Anticonvulsants

Question 1

Enhanced Na+ Channel Inactivation

Answer 1

Phenytoin
Carbamazepine
Divalproex/Valproate
Lacosamide
Lamotrigine
Zonisamide

Question 2

Decrease current through T-Type Ca2+ Channels

Answer 2

Divalproex

Ethosuxamide

Question 3

Enhanced GABA Transmission

Answer 3

Benzo’s - frequency
Barbiturates - duration
Gabapentin
Divalproex

Question 4

Reduced Excitatory NT release/Receptor blockade

Answer 4

Gabapentin, Pregabalin
Phenobarbital
Topiramate
Levetiracetam - SV2A

Question 5

Phenytoin

Answer 5

MOA: Enhanced Na+ Channel Inactivation

Binds Albumin
Can make Absence WORSE!

SE: Gingival Hyperplasia, Cystic Acne, Hypertrichosis, SJS
Aplastic anemia, Folate Deficiency
Decrease insulin secretion (bad for diabetics)

Teratogen: FAS, Phalange dysplasia

Question 6

Valproate/Divalproex

Answer 6

MOA: Several.
Enhanced Na+ Channel Inactivation, Works on T-Type Ca2+ channels, Inhibits GABA reuptake

Generalized Tonic-Clonic, Absence, Myoclonic

SE: Alopecia, Aplastic Anemia, Weight Gain
Hepatitis

Teratogen: FAS

Question 7

Lamotrigine

Answer 7

MOA: Enhanced Na+ Channel Inactivation

Generalized Tonic-Clonic, Absence
Simple Partial

SE: Rashes, SJS - Must be titrated

Question 8

Gabapentin

Answer 8

MOA: alpha2-delta T-Type Ca2+ Channels
Increase GABA release

SE: Weight gain

Question 9

Pregabalin

Answer 9

MOA: alpha2-delta T-Type Ca2+ Channels
Increase GABA release

SE: PR Prolongation
Need an EKG and Renal Adjustment

Question 10

Topiramate

Answer 10

MOA: Blocks Na+ channels, Enhances GABA, Reduces kainate activity

Generalized Tonic-Clonic, Lennox-Gastaut

SE: Cognitive Dysfunction (word recognition), Weight Loss, Rashes, Glaucoma

KIDNEY STONES - Need serum Bicarbonate
Renal Dose Adjustment

Question 11

Levetiracetam

Answer 11

MOA: Binds SV2A (synaptic vesicle) modifying the release of glutamate and GABA

Generalized Tonic-Clonic, Simple Partial
Generally the best to avoid drug interactions and contraindications!

SE: Psychiatric issues (ANGER)
Requires Renal Dose adjustment

Question 12

Zonisamide

Answer 12

MOA: Enhanced Na+ Channel Inactivation, poorly understood

Generalized Tonic-Clonic, Myoclonic

SE: Weight loss, rash
KIDNEY STONES - Need serum Bicarbonate
Renal Dose Adjustment

Question 13

Ethosuxamide

Answer 13

MOA: Decrease current through T-Type Ca2+ Channels

Absence seizures

SE: N/V, Sedation, Neutropenia
Monitor CBC and LFTs

Question 14

Perampanel

Answer 14

Adjunct for Tonic-Clonic
Mono for Partial seizures

Renal and Liver Dose adjustment

Question 15

Lacosamide

Answer 15

MOA: Enhanced Na+ Channel Inactivation

Simple Partial

SE: Slowed Cardiac conduction
NEED AN EKG!!!

Question 16

Carbamazepine

Answer 16

MOA: Enhanced Na+ Channel Inactivation

Not 1st but - Partial, General, Mixed Type
Can make Absence WORSE!
Strong CYP inducer

SE: Hyponatremia - don’t use in patients with Hypertension
Aplastic anemia, SJS (HLA-B1502)

Question 17

Oxcarbezapine

Answer 17

MOA: Enhanced Na+ Channel Inactivation

Not 1st but - Partial, General, Mixed Type
Can make Absence WORSE!

SE: Hyponatremia - don’t use in patients with Hypertension
Less side effects otherwise than Carbamazepine

Question 18

Myoclonic

Answer 18

1. Valproate
2. Levetiracetam
3. Zonisamide

Question 19

Enzyme Induction

Answer 19

Increase metabolism of other drugs
Phenobarbital
Phenytoin
Carbamazepine

** Be careful with birth control!

Question 20

Myoclonic

Answer 20

1. Valproate
2. Levetiracetam
3. Zonisamide

Question 21

MOA: Enhanced Na+ Channel Inactivation

Not 1st but - Partial, General, Mixed Type
Can make Absence WORSE!

