L1,2

Question 1

Definition of Epilipsy

Answer 1

neurological disorder, characterized by repeated seizures. there is
1- sudden, excessive & synchronous discharge of cerebral neurons.
2- loss of consciousness, abnormal movements & a typical behavior.

Question 2

Etiology of epilepsy

Answer 2

excessive firing of the neurons.
Due to genetic and unknown causes

Question 3

Drugs reduce seizures through such mechanisms as:

Answer 3

–1. Blocking voltage-gated channels (Na+ or Ca2+)
– 2. Enhancing inhibitory γ-aminobutyric acid (GABA)-ergic impulse
– 3. Interfering with excitatory glutamate transmission.

Question 4

Classical Anticonvulsants

Answer 4

1- phenytoin
2- carbamazepine
3- valporic Acid
4- Etho-suximide ( Absence seizer only )
5- phenbarbital
6- primidone
benzodiazepines

Question 5

Newer Anticonvulsants

Answer 5

Lamotrigine
Felbamate
Topiramate
Tiagabine
Vigabatrin
Gabapentin

Question 6

It is effective for treatment of
• partial seizures
• generalized tonic –clonic seizures
• in treatment of status epilepticus.
• Used in cardiac arrhythmia.

Answer 6

Phenytoin

Question 7

Mechanism of action of Phenytoin

Answer 7

Blocks Na- channels
معاه ca وسالفة GABA بس الصوديوم اهم

Question 8

Pharmacokinetics of phenytoin

Answer 8

-orally or IV
-Metabolites are excreted in urine
-Induces liver microsomal enzymes & can cause drug interactions
-Fosphenytoin is more water soluble, given by injection & rapidly converted to phenytoin in plasma ( for status )
-zero order kinetics (elimination )

Question 9

Phenytoin – Toxicity

Answer 9

-Chronic oral Toxicity
-Gingival Hyperplasia
-Hyperglycemia
-Hirsutism
– Osteomalacia due to inc metabolism of VIT D

Question 10

Carbamazepine MOA?

Answer 10

-Sodium channel blocker in brain only
-Potentiates post-synaptic action of GABA?مشمهم

Question 11

Therapeutic Uses of Carbamazepine

Answer 11

• Epilepsy (Partial) focal ((1st line for treatment this type))
• Generalized (tonic-clonic)
• Trigeminal neuralgia
• Bipolar depression

Question 12

AE of Carbamazepine

Answer 12

• aplastic anemia
  -Antidiuretic effect (anti ADH) ( increase it secretion )
  -Hyponatremia + edema
  (بسبب ADH الزايد)

Question 13

Contraindication of Carbamazepine?

Answer 13

-Absence seizures يزودهم
-myo-clonic

Question 14

has an auto induction?

Answer 14

Carbamazepine يكسر نفسه

+ مثل phenytoin انديوسر

Question 15

drug Effective in multiple seizure types
And its MOA
1. Blocks Na channels
2. Blocks Ca channels.
3. Inhibits GABA transamin

Answer 15

Valproic Acid الباشا
Ep يعالج كل انواع

Question 16

Drug inhibits phenobarbital and phenytoin metabolism?

Answer 16

Valproic Acid

غالب الادويه كانت تسوي induction
هذا لا , inhibition

وممكن يسبب neutropenia

Question 17

Adverse effect of Valproic Acid?

Answer 17

Teratogenicity Spina bifida cleft palate ( اكثر واحد ممنوع بالحمل )
fulminant hepatitis..
Heart burn
weight gain
Inc appetite
Hair loss ( alopecia )

Question 18

Inhibitors of Calcium Channels in thalamus?

Answer 18

Ethosuximide

Question 19

Drug of choice only used for Absence
seizure?

Answer 19

Ethosuximide

(Not effective in other seizure types )

Question 20

The only barbiturate with selective anticonvulsant effect?

Answer 20

Phenobarbital ( enhance GABA transmission )

Question 21

Used in status epilepticus?

Answer 21

Phenobarbital
فيه غيره مب هو فقط
لكنه نوع من barbiturate لو حدد السؤال

+more effective in children
ممكن يستعمل بانواع ثانيه من الصرع بس نادر

Question 22

Pharmacokinetics of Phenobarbital

Answer 22

orally, IM & IV.
easily cross blood brain barrier
Excretion is ↑ in alkaline urine
induce liver microsomal enzymes,

Question 23

Phenobarbital Toxicity

Answer 23

• ((Sedation)) ataxia, respiratory depression, stupor, coma
• ((Tolerance))dependence & abuse

Question 24

Converted to phenobarbitone in body?

Answer 24

Primidone

Question 25

Mostly used in status epilepticus?

Answer 25

benzodiazepine (Diazepam) and Lorazepam longer acting

Question 26

Adverse effects of Benzodiazepines?

Answer 26

Amnesia tolerance فيه اشياء بالمحاضره زياده

Question 27

Wide margin of safety as compared to barbiturates & phenytoin?

Answer 27

Benzodiazepines

Question 28

Benzodiazepines used in absence seizures ?

Answer 28

Clonazepam

Question 29

Benzodiazepines Used for infantile spasms & myoclonic seizures?

Answer 29

Nitrazepam Infantile = febrile

Question 30

-associated with visual field loss - irreversible

Answer 30

**Vigabatrin** (ranging from mild to severe in 30% or more of patients) V -> vision

Question 31

effective in a wide variety of seizure types, including focal, generalized, absence seizures, It is also used to treat bipolar disorder.

Answer 31

Lamotrigine

Question 32

MOA of Lamotrigine

Answer 32

-blocks sodium channels, as well as high voltage- dependent calcium channels. اول واحد جديد له علاقه بexcitatory transmitters وكويس بالحمل

Question 33

effective for use in partial and primary generalized epilepsy. It is also approved for prevention of migraine?

Answer 33

Topiramate حتى valproic acid بس واحد جديد وواحد كلاسيك

Question 34

Adverse effects of Topiramate

Answer 34

weight loss Renal stones Hyperthermia —————- oligohidrosis Somnolence glaucoma

Question 35

Epilepsy in pregnancy.

Answer 35

Planning is the most important component. All women should be provided with folic acid. Divalporex & barbiturates should be avoided.

Question 36

MOA of Benzodiazepines (diazepam, clonazepam)

Answer 36

Enhance GABA Transmission