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Anti-epileptics

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Anti-epileptics

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  1. 1What are the first generation anti-epileptic drugs?Carbamazepine
    Phenytoin
    Phenobarbital
    Ethosuximide
    Valproic acid
    Clonazepam
  2. 2What are the second generation anti-epileptic drugs?Oxcarbazepine
    Gabapentin
    Pregabalin
    Lamotrigine
    Levetiracetam
    Topiramate
    Felbamate
  3. 3Is the following drug a first or second generation anti-epileptic? CarbamazepineCarbamazepine: First
  4. 4Is the following drug a first or second generation anti-epileptic? PhenytoinPhenytoin: First
  5. 5Is the following drug a first or second generation anti-epileptic? PhenobarbitalPhenobarbital: First
  6. 6Is the following drug a first or second generation anti-epileptic? EthosuximideEthosuximide: First
  7. 7Is the following drug a first or second generation anti-epileptic? Valproic acidValproic acid: First
  8. 8Is the following drug a first or second generation anti-epileptic? ClonazepamClonazepam: First
  9. 9Is the following drug a first or second generation anti-epileptic? OxcarbazepineOxcarbazepine: Second
  10. 10Is the following drug a first or second generation anti-epileptic? GabapentinGabapentin: Second
  11. 11Is the following drug a first or second generation anti-epileptic? PregabalinPregabalin: Second
  12. 12Is the following drug a first or second generation anti-epileptic? LamotrigineLamotrigine: Second
  13. 13Is the following drug a first or second generation anti-epileptic? LevetiracetamLevetiracetam: Second
  14. 14Is the following drug a first or second generation anti-epileptic? TopiramateTopiramate: Second
  15. 15Is the following drug a first or second generation anti-epileptic? FelbamateFelbamate: Second
  16. 16Non-pharmacological therapy for epilepsy includes what?surgery, vagus nerve stimulation, deep
    brain stimulation, diets
  17. 17True or False Pharmacological treatment can control but not cure epilepsy.True
  18. 18True or False Status epilepticus is a medical emergency.True
  19. 19True or False Focal (partial) seizure initiates in a specific site.True
  20. 20What type of seizure is described below? minimal spread within brain; often clonic jerking, no diminished awareness, 20-60 sec durationSimple - Focal seizure
  21. 21What type of seizure is described below? localized onset but discharge spreads; alteration of consciousness (but not unconscious), automatisms (integrated motor behavior, e.g. lip smacking, button picking)Complex - Focal seizure
  22. 22What type of seizure is described below? focal seizure precedes a generalized tonic-clonic seizureSecondarily generalized - Focal seizure
  23. 23What type of seizure is described below? They start with a tingling in the right thumb. Then the thumb starts jerking. In a few seconds, the whole right hand is jerking. The jerking spreads up my arm. When it reaches the shoulder, I pass out and people tell me that my whole body starts to jerk.Focal Seizure with Secondary Generalization
  24. 24What is a Secondarily Generalized focal seizure?Focal seizure precedes a generalized
    tonic-clonic seizure
  25. 25What is a focal seizure?When the seizure initiates in a specific site.
  26. 26What is a Simple focal seizure?minimal spread within brain; often clonic jerking, no diminished awareness, 20-60 sec duration
  27. 27What is a Complex focal seizure?localized onset but discharge spreads; alteration of consciousness (but not unconscious), automatisms (integrated
    motor behavior, e.g. lip smacking, button picking)
  28. 28What is a generalized seizure?There is no evidence of localized onset.