SE: Hyponatremia - don’t use in patients with Hypertension
Less side effects otherwise than Carbamazepine

Answer 21

Oxcarbezapine

Question 22

Complex Partial

Answer 22

1. Levetiracetam
2. Lamotrigine
3. Oxycarbamazepine
4. Carbamazapine
5. Lacosamide

Question 23

Complex Partial

Answer 23

1. Levetiracetam
2. Lamotrigine
3. Oxycarbamazepine
4. Carbamazapine
5. Lacosamide

Question 24

MOA: Enhanced Na+ Channel Inactivation

Not 1st but - Partial, General, Mixed Type
Can make Absence WORSE!

SE: Hyponatremia - don’t use in patients with Hypertension
Aplastic anemia, SJS (HLA-B1502)

Answer 24

Carbamazepine

Question 25

MOA: Enhanced Na+ Channel Inactivation Not 1st but - Partial, General, Mixed Type Can make Absence WORSE! SE: Hyponatremia - don't use in patients with Hypertension Aplastic anemia, SJS (HLA-B1502)

Answer 25

Carbamazepine

Question 26

MOA: Enhanced Na+ Channel Inactivation Simple Partial SE: Slowed Cardiac conduction NEED AN EKG!!!

Answer 26

Lacosamide

Question 27

MOA: Decrease current through T-Type Ca2+ Channels Absence seizures SE: N/V, Sedation, Neutropenia Monitor CBC and LFTs

Answer 27

Ethosuxamide

Question 28

MOA: Enhanced Na+ Channel Inactivation, poorly understood Generalized Tonic-Clonic, Myoclonic SE: Weight loss, rash KIDNEY STONES - Need serum Bicarbonate Renal Dose Adjustment

Answer 28

Zonisamide

Question 29

MOA: Enhanced Na+ Channel Inactivation Not 1st but - Partial, General, Mixed Type Can make Absence WORSE! Strong CYP inducer SE: Hyponatremia - don't use in patients with Hypertension Aplastic anemia, SJS (HLA-B1502)

Answer 29

Carbamazepine

Question 30

MOA: Binds SV2A (synaptic vesicle) modifying the release of glutamate and GABA Generalized Tonic-Clonic, Simple Partial SE: Psychiatric issues (ANGER) Requires Renal Dose adjustment

Answer 30

Levetiracetam

Question 31

MOA: Blocks Na+ channels, Enhances GABA, Reduces kainate activity Generalized Tonic-Clonic, Lennox-Gastaut SE: Cognitive Dysfunction (word recognition), Weight Loss, Rashes KIDNEY STONES - Need serum Bicarbonate Renal Dose Adjustment

Answer 31

Topiramate

Question 32

MOA: Enhanced Na+ Channel Inactivation Generalized Tonic-Clonic, Absence Simple Partial SE: Rashes, *SJS* - Must be titrated

Answer 32

Lamotrigine

Question 33

MOA: Binds SV2A (synaptic vesicle) modifying the release of glutamate and GABA Generalized Tonic-Clonic, Simple Partial Generally the best to avoid drug interactions and contraindications! SE: Psychiatric issues (ANGER) Requires Renal Dose adjustment

Answer 33

Levetiracetam

Question 34

MOA: Blocks Na+ channels, Enhances GABA Generalized Tonic-Clonic, Lennox-Gastaut SE: Cognitive Dysfunction (word recognition), Weight Loss, Rashes Glaucoma KIDNEY STONES - Need serum Bicarbonate Renal Dose Adjustment

Answer 34

Topiramate

Question 35

MOA: Enhanced Na+ Channel Inactivation Binds Albumin Can make Absence WORSE! SE: Gingival Hyperplasia, Cystic Acne, Hypertrichosis, SJS Aplastic anemia, Folate Deficiency Teratogen: FAS, Phalange dysplasia

Answer 35

Phenytoin

Question 36

MOA: Several. Enhanced Na+ Channel Inactivation, Works on T-Type Ca2+ channels, Inhibits GABA reuptake Generalized Tonic-Clonic, Absence, Myoclonic SE: Alopecia, Aplastic Anemia, Weight Gain Teratogen: FAS

Answer 36

Divalproex/Valproate

Question 37

MOA: Several. Enhanced Na+ Channel Inactivation, Works on T-Type Ca2+ channels, Inhibits GABA reuptake Generalized Tonic-Clonic, Absence, Myoclonic SE: Alopecia, Aplastic Anemia, Weight Gain Hepatitis Teratogen: FAS

Answer 37

Valproate/Divalproex

Question 38

MOA: Enhanced Na+ Channel Inactivation Binds Albumin Can make Absence WORSE! SE: Gingival Hyperplasia, Cystic Acne, Hypertrichosis, SJS Aplastic anemia, Folate Deficiency Decrease insulin secretion (bad for diabetics) Teratogen: FAS, Phalange dysplasia

Answer 38

Phenytoin

Question 39

Cleft Lip and Palate

Answer 39

Phenytoin & Phenobarbital

Question 40

Myelomeningocele

Answer 40

Carbamazepine & Valproate

Question 41

Myelomeningocele

Answer 41

Carbamazepine & Valproate

Question 42

Teratogenic Drugs

Answer 42

Phenytoin Carbamazepine Valproate Topiramate