Anticonvulsants

Question 1

Epilepsy

Answer 1

disorder of brain function characterized by periodic and unpredictable seizures

Question 2

Seizure

Answer 2

alteration of behaviors due to excessive firing of brain neurons

Question 3

Partial/ Focal Seizure

Answer 3

neuron firing is localized to cerebral cortex

normally just one hemisphere

Question 4

Generalized Seizure

Answer 4

widespread neuron firing

both hemispheres

Question 5

Difference between Simple and Complex Partial Seizures

Answer 5

simple- consciousness preserved

complex- impaired consciousness

Question 6

Tonic- Clonic Seizures

Answer 6

tonic phase- loss of consciousness, muscle rigidity, respiratory arrest
clonic phase- muscle jerking, lip/ tongue biting, urinary/ fecal incontinence

Question 7

Absence Seizures

Answer 7

sudden onset and abrupt ending
impaired consciousness
stop around age 20

Question 8

Myoclonic Seizures

Answer 8

single or multiple myoclonic muscle jerks
no loss of consciousness
can happen many times in a day

Question 9

Pathophysiology of Epilepsy

Answer 9

hyperexcitable neurons fire abnormally and inhibitory (GABAa) synaptic currents break down to cause seizures

Question 10

Examples of Na Channel Modulators that enhance fast action

Answer 10

phenytoin
carbamazepine
valproate

Question 11

MOA of Na Channel Modulators that enhance fast inactivation

Answer 11

decrease Na influx, prolongs inactive state of neurons

Question 12

Phenytoin

Answer 12

IV only
1st order, 2nd at high doses
increases metabolism of other drugs- bad mix w/ contraceptives

Question 13

SE of Phenytoin

Answer 13

gingival hyperplasia
decreased bone density from increased Vit D metabolism
coarsening facial features

Question 14

Active Metabolite of Carbamazepine

Answer 14

10, 11 epoxide

Question 15

SE of Carbamazepine

Answer 15

blurred vision

stupor, coma, respiratory depression

Question 16

Valproate

Answer 16

covers all types of seizures

Question 17

MOA of Valproate

Answer 17

increases inactivated sodium channels at different sites than phenytoin and carbamazepine
reduces Ca currents in thalamic neurons
increases GABA

Question 18

SE of Valproate

Answer 18

elevated hepatic enzymes- hepatitis

Question 19

Examples of Na channel modulaters that enhance slow inactivation

Answer 19

Lacosamide

Question 20

Lacosimide SE

Answer 20

double vision

suicidal thoughts

Question 21

MoA of Ethosuximide

Answer 21

reduces Ca currents in thalamic neurons to inhibit absence seizures

Question 22

SE of Ethosuximide

Answer 22

nausea, vomiting, anorexia

photophobia

Question 23

Gabapentin MOA

Answer 23

GABA agonist by binding to a2sig of Ca channel, decreasing Ca entry

Question 24

SE of Gabapentin

Answer 24

none

Question 25

Diazepam MOA

Answer 25

act on GABA receptors and increase frequency of opening of GABA activated Cl channels

Question 26

Use of Clonazepam

Answer 26

absence and myoclonic seizures in children

Question 27

Use of Diazepam

Answer 27

status epilepticus

Question 28

MOA of Phenobarbital

Answer 28

increases duration of GABA receptor Cl channels

Question 29

SE of Phenobarbital

Answer 29

Morbilliform rash

Question 30

MOA of Perampanel

Answer 30

antagonist of AMPA glutamate receptor- prevents neuronal firing

Question 31

Pharmacokinetics of Perampanel

Answer 31

metabolized by hepatic CYP3A | decreases effectiveness of contraceptives, carbamazepine

Question 32

SE of Peramapanel

Answer 32

anxiety, double vision

Question 33

Drugs for Focal/ Partial Seizures

Answer 33

carbamazepine | phenytoin

Question 34

Drugs for Tonic- Clonic Seizures

Answer 34

carbamazepine phenytoin valproic acid

Question 35

Drugs for Absence Seizures

Answer 35

Ethosuximide

Question 36

Drug for Myoclonic Seizures

Answer 36

Valproic Acid

Question 37

Drug for Status Epilepticus

Answer 37

Diazepam