Epilepsy drugs

Question 1

What are 1st line drugs for focal/partial seizures?

Answer 1

Phenytoin 
CBZ/OxCBZ
VPA
Keppra
Lamictal
Zonisamide

Question 2

What are the 1st line drugs for absence?

Answer 2

Ethosuximide

VPA

Question 3

What are the 1st line drugs for myoclonic, atonic, atypical absence?

Answer 3

VPA

Keppra

Question 4

What are the 1st line drugs for tonic-clonic?

Answer 4

VPA
Keppra
Lamictal
OxCBZ
Topamax

Question 5

What is the MOA of pheny?

Answer 5

Stabilizes neuronal membranes by decreasing sodium influx/increasing sodium efflux through voltage-gated dependent sodium channel blockade

Question 6

What enzymes metabolize phenytoin?

Answer 6

2C9, 2C19

Question 7

Is phenytoin protein bound?

Answer 7

Highly 90%

Question 8

What is the therapeutic range of phenytoin?

Answer 8

10-20 Total

1-2 free

Question 9

What is the initial dose of phenytoin?

Answer 9

5mg/kg/d divided 1-3x/d

Question 10

What drugs cause an increased risk of SJS and TEN if HLA-B*1502 positive?

Answer 10

Phenytoin

CBZ

Question 11

What are the systemic SE of phenytoin?

Answer 11

Gingival hyperplasia
Hirsutism
Vit D deficiency
Folic acid deficiency
Impaired cognition
Osteomalacia

Question 12

What are the neurologic SE of phenytoin?

Answer 12

Confusion
Slurred speech
Diplopia
Ataxia
Neuropathy
Lethargy
Nystagmus

Question 13

What are the rare SE of phenytoin?

Answer 13

Rash

LDA

Question 14

What is the DOC for neonatal seizures?

Answer 14

Phenobarbital

Question 15

What is the MOA of phenobarb?

Answer 15

Elevate seizure threshold by decreasing postsynaptic excitation, possibly by stimulating postsynaptic GABA receptors

Question 16

What is the therapeutic range of phenobarbital?

Answer 16

10-40

Question 17

What is the dosing for phenobarb?

Answer 17

1-3 mg/kg/d

Question 18

What are the systemic SE of phenobarb?

Answer 18

Nausea

Rash

Question 19

What are the neurologic SE of phenobarb?

Answer 19

Altered sleep cycles
Sedation, lethargy
Behavioral changes, confusion
Hyperactivity
Ataxia
Tolerance
Dependence
Depression
Decreased libido

Question 20

What is the MOA of ethosuximide?

Answer 20

Inhibits T-Type ca channels

Question 21

What is the brand name of ethosuximide?

Answer 21

Zarontin

Question 22

What is the therapeutic range of ethosuximide?

Answer 22

40-100

Question 23

What is the dosing for zarontin?

Answer 23

500-1000mg BID (max 1500)

Question 24

What are the AE for zarontin?

Answer 24

N/V, hiccups
Sleep disturbance, drowsiness, HA
Blood dyscrasias

Question 25

What are the second generation AEDs?

Answer 25

CBZ (tegretol, carbatol) | VPA (depacon, depakene, stavor)

Question 26

What are the 3rd gen AEDs?

Answer 26

``` Felbamate (Felbatol) Gaba (neurontin) Pregaba (Lyrica) Lamotrigine (Lamictal) Levetiracetam (Keppra) OxCBZ (Trileptal) Tiagabine (Gabitril) Topiramate (Topamax) Zonisamide (Zonegran) Lacosamide (Vimpat) Vigabatrin (Sabril) Clobazam (Frisium, Onfi) Perampanel (Fycompa) Eslicarbazepine (Aptiom) Brivaracetam (Briviact) ```

Question 27

What AEDs may cause OC failure?

Answer 27

OxCBZ Pheny Phenobarb CBZ

Question 28

Why are seizures increased in pregnancy?

Answer 28

Estrogen has seizure activating effect Progesterone has a seizure protective effect Menstruation and ovulation may lower seizure threshold

Question 29

What happens to AEDs during pregnancy?

Answer 29

Increased clearance of many AEDs | Altered protein binding of some AEDs

Question 30

What do phenobarb and pheny cause in pregnancy?

Answer 30

Congenital heart malformation and orofacial clefts

Question 31

What do VPA and CBZ cause in pregnancy?

Answer 31

Spina bifida and hypospadias | VPA associated with impaired cognitive development in children exposed in utero to VPA

Question 32

What do we supplement in women on AEDs of child bearing potential?

Answer 32

Folic acid

Question 33

What is the safest AED?

Answer 33

Lamictal

Question 34

When can we WD AED therapy?

Answer 34

2-4 years seizure free Single type of partial seizure or single type of primary generalized tonic-clonic seizures EEG normalized w/tx

Question 35

How should AED WD be done?

Answer 35

Over 3-6 months

Question 36

What are non pharm therapies for seizures?

Answer 36

Ketogenic diet Surgery VNS

Question 37

What is a ketogenic diet?

Answer 37

High fat, low carbs/protein No sugar Vit and mineral supp Fluids controlled

Question 38

What is VNS?

Answer 38

Vagal nerve stimulation Implanted medical device >12 yo