  29. 29What type of seizure is describe below? tonic rigidity of all extremities, followed by relaxation, then by massive jerking of the body; patient is groggy/disoriented afterwards, urinary incontinence is common, 1-2 min durationTonic-clonic - Generalized
  30. 30What type of seizure is describe below? sudden onset, abrupt cessation; 10-45 sec duration; may occur >100 times per day; characterized by a spike and wave pattern on EEG; patient may simply stare (daydream) or show postural changes, autonomic phenomena, automatismsAbsence - Generalized
  31. 31What type of seizure is describe below? muscles spasm and limbs jerk; contractions and relaxations repeat rapidlyMyoclonic - Generalized
  32. 32What type of seizure is describe below? sudden loss of postural toneAtonic - Generalized
  33. 33What type of seizure is describe below? increased tone of all musclesTonic - Generalized
  34. 34What is a generalized Tonic seizure?Increased tone of all muscles
  35. 35What is a generalized Atonic seizure?Sudden loss of postural tone
  36. 36What is a generalized Myoclonic seizure?Muscles spasm and limbs jerk; contractions and relaxations
    repeat rapidly
  37. 37What is a generalized Absence seizure?Sudden onset, abrupt cessation; 10-45 sec duration; may occur >100 times per day; characterized by a spike and wave pattern on EEG; patient may simply stare (daydream) or show postural changes,
    autonomic phenomena, automatisms
  38. 38What is a generalized Tonic-clonic seizure?tonic rigidity of all extremities, followed by relaxation, then by massive jerking of the body; patient is groggy/disoriented afterwards, urinary incontinence is common, 1-2 min duration
  39. 39What type of seizure is described below? When it starts, she suddenly shrieks with this unnatural cry, then she falls, and every muscle in her body seems to be activated. Her teeth clench. Shortly after she falls, her arms and upper body start to jerk while her legs are more or less still stiff. This is the longest part of the seizure. Then it finally stops and she passes into a deep sleep.Generalized tonic-clonic seizure
  40. 40What type of seizure is described below?He is a 7 year old boy. He often “blanks out” for a few seconds. His teacher calls his name, but he doesn’t seem to hear her. He usually blinks a few times, and his eyes may roll up a bit. Then he is right back where he left off. Some days he has more than 50 of these spells.Generalized absence seizure
  41. 41What are the goals of therapy for epilepsy?Improve quality of life by:
     Controlling seizures
    Rarely are seizures eliminated; even occasional seizures are still a
    concern for patients
     Minimizing adverse effects
    Usually lifelong treatment
  42. 42What are the mechanisms of action of anti-epileptic drugs to inhibit excitability? Inhibit voltage dependent Na+ channels
    Reduce the rate of Na+ channel opening; use dependent blockade
    phenytoin, carbamazepine, oxcarbazepine, lamotrigine, topiramate, valproate
    Inhibit glutamate receptors
    NMDA – felbamate
    AMPA – topiramate
    Modulate glutamate release (putative)
    Gabapentin, pregabalin, levetiracetam
  43. 43What are the mechanisms of action of anti-epileptic drugs to increase inhibitory neurotransmission? Enhance GABA-A activity (positive allosteric modulation)
    Phenobarbital, clonazepam, topiramate
     Enhance GABA availability
    Several proposed
  44. 44What are the mechanisms of action of anti-epileptic drugs to Inhibit T-type Ca2+ channels? Neurons in thalamus are dependent on calcium channel pacemaker currents for depolarization
     Depolarization of thalamic neurons activates cortical neurons
    Ethosuximide, valproate
  45. 45What is/are the mechanism(s) of action of Carbamazepine?Inhibit excitability
     Inhibit voltage dependent Na+ channels
    - Reduce the rate of Na+ channel opening; use dependent blockade
    - At therapeutic concentrations, prolongs inactivated state of Na+ channel
  46. 46What is/are the mechanism(s) of action of Phenytoin?Inhibit excitability
     Inhibit voltage dependent Na+ channels
    - At therapeutic concentrations, prolongs inactivated state of Na+ channel
  47. 47What is/are the mechanism(s) of action of Phenobarbital?Increase inhibitory neurotransmission
     Enhance GABA-A activity (positive allosteric modulation)
  48. 48What is/are the mechanism(s) of action of Ethosuximide?Inhibit T-type Ca2+ channels
     Neurons in thalamus are dependent on calcium channel pacemaker currents for depolarization
     Depolarization of thalamic neurons activates cortical neurons
