Antiepileptics

Question 1

Genetic causes of seizures?

Answer 1

Juvenile myoclonic epilepsy

Question 2

Metabolic causes of seizures?

Answer 2

Hyponatremia

Hypernatremia

Hypomagnesemia

Hypocalcemia

Question 3

Infectious causes of seizures?

Answer 3

Meningoencephalitis

Question 4

Is breast feeding contraindicated in antiepileptic treatment?

Answer 4

No

Question 5

How is childhood absence epilepsy identified?

Answer 5

Sudden impairment in consciousness

No change in body/motor tone

Only lasts a few seconds

Usually remits by puberty

No post-ictal confusion

Question 6

Treatment of childhood absence epilepsy? Mechanism?

Answer 6

Ethosuximide

Calcium channel blocker

Question 7

What is pre-eclampsia?

Answer 7

Hypertension, proteinuria and oedema

Question 8

What is eclampsia?

Answer 8

Pre-eclampsia plus seizures

Question 9

Treatment of eclampsia?

Answer 9

MgSO4

Question 10

How are seizures broken?

Answer 10

First line treatment is benzodiazepines, lorazepam is the drug of choice

Also often administer phenytoin pr forphenytoin to prevent recurrent seizures

After these two step if patient is still seizing then give phenobarbital

Often will then give general anaesthesia and intubate

Question 11

Na inactivating antiepileptics?

Answer 11

Phenytoin

Carbamazepine

Lamotrigine

Valproic acid

(So all the main ones)

Question 12

GABA activating antiepileptics

Answer 12

Phenobarbital

Valproic acid

TiaGABine

ViGABAtrin

Question 13

Feature of older antiepileptics?

Answer 13

Liver inducers

Question 14

Drug for absence seizures?

Answer 14

Ethosuximide

Question 15

Which antiepileptucs are teratogenic?

Answer 15

All of them

Question 16

Uses of carbamazepine?

Answer 16

Partial and generalised seizures drug of choice

Also bipolar disorder

Also trigeminal neuralgia

Question 17

Drug of choice for epilepsy in pregnant women?

Answer 17

Carbamazepine

Question 18

Relevance of the liver enzyme inducing effects of carbamazepine?

Answer 18

Need dose adjustment over time

Affects other drugs

Question 19

Side effects of carbamazepine?

Answer 19

Bone marrow suppression

Liver toxicity

SIADH (low Na)

Stevens-Johnson syndrome

Question 20

Necessary for patient taking carbamazepine?

Answer 20

Monitor blood drug level

Question 21

What is Stevens-Johnson syndrome?

Answer 21

Extensive skin lesions

Skin necrosis and sloughing

Question 22

What is the drug of choice for childhood absence seizures?

Answer 22

Ethosuximide

Question 23

Mechanism of ethosuximide?

Answer 23

Calcium channel blocker

Question 24

What other drug is used for absence seizures in general?

Answer 24

Valproate

Question 25

Side effects of ethosuximide

Answer 25

Interacts with valproic acid decreasing ethosuximide clearance Lethargy or fatigue

Question 26

Side effect of phenobarbital?

Answer 26

CNS/myocardial/resp depression

Question 27

Drugs that induce cyp450?

Answer 27

Carbamazepine Phenobarbital Phenytoin

Question 28

Phenytoin side effects

Answer 28

Gingival hyperplasia Coarsening of facial features Vit D issues - osteomalacia Hairiness

Question 29

Drug particularly bad in pregnancy?

Answer 29

Valproate

Question 30

Big danger with valproate

Answer 30

Hepatotoxicity

Question 31

Side effects of lamotrigine?

Answer 31

Somnolence Stevens-Johnson syndrome

Question 32

How do gabapentin and pregabalin work?

Answer 32

Analogs of GABA

Question 33

Hiw does vigabatrin work?

Answer 33

Inhibits GABA aminotransferase

Question 34

Mechanism of tiagabine?

Answer 34

Inhibits GABA uptake

Question 35

Benefits of newer drugs

Answer 35

A broader spectrum of activity Well tolerated

Question 36

How are drugs for generalised tonic-clonic seizures related to those used for partial seizures?

Answer 36

They are the same

Question 37

Drugs effective against absence seizures

Answer 37

Ethosuximide Valproate Clonazepine

Question 38

Treatment strategy for myoclonic syndromes?

Answer 38

Valproate Alternatively lamotrigine and topiramate

Question 39

Treatment strategy for infantile spasms?

Answer 39

Intramuscular corticotropin (ACTH analog like cosyntropine) Repository corticotropin for injection Clonazepam or nitrazepam Vigabatrin

Question 40

Treatment strategy for status epilepticus

Answer 40

Diazepam or lorazepam Fosphenytoin, I/V valproate Phenobarbital Intubation and ventilation Muscular relaxants General anaesthesia

Question 41

Common other uses of antiepileptic drugs?

Answer 41

Migraines - valproate, topiramqte Neuropathic pain - carbamazepine, gabapentin, pregabalin

Question 42

Greatest teratogenicity?

Answer 42

Phenytoin - fetal hydantoin syndrome Valproate - spina bifida and fetal valproate syndrome

Question 43

Difference between fetal hydantoin syndrome and fetal valproate syndrome?

Answer 43

Broad forehead and limb and heart defects and spina bifoda and hypospadias in the latter