TPX Epilespy & Migraine& Pain

Question 1

Focal seizures

Answer 1

Treatment of choice:
Levetiracetam
Lamotrigine
Oxcarbazepine

Others:
Carbamazepine
Lacosamide

Question 2

Carbamazepine

Answer 2

Tegretol

Na channel blocker

Enzyme Inducer

Side effects:

Black box warning for rash (HLA Variants)

helps with depression

sedation

Question 3

Drugs with rash cross sensitivity

Answer 3

Lamotrigine
Carbamazepine
Phenytoin
Phenobarbital

Question 4

Dose reduction with GFR reduction

Answer 4

Pregabalin
Gabapentin
Levetiracetam
Oxcarbamazepine

Question 5

Phenobarbital

Answer 5

Luminal
Barbiturate
Prolong GABA openings

sedation

Question 6

Benzodiazepines

Answer 6

Increase frequency of GABA openings

Question 7

Tiagabine

Answer 7

Gabatril

Inhibits GAT-1

causes sedation

Question 8

Vigabatrin

Answer 8

• Sabril*
  Inhibits GABA-T

Question 9

Phenytoin

Answer 9

Dilantin

Sodium channel blocker
causes sedation

Question 10

Lamotrigine

Answer 10

Sodium channel blocker

Question 11

Zonisamide

Answer 11

Na channel blocker
Calcium channel blocker
CA inhibitor

Weight loss
depression

Question 12

Lacosamide

Answer 12

Vimpat

Slow inactivation of Na channels

Helps depression

Question 13

Valproate

Answer 13

Depakote

GABA enhancement
Na channels
Ca channels

helps w/ depression
weight gain

Question 14

Gabapentin and pregabalin

Answer 14

Ca channels

Weight gain
Renally dosed

Question 15

Topiramate

Answer 15

Na channels
Ca channels
Antagonizes glutamate
CA inhibitor

Weight loss
Depression
Sedation

Question 16

Ethosuximide

Answer 16

Zarontin

T-type Ca channels

Question 17

Perampanel

Answer 17

Fycompa
antagonist of AMPA receptor

Question 18

Levetiracetam

Answer 18

keppra

binds SV2A

depression
renally dosed

Question 19

Felbamate

Answer 19

blocks NDMA
GABA enhancement

Question 20

Generalized Seizures

Answer 20

Lamotrigine
Levetiracetam
Valproate

Others:
Topiramate
Zonisamide

Question 21

ASMs and depression

Answer 21

Positive impact: Carbamazepine, Lamotrigine, Valproate, Lacosamide

Negative: Levetiracetam, Topiramate, Zonisamide

Question 22

Absence Seizures

Answer 22

Ethosuximide
Valproate

Other:
Lamotrigine

Question 23

ASM weight gain

Answer 23

Valproate
Oxcarbamazepine
Gabapentin
Pregablin

Question 24

Weight loss

Answer 24

Zonisamide, topiramate

Question 25

ASMs that do not affect bone density

Answer 25

Lamotrigine, levetiracetam, zonisamide

Question 26

Sedation

Answer 26

Carbamazepine, Oxcarbamazepine, Phenytoin, Phenobarbital, Topiramate, Tiagabine

Question 26

Oxcarbamazepine

Answer 26

Renally dosed Weight gain Sedation

Question 27

Tension Headaches (prophylaxis)

Answer 27

1st line: non-pharmacological 2: Amitriptyline 30-75 mg nightly Alternatives: Mirtazapine 30 mg nightly Venlafaxine 150 mg nightly

Question 28

Migraines (Acute treatment)

Answer 28

1st Line: analgesics 2nd Line: Triptans Alternatives: CGRPs Ergots

Question 29

Ergot derivatives

Answer 29

Black box warning: ischemia if taken with CYP3A4 inhibitors Contraindications: PVD, IHD, renal or hepatic impairment

Question 30

Migraines (preventative)

Answer 30

1st Line: Beta-blockers, anticonvulsants, Frovatriptan (for menstrual related migraines only) 2nd Line: Amitriptyline Venlafaxine Alternatives: CGRP Botox

Question 31

Cluster Headaches

Answer 31

1st Line: Oxygen therapy 2nd Line: Sumatriptan Zolmitriptan Alternatives: Intranasal Lidocaine Ergot

Question 32

Opioids to avoid in renal impairment

Answer 32

morphine hydromorphone

Question 33

Opioids to avoid in hepatic impairment

Answer 33

codeine tramadol hydrocodone

Question 34

Opioid Tolerance

Answer 34

>60 mg OME for >1 week

Question 35

Codeine DDI

Answer 35

CYPD2D6 phenotypes

Question 36

Tramadol DDI

Answer 36

CYPD26 & CYP3A4 inducers/inhibitors CYPD2D6 phenotypes

Question 37

Buprenorphine DDI

Answer 37

CYP3A4 inducers/inhibitors

Question 38

Neuropathic pain agents

Answer 38

Gabapentinoids, TCAs, SNRIs

Question 38

Tapentadol DDI

Answer 38

MAOIs

Question 39

Asthma Diagnosis

Answer 39

-FEV1 and FVC increases from baseline by 12% and 200 mL after SABA -FEV1 increases from baseline by 10% from predicted FEV1 after SABA -PEF increases by 20% in adults or 15% in children

Question 40

GINA score for adults

Answer 40

-Step 1-2: infrequent asthma symptoms or asthma symptoms less than 3-5 days/wk -Step 3: asthma symptoms most days, waking due to asthma once a week or more -Step 4: daily asthma symptoms, waking at night, current smokers

Question 41

GINA score for children

Answer 41

Step 1: infrequent symptoms (1-2 days/wk) Step 2: 3-5days/wk Step 2-3: most days, waking due to asthma Step 4: daily asthma symptoms