     Limits 3Hz spike-wave
  49. 49What is/are the mechanism(s) of action of Valproic acid?Inhibit excitability
    Inhibit voltage dependent Na+ channels
    Reduce the rate of Na+ channel opening; use dependent blockade
    Inhibit T-type Ca2+ channels
     Neurons in thalamus are dependent on calcium channel pacemaker currents for depolarization
     Depolarization of thalamic neurons activates cortical neurons
  50. 50What is/are the mechanism(s) of action of Clonazepam?Increase inhibitory neurotransmission
     Enhance GABA-A activity (positive allosteric modulation)
  51. 51What is/are the mechanism(s) of action of Oxcarbazepine?Inhibit excitability
    Inhibit voltage dependent Na+ channels
    Reduce the rate of Na+ channel opening; use dependent blockade
  52. 52What is/are the mechanism(s) of action of Gabapentin?Inhibit excitability
    Modulate glutamate release (putative)
  53. 53What is/are the mechanism(s) of action of Pregabalin?Inhibit excitability
    Modulate glutamate release (putative)
  54. 54What is/are the mechanism(s) of action of Lamotrigine?Inhibit excitability
    Inhibit voltage dependent Na+ channels
    - Reduce the rate of Na+ channel opening; use dependent blockade
    - At therapeutic concentrations, prolongs inactivated state of Na+ channel
  55. 55What is/are the mechanism(s) of action of Levetiracetam?Mechanism of Action: Under investigation
     Synaptic Vesicle Glycoprotein 2A (SV2A)
     Likely modifies release of Glu / GABAA
  56. 56What is/are the mechanism(s) of action of Topiramate?Increase inhibitory neurotransmission
     Enhance GABA-A activity (positive allosteric modulation)
    Inhibit excitability
     Inhibit voltage dependent Na+ channels
    - Reduce the rate of Na+ channel opening; use dependent blockade
    Inhibit Excitability
     Inhibit glutamate receptors
    - AMPA – topiramate
  57. 57What is/are the mechanism(s) of action of Felbamate?Inhibit Excitability
     Inhibit glutamate receptors
    NMDA – felbamate
    Mechanism of Action: not fully characterized
     Use-dependent block of postsynaptic NMDA
  58. 58Neurons in thalamus are dependent on what for depolarization?Neurons in thalamus are dependent on calcium channel pacemaker currents for depolarization
  59. 59Depolarization of thalamic neurons activates what?Cortical neurons
  60. 60The following is a drug of choice for which type(s) of epileptic seizure? CarbamazepineFocal (Partial)
  61. 61The following is a drug of choice for which type(s) of epileptic seizure? LamotrigineFocal (Partial) and Primary GTC
  62. 62The following is a drug of choice for which type(s) of epileptic seizure? OxcarbazepineFocal (Partial)
  63. 63The following is a drug of choice for which type(s) of epileptic seizure? LevetiracetamFocal (Partial) Approved as adjunctive therapy only
    and Primary GTC
  64. 64The following is a drug of choice for which type(s) of epileptic seizure? ValproatePrimary GTC and Absence
  65. 65The following is a drug of choice for which type(s) of epileptic seizure? EthosuximideAbsence
  66. 66What are the drugs of choice for Focal (Partial) seizures?Carbamazepine
    Lamotrigine
    Oxcarbazepine
    Levetiracetam*
    * Approved as adjunctive therapy only
  67. 67What are the drugs of choice for Primary GTC seizures?Valproate
    Lamotrigine
    Levetiracetam
  68. 68What are the drugs of choice for Absence seizures?Ethosuximide
    Valproate
  69. 69What are the alternative drugs for Absence seizures?Clonazepam
    Levetiracetam
  70. 70What are the alternative drugs for Primary GTC seizures?Valproate
    Lamotrigine
    Levetiracetam
  71. 71What are the alternative drugs for Focal (Partial) seizures?Valproate
    Phenytoin
    Topiramate
    Gabapentin*
    Pregabalin*
  72. 72The following is an alternative drug for which type(s) of epileptic seizure? ValproateFocal (Partial)
  73. 73The following is an alternative drug for which type(s) of epileptic seizure? PhenytoinFocal (Partial) and Primary GTC
  74. 74The following is an alternative drug for which type(s) of epileptic seizure? TopiramateFocal (Partial) and Primary GTC
  75. 75The following is an alternative drug for which type(s) of epileptic seizure? GabapentinFocal (Partial)
    Approved as adjunctive therapy only
  76. 76The following is an alternative drug for which type(s) of epileptic seizure? PregabalinFocal (Partial)
    Approved as adjunctive therapy only
  77. 77The following is an alternative drug for which type(s) of epileptic seizure? ClonazepamAbsence
