Unit 4: Epilepsy and Anti-Seizure Agents

Question 1

L1: Mechanism of Action? BZDs

Answer 1

Facilitates GABA transmission

Question 2

L1: Mechanism of Action? Phenobarbital

Answer 2

Enhance GABA, inhibit glutamate

Question 3

L2: Clinical Uses? Diazepam

Answer 3

Status epilepticus

Question 4

L2: Clinical Uses? Ethosuximide

Answer 4

Absence Seizures

Question 5

L2: Clinical Uses? Levetiracetam

Answer 5

Tonic-Clonic Seizures

Question 6

L2: Clinical Uses? Phenobarbital

Answer 6

Adjunctive Agent

Question 7

L2: Mechanism of Action? Carbamazepine

Answer 7

Blocks Na channels

Question 8

L2: Mechanism of Action? Clonazepam

Answer 8

Inhibition of T-type Ca channels (BZD)

Question 9

L2: Mechanism of Action? Ethosuximide

Answer 9

Inhibition of T-type Ca channels

Question 10

L2: Mechanism of Action? Levetiracetam

Answer 10

Unknown/Ca channels

Question 11

L2: Mechanism of Action? Phenytoin

Answer 11

Blocks Na channels

Question 12

L2: Name 2 agents used in absence seizures

Answer 12

Ethosuximide, Valproate

Question 13

L2: Name three non-medical treatments for epilepsy.

Answer 13

Ketogenic diet, surgery, vagal nerve stimulation

Question 14

L2: What is the diagnosis? Generalized seizures and cognitive dysfunction with typical onset in early childhood; slow spike and wave EEG pattern, caused by infections, malformations or tuberous sclerosis

Answer 14

Lennox Gastaut Syndrome

Question 15

L2: Which epilepsy treatment? Kidney stones, QT prolongation, bruising, pancreatitis, immunosuppression

Answer 15

Ketogenic diet

Question 16

L2: Which epilepsy treatment? Temporary hoarseness, cough, shortness of breath

Answer 16

Vagal nerve stimulation

Question 17

L2: Which pharmacologic agent? Diplopia, ataxia, n/v, Stevens Johnson sydnrome, rarely: blood dyscrasias or hepatotoxicity

Answer 17

Carbamazepine

Question 18

L2: Which pharmacologic agent? Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, rash

Answer 18

Phenytoin

Question 19

L2: Which pharmacologic agent? Somnolence and development of tolerance

Answer 19

Diazepam

Question 20

L2: Which type of seizure? Associated with fever, focal, longer than 15 minutes, recurs in less than 24 hours

Answer 20

Febrile complex

Question 21

L2: Which type of seizure? Associated with fever, generalized, less than 15 minutes without recurrence within 24 hours

Answer 21

Febrile simple

Question 22

L2: Which type of seizure? Involves simple behavrios such as chewing or picking at clothing

Answer 22

Partial complex

Question 23

L2: Which type of seizure? Period of altered mental status unaccompanied by major motor manifestations

Answer 23

Partial complex, Absence

Question 24

L2: Which type of seizure? Recurrent major motor seizures without regained consciousness between episodes

Answer 24

Status epilepticus

Question 25

L2: Which type of seizure? Slower frequency EEG pattern than absence seizures

Answer 25

Partial simple and Partial complex

Question 26

L3: Clinical Uses? Carbamazepine

Answer 26

Partial Seizures, Tonic-Clonic Seizures, Trigeminal neuralgia

Question 27

L3: Clinical Uses? Lamotrigine

Answer 27

Partial or Generalized seizures, mania, migraine

Question 28

L3: Clinical Uses? Valproate/Divalproex

Answer 28

Tonic-Clonic Seizures, Absence seizures

Question 29

L3: Mechanism of Action? Absence Seizures

Answer 29

Inappropriate activation of T-type Ca channels

Question 30

L3: Mechanism of Action? Gabapentin

Answer 30

GABA analog that decreases glutamate via VSSC action

Question 31

L3: Mechanism of Action? Lamotrigine

Answer 31

Unclear/suppression of repetitive APs, inhbition of excitatory NTs, VSCC modulation

Question 32

L3: Mechanism of Action? Tonic-Clonic Seziures

Answer 32

Loss of GABA tone (possible increased glutamate or Na channel excitation)

Question 33

L3: Mechanism of Action? Valproate/Divalproex

Answer 33

Unclear/ potentiation of GABA, limits T-type Ca channels

Question 34

L3: Name 3 agents used in status epilepticus as first-line treatment

Answer 34

Diazepam, Lorazepam, Midazolam

Question 35

L3: Which 2 anti-seizure agents should be avoided in pregnant patients?

Answer 35

Valproate/Divalproex, Phenobarbital

Question 36

L3: Which pharmacologic agent? Dizziness, ataxia, diplopia, skin rash, nausea, milder than phenytoin

Answer 36

Lamotrigine

Question 37

L3: Which pharmacologic agent? Fatigue, somnolence, asthenia, dizziness

Answer 37

Levetiracetam

Question 38

L3: Which pharmacologic agent? n/v, headache/dizziness, rarely: bone marrow suppresion, tongue pain, gum hypertrophy

Answer 38

Ethosuximide

Question 39

L3: Which pharmacologic agent? n/v, weight gain, easy bruising, hepatotoxicity especially in patients

Answer 39

Valproate/Divalproex

Question 40

L3: Which pharmacologic agent? Sedation and possible behavioral problems

Answer 40

Clonazepam

Question 41

L4: Name 4 broad-spectrum anti-seizure agents

Answer 41

Phenobarbital, Diazepam, Valproate, Divalproex

Question 42

L4: Name 5 agents used in Tonic-clonic (Grand mal) seizures

Answer 42

Valproate, Lamotrigine, Levetiracetam, Phenytoin, Carbamazepine

Question 43

L4: Which 3 anti-seizure agents induce the CYP450 system?

Answer 43

Phenobarbital, Phenytoin, Carbamazepine