Epilepsy Drugs

Question 0

Benzodiazepines:
Lorazepam
Diazepam

Answer 0

Increase GABA-A action

Use: status epilepticus (first line for acute)

s/e: sedation, tolerance, dependence, respiratory depression

Also for eclampsia seizures (MgSO4 is first line)

Question 1

Ethosuximide

Answer 1

Blocks thalamic T-type Ca channels

Use: silent/absence seizures

s/e: Fatigue, GI distress, Headache, Itching (urticaria), stevens-Johnson syndrome
(EFGHIJ)

Mnemonic: Sux to have Silent Seizures

Question 2

Phenytoin

Answer 2

Increase National channel inactivation: zero order kinetics

Use: simple, complex, tonic-clonic (first line), status epilepticus (first line for prophylaxis)
All but absence

s/e: nystagmus, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydration syndrome), SLE- like syndrome, induction of p450, lymphadenopathy, Stevens-Johnson syndrome, osteopenia

Fosphenytoin for parenteral use

Question 3

Carbamazepine

Answer 3

Increase National channel inactivation

Use: simple, complex, tonic-clonic
First line for acute for all three

s/e: diplopia, ataxia, blood dyscrasias (aplastic anemia, agranulocytosis), liver toxicity, teratogenesis, induction of p450, SIADH, Stevens-Johnson syndrome

First line for trigeminal neuralgia

Question 4

Valproic acid

Answer 4

Increase Na channel inactivation,
Increase GABA concentration by inhibiting GABA transaminase

Use: simple, complex, tonic-clonic (first line acute), absence

s/e: GI distress, fatal hepatotoxicity, NT defects, tremor, weight gain, C/I in pregnancy

Also for myoclonic seizures, bipolar disorder

Question 5

Gabapentin

Answer 5

Inhibits high voltage activated Ca channels;designed as GABA analog

Use: simple, complex, tonic-clonic

s/e: sedation, ataxia

Also for: peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder

Question 6

Phenobarbital

Answer 6

Increase GABA-A action

Use: simple, complex, tonic-clonic

s/e: sedation, tolerance, dependence, induction of p450, cardiorespiratory depression

First line in neonates

Question 7

Topiramate

Answer 7

Blocks Na channels, Increase GABA action

Use: simple, complex, tonic-clonic

s/e: sedation, mental dulling, kidney stones, weight loss

Also for migraine prevention

Question 8

Lamotrigine

Answer 8

Blocks voltage gated Na channels

Use: simple, complex, tonic-clonic, absence

s/e: Stevens-Johnson syndrome (titrate slowly)

Question 9

Levetiracetam

Answer 9

May modulate GABA and glutamine release

Use: simple, complex, tonic-clonic

Question 10

Tiagibine

Answer 10

Increase GABA by inhibiting reuptake

Use: simple, complex

Question 11

Vigabatrin

Answer 11

Increase GABA by irreversibly inhibiting GABA transaminase