  78. 78The following is an alternative drug for which type(s) of epileptic seizure? LevetiracetamAbsence
  79. 79For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? CarbamazepineDrug of Choice: Focal (Partial)
  80. 80For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? LamotrigineDrug of Choice:
    Focal (Partial) and Primary GTC
  81. 81For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? OxcarbazepineDrug of Choice: Focal (Partial)
  82. 82For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? LevetiracetamDrug of Choice: Focal/Partial (Approved as adjunctive therapy only) and Primary GTC
    Alternative: Absence
  83. 83For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? ValproateDrug of Choice: Primary GTC and Absence
    Alternative: Focal (Partial)
  84. 84For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? EthosuximideDrug of Choice: Absence
  85. 85For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? PhenytoinAlternative: Focal (Partial) and Primary GTC
  86. 86For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? TopiramateAlternative: Focal (Partial) and Primary GTC
  87. 87For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? GabapentinAlternative: Focal (Partial)
    Approved as adjunctive therapy only.
  88. 88For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? PregabalinAlternative: Focal (Partial)
    Approved as adjunctive therapy only.
  89. 89For which type of epileptic seizures is the following a drug of choice for? Alternative drug for? ClonazepamAlternative: Absence
  90. 90Which type of anti-epileptic is described below?  Oldest non-sedating, anti-seizure drug  Effective but no longer drug of choice because of pharmacokinetics, adverse effects and drug interactionsPhenytoin
  91. 91The following are the Pharmacokinetics for which drug?  Many PO formulations available – IR / ER formulations  90% _____ in vascular space is bound to albumin  At steady-state, 10% ______ in vascular space, 90% tissue  Takes up to 6 weeks to achieve steady state, depending ondosePhenytoin
  92. 92What are the Pharmacokinetics of Phenytoin? Many PO formulations available – IR / ER formulations
     90% of phenytoin in vascular space is bound to albumin
     At steady-state, 10% phenytoin in vascular space, 90% tissue
     Takes up to 6 weeks to achieve steady state, depending on dose
     Metabolism: dose-dependent capacity-limited pharmacokinetics (zero order metabolism)
     MUST MONITOR SERUM LEVELS
     10-20 mg/L is common therapeutic range
  93. 93The following is true for what drug? Metabolism: dose-dependent capacity-limited pharmacokinetics (zero order metabolism)  MUST MONITOR SERUM LEVELS  10-20 mg/L is common therapeutic rangePhenytoin
  94. 94Why are there dramatic increases in plasma phenytoin with small increases in dose?Caused by dose-dependent
    metabolism
  95. 95What are the dose related adverse effects (seen in CNS) of Phenytoin?List in order of Increasing serum concentration
     Nystagmus – common at therapeutic levels
     Dizziness, sedation – seen with IV loading
     Diplopia, ataxia – require dose reduction
     Involuntary movements – seen at high doses
     May interfere with learning
  96. 96The following are the dose related adverse effects (seen in CNS) of which drug?  Nystagmus – common at therapeutic levels  Dizziness, sedation – seen with IV loading  Diplopia, ataxia – require dose reduction  Involuntary movements – seen at high doses  May interfere with learningPhenytoin
  97. 97What are the chronic therapy related adverse effects of Phenytoin? Gingival hyperplasia (40%)
     Acne / Hirsuitism / Coarsening of facial features
     Folate and Vitamin D deficiencies (megaloblastic anemia, osteomalacia)
     Vitamin D and Calcium supplementation appropriate
     No routine supplementation with folate - can affect phenytoin levels
  98. 98The following are the chronic therapy related adverse effects of which drug?  Gingival hyperplasia (40%)  Acne / Hirsuitism / Coarsening of facial features  Folate and Vitamin D deficiencies (megaloblastic anemia, osteomalacia)  Vitamin D and Calcium supplementation appropriate  No routine supplementation with folate - can affect phenytoin levelsPhenytoin
  99. 99What is shown here? For what drug is it a chronic therapy related adverse effect?Gingival hyperplasia - chronic therapy related adverse effect of Phenytoin (40%)
     Upper – after 2 yrs of
    unsupervised PHT therapy
     Lower – 3 months after
    removal of PHT    What is shown here? For what drug is it a chronic therapy related adverse effect?
