Week 10 - Anticonvulsants

Question 1

This class of medications is 1st line for tonic-clonic and partial complex seizures

Answer 1

Hydantoins
* phenytoin
* fosphenytoin

Question 2

Abrupt discontinuation of any of the anticonvulsants increases the risk for _______

Answer 2

seizure

Question 3

What is the MOA of the hydantoin class?

Answer 3

affect Na+ influx into neurons = decreased propagation of nerve impulses

Question 4

True or false

The hydantoins are the most sedating of all the anticonvulsants

Answer 4

False
They are the least sedating

Question 5

The hydantoins may worsen which type of seizures?

Answer 5

Absence

Question 6

Due to the MOA, hydantoins are contraindicated in patients with ________ disease

Answer 6

heart disease
* may cause bradycardia/heart block (Na+ channel affects)

Question 7

What monitoring is required for the hydantoin class?

Answer 7

Plasma drug levels

Question 8

The carbamezapine anticonvulsants are structurally related to _______

Answer 8

Tricyclic antidepressants

Question 9

The carbamezapine class of medications is used to treat _______

Answer 9

Partial or tonic-clonic seizures
Epilepsy
Bipolarism
Aggressive/assaultive behavior

Question 10

What is the black box warnings associated with the carbamezapine class?

Answer 10

• Steven-Johnson Syndrome and Toxic epidermal necrolysis (Asian population especially at risk)
• Potential for blood dyscrasias

Question 11

The carbamezapine class carries a risk of decreased ________ function

Answer 11

thyroid

Question 12

What are the monitoring considerations with the carbamezapine class?

Answer 12

• CBC
• Liver function tests
• TSH levels

Question 13

Because of their structural relation to another class of medications, it is important that the Carbamezapines are not administered within 14 days of _________

Answer 13

MAOI’s

Question 14

Carbamazapine MOA

Answer 14

Affects Na+ channels and nerve impulse propagation

Question 15

Many of the anticonvulsants share a common ADR of ___________

Answer 15

increased suicidal thoughts

Question 16

Lamotrigine is used as __________ therapy for patients with partial or generalized seizures

Answer 16

adjunct

Question 17

Lamotrigine carries a black box warning of?

Which medication given in conjunction increases this risk?

Answer 17

Steven-Johnson syndrome, Toxic epidermal necrolysis

Valproate

Question 18

This possible ADR of lamotrigine necessitates monitoring of CBC

Answer 18

Blood dyscrasias

Question 19

Anticonvulsant drugs that affect GABA include:

Answer 19

• Gabapentin
• Topiramate

Question 20

True or false

Plasma drug level monitoring is required for gabapentin and topiramate

Answer 20

False

Question 21

Behavior problems such as hostility/aggression, “thought disorder”, and worsening school performance has been observed in patients aged 3-12 taking ___________

Answer 21

Gabapentin

Question 22

What possible ADR of topiramate requires labratory monitoring?

Answer 22

Decreased serum bicarbonate, altered electrolytes

Question 23

Patients taking topiramate who have eye pain or blurred vision should _________

Answer 23

contact their provider immediately
* drug reaction causing acute myopia and angle closure glaucoma

Question 24

Ethosuximide is a(n) ___________ with an indication of _____________

Answer 24

anticonvulsant, childhood and adult absence seizures

Question 25

With careful monitoring of plasma drug levels, ethosuximide may be safe for use during ___________

Answer 25

Pregnancy

Question 26

The most common ADR associated with ethosuximide is ___________ and may be relieved by ___________

Answer 26

GI upset, taking the medication with food or milk

Question 27

Ethosuximide may decrease the effectiveness of ___________

Answer 27

oral contraceptives

Question 28

Leviteracetam is used for _________

Answer 28

adjunct therapy in partial or generalized seizures

Question 29

The most common ADR's associated with leviteracetam include:

Answer 29

* Somnolence * dizziness

Question 30

What is a common severe side effect of phenytoin (not CNS related)

Answer 30

Phenytoin-induced hepatitis is a common hypersensitivity reaction

Question 31

What black-box warning does phenytoin carry?

Answer 31

Rapid IV administration may cause severe cardiovascular events such as... Bradycardia SA block 2nd, 3rd degree block Stokes-Adams

Question 32

Phenytoin is a pregnancy category...

Answer 32

D May cause malformations and infants exposed may experience lower vitamin K dependent clotting factors

Question 33

What labs should be monitored with administration of phenytoin?

Answer 33

CBC Liver labs Urinalysis Thyroid labs (may alter thyroid hormone demand)

Question 34

What benign effect may happen to patients when on phenytoin?

Answer 34

May discolor urine a reddish color, not cause for alarm

Question 35

Regarding lab values with carbamazepine, what may occur after months of treatment despite good compliance?

Answer 35

Initial concentrations within the therapeutic range may fall.

Question 36

Patients taking gabapentin may experience weight __________ ?

Answer 36

Gain

Question 37

Patients taking gabapentin may experience increased risk of?

Answer 37

Suicidal ideation

Question 38

Patients taking lamotrigine may experience weight ________ ?

Answer 38

Loss

Question 39

When combined with phentermine, topiramate can be used to treat

Answer 39

Anorexia

Question 40

When used alone, topiramate causes appetite ____________ ?

Answer 40

Suppression Use cautiously in patients with eating disorders due to the risk of developing low serum bicarb

Question 41

Topiramate may cause ___________ if coadministered with carbonic anhydrase inhibitors (ex. acetazolamide)?

Answer 41

Renal calculi

Question 42

What is the MOA of levetiracetam?

Answer 42

Inhibits burst firing without affecting normal excitability, prevents spread of seizure.

Question 43

Lab monitoring needed for patients started on levetiracetam?

Answer 43

Trick question: None Though you may see a transient decrease in WBC

Question 44

Unique to levetiracetam is that it is approved for children ___________ month(s) or older.

Answer 44

One

Question 45

The two most common adverse reactions to the succinimide class are?

Answer 45

GI distress and CNS depression Relieve by taking meds with food and milk

Question 46

What is the most common Hydantoin used?

Answer 46

Phenytoin

Question 47

Gabapentin and topiramate are also used for?

Answer 47

Neuropathic pain Migraines