Pharmacology - Epilepsy

Question 1

true or false

seizures are generally self-limiting

Answer 1

true

Question 2

focal seizures are also known as ___ seizures

Answer 2

partial

Question 3

some neonates are not treated with antiepileptics but with….

Answer 3

steroids

for isoniazid seizures use pyridoxial

Question 4

***perampanel MOA

Answer 4

specific AMPA receptor antagonist

Question 5

name 6 drugs that block voltage gated sodium channel

Answer 5

phenytoin
fospheyntoin
carbamazepine
oxcarbazepine
eslicarbazepine
zonisamide

Question 6

name a drug that blocks voltage gated sodium channels AND enhances GABA release

Answer 6

cenobamate

Question 7

what drug inhibits GABA transaminase with little - no metabolism?

Answer 7

vigabatrin

Question 8

what drug inhibits GAT-1

Answer 8

tigabine

Question 9

3 MOA of valproate (depakote)

Answer 9

1. inhibits GABA transaminase
2. blocks voltage gated sodium channels
3. downregulates NMDA receptors

Question 10

name 3 benzodiazepines

Answer 10

diazepam
lorazepam
clonazepam

Question 11

**name 2 drugs that interact with SV2A proteins and what this does

Answer 11

inhibits repetitive burst firing of neurons

leviteracetam, brivaracetam

Question 12

** AE of levitiracetam and briviracetam, particularly in kids

Answer 12

increased aggression

Question 13

*MOA retigabine

Answer 13

neuronal KCNQ/Kv7 potassium channel opener

Question 14

ethosuximide MOA

Answer 14

blocks T-type calcium channels

Question 15

MOA of gabapentin and pregabalin

Answer 15

inhibits the alpha, delta subunits of voltage gated calcium channels

Question 16

true or false

both gabapentin and pregabalin undergo little-no metabolism

Answer 16

true

Question 17

**MOA phenytoin

Answer 17

blocks voltage gated sodium channels

Question 18

*phenytoin dosing concern

Answer 18

dose correct WEEKLY

does not have a stable half life and follows non linear kinetics. also highly protein bound

Question 19

true or false

fosphenytoin has much better kinetics than phenytoin

Answer 19

true, but also is a lot more money

Question 20

what kind of seizures can phenytoin be used in

Answer 20

all except absence

Question 21

**phenytoin inhibits both the ___ and ____ of seizures

Answer 21

spread and initiation

(inhibition of spread is greater)

if action potential DOES occur, prevents the spread

Question 22

*AE of phenytoin

Answer 22

osteoporosis/osteomalacia (rickets)

wide array of blood disorders - have to look at CBC

SJS

encephalopathy (ataxia, slurred speech) - it’s a cerebellar toxin!

DISLE (drug induced lupus)

can lead to dysarrhtyhmias and SA/AV blocks (bc class IB antiarrhythmic)

lethargy

Question 23

phenytoin DDI concerns

Answer 23

CYP2C9, 2C29

highly protein bound

Question 24

1st AE that tends to show up in a person with phenytoin toxicity

Answer 24

horizontal gaze nystagmus

Question 25

as phenytoin concentration gets above ______, toxicities begin what to look for 1st

Answer 25

20mg/L nystagmus 30-40 = ataxia 40-50 = lethargy

Question 26

most antiepileptics ___ the CNS what effect can this have in kids

Answer 26

depress the CNS drugs like phenytoin can impair learning and memory in kids

Question 27

*dihydroergotamine

Answer 27

false

Question 28

**MOA carbamazepine

Answer 28

blocks sodium channels AND calcium channels

Question 29

the MODERN antiepileptics mainly block what

Answer 29

calcium channels

Question 30

common AE of carbamazepine

Answer 30

hyponatremia

Question 31

true or false eslicarbazepine is a prodrug

Answer 31

true

Question 32

AE cenobamate (XCOPRI)

Answer 32

DRESS drug induced eosinophilic syndrome

Question 33

**lamotrigine MOAs

Answer 33

-blocks sodium channels -suppresses release of glutamate and aspartate (excitatory amino acids)

Question 34

lamotrigine concern

Answer 34

SJS if you rapidly dose escalate

Question 35

*4 antiepileptics metabolized by CYP3A4

Answer 35

carbamazepine zonisimide ethosuximide perampenal

Question 36

**MOA valproate

Answer 36

-blocks GABA transaminase -weak block on sodium channels also downregulates NMDA receptors

Question 37

*AE valproate is it teratogenic?

Answer 37

weight gain/loss, increased or decreased appetite, mood swings YES teratogenic

Question 38

vigabatrin MOA

Answer 38

inhibits GABA transminase

Question 39

what enzyme metabolizes phenobarbital

Answer 39

CYP2C19

Question 40

tiagabine MOA

Answer 40

inhibits GABA reuptake - does not inhibit GABA transaminase

Question 41

**ethosuximide MOA

Answer 41

inhibits voltage gated calcium channels

Question 42

ethosuximide may worsen what kind of seizures

Answer 42

tonic-clonic

Question 43

phenobarbital is an enzyme inducer or inhibitor

Answer 43

inducer

Question 44

*MOA gabapentin

Answer 44

multi moa, but MAIN is blocking voltage gated calcium channels but also elevates GABA and blocks sodium channel (possible select all that apply and the answer is all of the above)

Question 45

advantage of pregabalin over gabapentin in diabetics

Answer 45

pregabalin works better for them for peripheral neuropathy

Question 46

***MOA lacosamide

Answer 46

enhances the slow inactivation of voltage gated sodium channels without affecting the fast inactivation of sodium channels

Question 47

*lacosamide modulates ____. this preventws what

Answer 47

modulates CRMP-2 (collapsin response mediator protein-2 prevents abnormal neuronal connections in the brain

Question 48

*lacosamide only affects which nerons and how is this beneficial

Answer 48

neurons that are depolarized or active for long periods of time this is good bc we want to target these neurons for epilepsy

Question 49

*MOA topiramate

Answer 49

blocks sodium channels downregulates AMPA/kainate receptors (so suppresses glutamate activity)

Question 50

*felbamate MOA

Answer 50

blocks sodium channels upregulates GABA receptors downregulates NMDA receptors (inhibits glutamate effects)

Question 51

**MOA keppra

Answer 51

reduces/inhibits neurotransmitter release by binding SV2A also inhibits presynaptic calcium channels

Question 52

2 MOA briviracetam

Answer 52

-blocks SV2A -inhibits sodium channels

Question 53

AMPA is a ___ receptor subtype

Answer 53

glutamate

Question 54

BBW perampenal

Answer 54

aggression and unusual hostility

Question 55

*AMPA receptor antagonist

Answer 55

perampenal

Question 56

*tiagabine inhibits ____

Answer 56

GAT-1 transporter