  100. 100The following describes what the drug-to-drug reactions of what anti-epileptic? Significant enzyme induction  CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein  Warfarin: _____ can decrease anticoagulant effect  Can reduce blood levels of contraceptive hormones  Interactions due to plasma protein binding  e.g. valproate inhibits plasma protein binding and inhibits metabolism of _______FPhenytoin
  101. 101What are the drug-drug interactions of Phenytoin? Significant enzyme induction
     CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4, P-glycoprotein
     Warfarin: Phenytoin can decrease anticoagulant effect
     Can reduce blood levels of contraceptive hormones
     Interactions due to plasma protein binding
     e.g. valproate inhibits plasma protein binding and inhibits metabolism of phenytoin
  102. 102The following are the contraindications / precautions of what anti-epileptic?  Contraindication: IV use for patients with sinus bradycardia, sinoatrial block, second- and third-degree heart block  Precaution: black box warning on rate of IV administration (<50mg/min)  Teratogenic riskPhenytoin
  103. 103What are the contraindications / precautions of Phenytoin? Contraindication: IV use for patients with sinus bradycardia, sinoatrial block,
    second- and third-degree heart block
     Precaution: black box warning on rate of IV administration (<50mg/min)
     Teratogenic risk
  104. 104The following are the Pharmacokinetics of which anti-epileptic?  Induces its own metabolism; t1/2 ~36 hr ~20 hr  Induces metabolism of phenytoin, ethosuximide, valproate, clonazepam  Drug level affected by CYP3A4 inducers (phenytoin, phenobarbital), inhibitors  Reduces blood levels of contraceptive hormonesCarbamazepine
  105. 105What are the Pharmacokinetics of Carbamazepine? Induces its own metabolism; t1/2 ~36 hr ~20 hr
     Induces metabolism of phenytoin, ethosuximide, valproate, clonazepam
     Drug level affected by CYP3A4 inducers (phenytoin, phenobarbital), inhibitors
     Reduces blood levels of contraceptive hormones
  106. 106The following are the Dose related adverse effects of which anti-epileptic?  CNS • Transient diplopia; ataxia • Dizziness, drowsiness, nausea, anorexia - common upon initiation; tolerance develops Hyponatremia, common but mildCarbamazepine
  107. 107What are the dose related adverse effects of Carbamazepine? CNS
    • Transient diplopia; ataxia
    • Dizziness, drowsiness, nausea, anorexia
    - common upon initiation; tolerance develops
    Hyponatremia, common but mild
  108. 108The following are idiosyncratic adverse reactions to which anti-epileptic? • Rare serious blood dyscrasias • Skin rash (5%) • Stevens-Johnson syndrome (1:10,000) - HLA-B*1502Carbamazepine
  109. 109What are the idiosyncratic adverse reactions to Carbamazepine?• Rare serious blood dyscrasias
    • Skin rash (5%)
    • Stevens-Johnson syndrome (1:10,000)
    - HLA-B*1502
  110. 110The following are the contraindications/precautions of which anti-epileptic? HLA-B*1502, common in Asians, linked to 10X increased incidence of Stevens-Johnson syndrome Recommended to test Asians for this allele prior to initiating carbamazepine therapy Teratogenic riskCarbamazepine
  111. 111What are the contraindications/precautions of Carbamazepine?HLA-B*1502, common in Asians, linked to 10X increased incidence of Stevens-Johnson syndrome
    Recommended to test Asians for this allele prior to initiating carbamazepine therapy
    Teratogenic risk
  112. 112True or False Valproate is a drug of choice for women of childbearing potential.False
    Valproate is no longer a drug of 1st choice for women of childbearing potential
  113. 113Which anti-epileptic is described below?  No longer a drug of 1st choice for women of childbearing potential  Effective and well tolerated so used for many seizure types  Also used for migraine prophylaxis and bipolar disorderValproate
  114. 114The following are the Pharmacokinetics of which anti-epileptic?  90% protein bound – can be significant  Many enzymes responsible for valproate metabolism - (2A6, 2B6, 2C9, UGT, etc.)Valproate
  115. 115What are the Pharmacokinetics of Valproate? 90% protein bound – can be significant
     Many enzymes responsible for valproate metabolism
    - (2A6, 2B6, 2C9, UGT, etc.)
