drugs for seizures

Question 1

2 general classes of MOAs for seizure medications

Answer 1

inhibit depolarization

increase actions of GABA

Question 2

adjunctive therapy should only be tried when-

Answer 2

2-3 primary medications have failed

Question 3

consider d/c of seizure med when-

Answer 3

pt has been seizure free x 2 years

Question 4

3 seizure meds with high risk of depression/suicide

Answer 4

Levetiracetam, Topiramate, Tiagabine

Question 5

3 seizure meds with highest teratogenicity

Answer 5

Valproate, carbamazepine, phenobarbital

Question 6

typical birth defects related to AEDs

Answer 6

cleft lip/palate, neural tube defects

Question 7

pregnancy and AED use

Answer 7

ideally, stop 6 mo before pregnancy

if already pregnant continue meds

Question 8

what is given to pregnant women on AEDs in the last month of pregnancy, why?

Answer 8

give vit K supplementation, help to prevent risk of hemorrhage

Question 9

MOA of carbamazepine

Answer 9

blocks Na channels

Question 10

carbamazepine is 1st line for (3)

Answer 10

simple partial
complex partial
generalized tonic-clonic

Question 11

metabolism of carbamazepine

Answer 11

1A2, 3A4; undergoes autoinduction= decrease in T 1/2 over first month

Question 12

carbamazepine drug interactions

Answer 12

CYP inducer - decreases levels of other drugs q

Question 13

other uses of carbamazepine (3)

Answer 13

trigeminal neuralgia (TOC)
bipolar disorder
neuropathic pain

Question 14

SJS and carbamazepine

Answer 14

10x increased risk in Asians (screen for HLA-B1502 allele)

Question 15

2 classes of severe reactions from carbamazepine

Answer 15

blood: leukopenia, SLE, aplastic anemia
Sodium: SIADH, hyponatremia

Question 16

in utero exposure to valproate is associated with-

Answer 16

neural tube defects

Question 17

most notable ADR for phenytoin

Answer 17

gingival hyperplasia

Question 18

ethosuximide MOA

Answer 18

blocks T-type Ca channels

Question 19

ethosuxamine is preferred for-

Answer 19

absence seizures

Question 20

3 AEDs that can cause SJS

Answer 20

carbamazepine
lamotrigene
zonisamide

Question 21

gingival hyperplasia is a SE of-

Answer 21

phenytoin

Question 22

paresthesias are a SE of-

Answer 22

topiramate

Question 23

alopecia is a SE of-

Answer 23

valproate

Question 24

nystagmus is a SE of-

Answer 24

phenytoin

Question 25

which medication follows zero order kinetics at high doses?

Answer 25

phenytoin

Question 26

MOA of vigabatrin

Answer 26

inhibits GABA breakdown

Question 27

which AEDs cause SJS?

Answer 27

carbamazepine phenobarbital lamotrigene zonisamide

Question 28

valproate can be used for what types of seizures? (3) what other disorders? (3)

Answer 28

seizures- tonic-clonic, myoclonic, absence | other- migraine prophy, trigeminal neuralgia, neuropathic pain

Question 29

treatment for febrile seizures

Answer 29

acetaminophen + benzo

Question 30

treatment for status epilepticus

Answer 30

lorazepam + cabamazepine | if no response, then phenobarbital

Question 31

what is the mechanism for gingival hyperplasia with phenytoin?

Answer 31

increased PDGF activates macrophages to increase bone and gum development