Anticonvulsants - egleton

Question 1

abnormal EEG is indicates what

Answer 1

Seizure

Question 2

Generalized tonic-clinic seizures so frequent that another seizure occurs before the patient returns to normal consciousness from the postictal state
- how severe is this? how?

Answer 2

Status Epilepticus
medical emergency and high mortality rate
hypoxia leads to brain damage

Question 3

What is the treatment for Status Epilepticus

Answer 3

IV Benzodiazapams

followed with IV Phenytoin/Fosphenytion ( prevent reoccurance)

Question 4

what treatment is used for status Epilepticus if refractory? and if this doesn work? Any extra support

Answer 4

more phenytoin and more BCZ

• Barbituates ( phenobarbital/phentobarbtial/Midazolam/propofol)
• may need respiratory support

Question 5

what are 3 parts of a history of seizure

Answer 5

aura
ictus: seizure itself
Postictus

Question 6

how is epilepsy diagnosis made

Answer 6

history with electrical studies

Question 7

what are 3 MOA for antiepileptic drugs

Answer 7

1. inhibition of sodium and calcium influx
2. augmentation of inhibitory GABA neurotransmission
3. inhibition of excitatory glutamate neurotransmission

Question 8

MOA for Phenytion

Answer 8

• inhibition of seizure spread: blockade of Ca influx, enhances Cl- IPSPs
• suppression of epileptic focus: affinity for inactivated Na channels at depolarized membrane potentials, stimulates Cl- mediated IPSP

Question 9

Use of Phenytion

Answer 9

Initial treatment for: Absence Epilepsy Atonic Seizures

effective treatment for: generalized tonic-clonic seizures, partial and status epiepticus

Question 10

if Phenytoin is give IM what happens

Answer 10

crystallization and possible muscle necrosis

Question 11

when the hepatic hyroxylation system becomes saturated small increases in dose of Phenytoin causes what

Answer 11

large increase in the plasma concentration of drug

Question 12

Side effects of Phenytoin

Answer 12

Hirsutism 
gingival hyperplasia
nystagmus 
Steven-Johnson syndrome
Hematological reactions

Question 13

what allergic reactions to Phenytoin require cessation of therapy

Answer 13

Hematological reactions

Steven-Johnsons

Question 14

how is Phenytoin administered for cardivascular collapse

Answer 14

IV

Question 15

what are fetal abnormalities of Phenytion

Answer 15

pregnancy category D

heart malformations

Question 16

what is the prodrug of Phenytion

Answer 16

Fosphenytion

Question 17

MOA for Carbamazepine

Answer 17

unknown

Question 18

Carbamazepine 2nd line of drug for what

Answer 18

2nd: generalized tonic-clonic seizures
complex partial seizures
other: may make myoclonic seizures worse
trigeminal neuralgia

Question 19

Carbamazepine has an autoinduction of metabolism of what

Answer 19

CYP 1A2 / 2C/ 3A

Question 20

when does the rate of metabolism increase for Carbamazepine? 1/2 lives?

Answer 20

first 4-6 weeks
30hr = naive patient
10-20 hours - after few weeks

Question 21

what are side effects of Carbamazepine

Answer 21

G.I. upset
vertigo
Hematological disorders
hepatoxicity

Question 22

MOA for PHenobarbital

Answer 22

enhances the GABA mediated Cl-flux that causes membrane hyperpolarization
- older drug

Question 23

Side effects of Phenobarbital

Answer 23

sedation
addiction
rashes

Question 24

Drug interaction of Phenobarbital

Answer 24

induces various CYPs
addictive with other CNS depressants
Valproic acid increases Phenobarbital blood levels

Question 25

Primidone

Answer 25

antiepileptic drug

Question 26

MOA for Valproic acid/Divalproex

Answer 26

Interacts with GABAergic: | blocks both Na and K channels and T-type calcium channels

Question 27

uses for Valproic acid/Divalproex

Answer 27

absence seizures refractory to ethosuximide | bipolar

Question 28

what is so great about Valproic acid/Divalproex

Answer 28

well absorbed in gut low molecular weight fatty acid "sprinkles"

Question 29

Side effects of Valproic acid/Divalproex

Answer 29

Alopecia hepatic failure decrease in platelet and clotting function

Question 30

for Valprioc acd/Divalproex who does hepatic failure have the greatest risk for

Answer 30

under 2 years

Question 31

what is drug interaction of Valproic acid/Divalproex

Answer 31

inhibits P450s displaces phenytoin from plasma protein decreases elimination of Phenytoin

Question 32

Should you take Valproic acid/Divalproex while pregnant or child bearing age

Answer 32

no

Question 33

what is the use for Ethosuximide

Answer 33

absence seizures - only indication

Question 34

MOA of Ethosuximide

Answer 34

blocks T-type Ca channels

Question 35

what are side effects of Ethosuximide

Answer 35

GI CNS depression Rashes Blood dyscrasia

Question 36

which Lorazepam if given as an IV agent for status Epilepticus

Answer 36

Clonazepam | Diazepam

Question 37

MOA for Lorazepams

Answer 37

action on Benzodiazepine binding site of GABAa receptor complex: promoting GABA action

Question 38

what is Gabapentin used for

Answer 38

diabetic neuropathy

Question 39

what are side effects of Gabapentin

Answer 39

CNS: dizziness | weight gain

Question 40

MOA for Lamotrigine

Answer 40

inhibits voltage-sensitive Na channels | may inhibit Ca channel

Question 41

what is the side effect of Lamotrigine? how can this be reduced

Answer 41

severe steven-johnson and potentially life threatening | -titrating dose

Question 42

What are side effects for Topiramate

Answer 42

renal stone formation | paresthesias ( carbonic anhydrase inhibitor) can be used in treatment of IICH

Question 43

MOA for OXacarbazepine

Answer 43

blocks voltage dependent Na channels

Question 44

what are other uses for Levetriacetam

Answer 44

migraine

Question 45

Side effects of Oxcarbazepine

Answer 45

Hyonatremia common in first 3 months

Question 46

What is Pregabalin used for

Answer 46

Neuropathic pain | Diabetic peripheral neuropathy

Question 47

what drugs are used for broad spectrum (all seizure types: generalized from onset and partial onset seizures)

Answer 47

Lamotrigine Levetiracetam topiramate Valproate

Question 48

what drugs are used for narrow spectrum ( simple partial, complex partial, and secondarily generalized seizures)

Answer 48

Carbamazepine oxycarbazepine phenobarbital phenytoin

Question 49

what drugs are used for absence seizure

Answer 49

Ethosuximide

Question 50

how do anticonvulsants impact contraceptive

Answer 50

hepatic metabolism plasma protein binding - unplanned pregnancy, birth defects

Question 51

what is the drug interaction of Lamotrigine

Answer 51

metabolism induced by phenytoin, carbamazepine, | inhibited by valproic acid

Question 52

if an epileptic gets pregnant what happens to the frequency of epilipsy

Answer 52

increases