoclonic, atonic seizures

Answer 47

valproate lamotrigine levetiracetam

Question 48

increased suicide

Answer 48

patients on AEDs

Question 49

mother taking AED

Answer 49

increased risk congenital malformations

Question 50

16yo F, convulsion, to ER, grand mal in ER drug choice?

Answer 50

carbamazepine - 1st line phenytoin - side effects - coarse facial features, gingival hyperplasia, hirsutism, osteomalacia

Question 51

60yo F - warfarin therapy, complex partial seizures -first on carbamazepine - switched to levetracetam get epistaxis why?

Answer 51

carbamazepine - enzyme induction - so had increased warfarin dose when stopped drug - also needed to decrease warfarin dose

Question 52

25yo M, ER, status epilepticus - on carbamazepine - drug tx?

Answer 52

lorazepam - long acting - compared to diazepam also IV phenytoin, benzo, phenobarb