BMB 2 - Anti-Seizure Medications

Question 1

What is the anti-seizure mechanism of action of phenobarbital?

Answer 1

Binds GABA-A;

prolongs duration of Cl^- channels

Question 2

What is the anti-seizure mechanism of action of phenytoin?

Answer 2

Inactivates Na⁺ channels

Question 3

What is the anti-seizure mechanism of action of carbamazepine?

Answer 3

Inactivates Na⁺ channels

Question 4

What is the anti-seizure mechanism of action of lamotrigine?

Answer 4

Inactivates Na⁺ channels

Question 5

What is the anti-seizure mechanism of action of ethosuximide?

Answer 5

Blocks T-type Ca²⁺ channels

Question 6

What is the anti-seizure mechanism of action of gabapentin?

Answer 6

Blocks presynaptic Ca²⁺ channels

Question 7

What is the anti-seizure mechanism of action of pregabalin?

Answer 7

Blocks presynaptic Ca²⁺ channels

Question 8

What is the anti-seizure mechanism of action of levetiracetam?

Answer 8

Decreases neurotransmitter release (via SAV2 inhibition)

Question 9

What is the anti-seizure mechanism of action of valproate?

Answer 9

Blocks Na⁺ channels;

increases GABA

Question 10

What is the anti-seizure mechanism of action of topiramate?

Answer 10

Blocks Na⁺ channels;

increases GABA

Question 11

How is status epilepticus treated?

Answer 11

IV lorazepam + broad-spectrum anti-epileptic drugs

(If refractory, add more anesthetic agents.)

Question 12

Which anti-epileptic medication is especially useful in treating neonatal seizures?

Answer 12

Phenobarbital

Question 13

Which barbituate is useful in treating essential tremor?

Answer 13

Primidone

Question 14

Name the broad-spectrum anti-seizure medications.

Answer 14

Valproate

Lamotrigine

Topiramate

Zonisamide

Levetiracetam

Question 15

Name the narrow-spectrum anti-seizure medications.

Answer 15

Phenytoin

Phenobarbital

Carbamazepine

Oxcarbazepine

Gabapentin

Ethosuximide

Question 16

Name the anti-seizure medications that are useful in treating focal seizures.

Answer 16

Carbamazepine

Oxcarbazepine

Lamotrigine

Topiramate

Gabapentin

Valproate

Question 17

Name the anti-seizure medications that are useful in treating generalized seizures.

Answer 17

Lamotrigine

Valproate

Topiramate

Question 18

Name the anti-seizure medications that are useful in treating absence seizures.

Answer 18

Ethosuximide

Question 19

Which anti-seizure medications are relatively low-risk for pregnant patients?

Answer 19

Gabapentin

Lamotrigine

Levetiracetam

Question 20

Which anti-seizure medications are relatively high-risk for pregnant patients?

Answer 20

Valproate

Phenobarbital

Primidone

Phenytoin

Carbamazepine

Oxcarbazepine

Topiramate

Question 21

What are the teratogenic effects of valproate?

Answer 21

Cardiac, cleft, cognitive, and neural tube defects; hypospadias

Question 22

What are the teratogenic effects of phenobarbital or primidone?

Answer 22

Cardiac defects

Question 23

What are the teratogenic effects of phenytoin?

Answer 23

Cleft palate

Question 24

What are the teratogenic effects of carbamazepine or oxcarbazepine?

Answer 24

Neural tube defects

Question 25

What are the teratogenic effects of topiramate?

Answer 25

Cleft lip, hypospadias, low birth weight

Question 26

Name some of the anti-seizure medications that are GABA-ergic.

Answer 26

Phenobarbital, primidone (the barbituates)

Question 27

Name some of the anti-seizure medications that are sodium channel blockers.

Answer 27

Phenytoin, carbamazepine, oxcarbazepine, lamotrigine

Question 28

Name some of the anti-seizure medications that are calcium channel blockers.

Answer 28

Ethosuximide, gabapentin, pregabalin

Question 29

Name some of the anti-seizure medications that are SAV2 inhibitors.

Answer 29

Levetiracetam

Question 30

Name some of the anti-seizure medications that have multiple drug targets.

Answer 30

Valproate, topiramate ## Footnote *(Hence why they are broad-spectrum.)*

Question 31

Which anti-seizure medications are P450 inducers?

Answer 31

Carbamazepine, phenobarbital, phenytoin, primidone ## Footnote *(to a smaller extent, also topiramate and oxcarbazepine)*

Question 32

Which anti-seizure medications are P450 inhibitors?

Answer 32

Valproate

Question 33

What are the major potential negative side effects of phenobarbital use?

Answer 33

Renal and hepatic toxicities; decreased bone density

Question 34

What are the major potential negative side effects of phenytoin use?

Answer 34

Gingival hyperplasia, hirsutisum, dyslipidemia, osteoporosis

Question 35

Which anti-seizure medication is notable as following zero-order kinetics?

Answer 35

Phenytoin

Question 36

What are the major potential negative side effects of carbamazepine use?

Answer 36

**Black box warning** for _Steven-Johnson syndrome_, especially in patients with HLA-B1502; also, _aplastic anemia_

Question 37

Which two anti-seizure medications carry a risk of triggering Steven-Johnson syndrome?

Answer 37

Carbamazepine, lamotrigine

Question 38

Ethosuximide use can sometimes result in some ___________ discomfort.

Answer 38

Ethosuximide use can sometimes result in some **_abdominal_** discomfort.

Question 39

What is the main side effect of gabapentin or pregalin use?

Answer 39

Sedation

Question 40

What is the main side effect of levetiracetam use?

Answer 40

Somnolence

Question 41

What are the main side effects of valproate use?

Answer 41

Teratogenic, hepatotoxicity, pancreatitis

Question 42

What are the main side effects of topiramate use?

Answer 42

Weight loss, nephrolithiasis, cognitive slowing