Exam 1: Anti - Seizure meds (partial summary of key stuff! not enough time to do all the info)

Question 1

First choice drugs for:

Tonic-clonic seizures

Answer 1

Carbamazepine, Valproic acid, Phenytoin, Lamotigrine

Question 2

First choice drugs for:

Simple partial seizures

Answer 2

Carbamazepine, Phenytoin, Valproic acid, Lamotigrine

Question 3

First choice drugs for:

Complex partial seizures

Answer 3

Carbamazepine, Phenytoin, Valproic acid, Lamotigrine

Question 4

First choice drugs for:

Absence seizures

aka petite mal

Answer 4

Ethosuximide, Valproic acid

Question 5

First choice drugs for:

Myoclonic and Atonic seizures

Answer 5

Valproic acid, Clonazepam

Question 6

First choice drugs for:

Status Epilepticus seizures

Answer 6

Diazepam (1), Lorazepam (1)

Phenytoin (2)

Question 7

First choice drugs for:

Infantile spasms

Answer 7

ACTH, Corticosteroids

Question 8

First choice drugs for:

Lennox Gastaut syndrome

Answer 8

Clonazepam, Lamotigrine

Question 9

First choice drugs for:

Febrile seizures

Answer 9

Diazepam

Question 10

Drugs for the chemical class:

Hydantoins

Answer 10

Phenytoin

Question 11

Drugs for the chemical class:

Tricyclics

Answer 11

Carbamazepine

Question 12

Drugs for the chemical class:

Barbiturates

Answer 12

Phenobarbital

Question 13

Drugs for the chemical class:

Valproates

Answer 13

Valproic acid, Valproate sodium

Question 14

Drugs for the chemical class:

Succinimides

Answer 14

Ethosuximide

Question 15

Drugs for the chemical class:

Benzodiazepines

Answer 15

Clonazepam, diazepam, lorazepam

Question 16

Drugs for the chemical class:

GABAergic drugs

Answer 16

Gabapentin

Question 17

Drugs for the chemical class:

Others

Answer 17

Lamotrigine, topiramate

Question 18

Efficacy of birth control pills is _____ due to seizure medications inducing _____ enzyme.

If a medication must be given during pregnancy, _____ and _____is the safest

Answer 18

Efficacy of birth control pills is decreased due to seizure medications inducing CYP 450 enzyme.

If a medication must be given during pregnancy, phenobarbital and lamotrigine is the safest

Question 19

Phenytoin Side Effects:

Answer 19

Side Effects

Nystagmus (rhythmic, oscillating eye movement)

Diplopia (double vision) DOSE-RELATED

Ataxia (loss of coordination of voluntary muscles) DOSE –RELATED

Gingival hyperplasia (overgrowth of gum tissues in the mouth)

Hirsutism (excessive hair growth of face or body in women)

Sedation (CNS depression)

Coarsening of facial features (occurs with long-term therapy)

Mild peripheral neuropathy (diminished deep tendon reflexes) (occurs with long-term therapy)

Abnormalities in Vitamin D metabolism with osteomalacia (occurs with long-term therapy)

Megaloblastic anemia (decreased folate levels)

Aplastic anemia

Teratogenicity (Pregnancy Category D)

Fetal hydantoin syndrome (increased risk of congenital malformations like cleft lip and palate)

Question 20

Valproic acid/Valproate BLACK BOX WARNING OF SIDE EFFECTS:

Answer 20

BLACK BOX WARNING OF SIDE EFFECTS

Hepatotoxicity →higher risk in patients <2 years old and on multiple medications

Oral or Intravenous L-carnitine may help reduce hepatotoxicity

Teratogenicity → spina bifida (Pregnancy Category D)

Pancreatitis

Question 21

Lamotrigine BLACK BOX WARNING OF SIDE EFFECTS:

Answer 21

BLACK BOX WARNING OF SIDE EFFECTS

Skin rashes like Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Question 22

MOA for:

Phenytoin

Answer 22

Blocks Axonal Na+ channels in their native state

inhibit generation of rapidly repetitive action potentials

increases GABA-mediated inhibition

Decreases Ca+ influx

Question 23

MOA for:

Carbamazepine

Answer 23

Blocks Na+ channels

Question 24

MOA for:

Phenobarbital

Answer 24

Potentiates GABA mediated inhibitoy stimuli in the presence of GABA by prolonging the opening of Cl- channels

Inhibits Na+ Channels and Ca+ channels

Blocks excitaroty AMPA recpetors

Directly opens GABA-A recpetors

Question 25

_MOA for_: ## Footnote **Ethosuximide**

Answer 25

Blocks T-Type Ca++ Channels in thalamic neurons

Question 26

_MOA for_: ## Footnote **Valproic Acid/ Valproate**

Answer 26

Blocks Na+ channels Enhances GABA Mediated inhibition Increases K+ Currents Blocks T-Type Ca++ Channels Blocks Excitatory NMDA recptor-mediated excitation

Question 27

_MOA for_: ## Footnote **Lamotrigine**

Answer 27

Blocks Na+ channels

Question 28

_MOA for_: ## Footnote **Gabapentin**

Answer 28

Unclear

Question 29

_MOA for_: ## Footnote **Topiramate**

Answer 29

Blocks Na+ channels Augments the action of GABA at GABA-A recpetors Antagonizes glutamate recptors inhibits carbonic anhydrase

Question 30

_MOA for_: ## Footnote **Felbamate**

Answer 30

Blocks Na+ channels

Question 31

_MOA for_: ## Footnote **Clonazepam (Benzodiazepine)**

Answer 31

Benzodiazepine that facilitiates actions of GABA

Question 32

_MOA for_: ## Footnote **Lorazepam (Benzodiazepine)**

Answer 32

Benzodiazepine that facilitiates actions of GABA

Question 33

_MOA for_: Diazepam (Benzodaizepine)

Answer 33

Benzodiazepine that acts on parts of the limbic system, thalamus, and hypothalamus and induces calming effects