  116. 116The following are the drug-drug interactions for which anti-epileptic?  Fewer drug interactions than phenytoin or carbamazepine  Enzyme inducers can increase valproate clearance  Can increase plasma levels of carbamazepine metabolite, phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressantsValproate
  117. 117What are the drug-drug interactions of Valproate? Fewer drug interactions than phenytoin or carbamazepine
     Enzyme inducers can increase valproate clearance
     Can increase plasma levels of carbamazepine metabolite,
    phenytoin, phenobarbital, ethosuximide, lamotrigine and tricyclic antidepressants
  118. 118The following are the Dose related adverse effects of which anti-epileptic? • GI discomfort (tolerance) • CNS: dizziness /tremor • Weight gain / alopecia • Thrombocytopenia • Monitor for liver function • Hyperammonemia  VPA inhibits urea synthesis and can increase renal production of ammonia.  Hyperammonemia usually asymptomatic; but may alter mental statusValproate
  119. 119What are the Dose related adverse effects of Valproate?• GI discomfort (tolerance)
    • CNS: dizziness /tremor
    • Weight gain / alopecia
    • Thrombocytopenia
    • Monitor for liver function
    • Hyperammonemia
     VPA inhibits urea synthesis and can increase renal production of ammonia.
     Hyperammonemia usually asymptomatic; but may alter mental status
  120. 120The following are idiosyncratic adverse reactions to which anti-epileptic? • Fulminant hepatitis • Acute pancreatitis • Stevens-Johnson syndrome (rare) • Menstrual abnormalities / polycystic ovariesValproate
  121. 121What are the idiosyncratic adverse reactions to Valproate?• Fulminant hepatitis
    • Acute pancreatitis
    • Stevens-Johnson syndrome (rare)
    • Menstrual abnormalities / polycystic
    ovaries
     Teratogenic risk
     Lamotrigine often used instead
     Not used in children <3 yrs
    because of risk of liver failure
  122. 122The following are adverse effects of which anti-epileptic? Nausea, vomiting, hiccups, behavioral changesEthosuximide
  123. 123What are the adverse effects of Ethosuximide?Nausea, vomiting, hiccups, behavioral changes
  124. 124What are the drug-drug interactions of Ethosuximide?Metabolism inhibited by valproate
  125. 125The following are the drug-drug interactions of what anti-epileptic? Metabolism inhibited by valproateEthosuximide
  126. 126Which type of anti-epileptic is described below? Used in children more than adults Febrile seizures Infrequently used for seizures due to adverse effects, and risksPhenobarbital
  127. 127True or False Phenobarbital is rarely used in children.False
    It is used in children more than adults.
  128. 128The following are the adverse reactions of what anti-epileptic? Sedation, tolerance, dependence, respiratory depressionPhenobarbital
  129. 129What are the adverse reactions of Phenobarbital?Sedation, tolerance, dependence, respiratory depression
  130. 130The following are the drug-drug interactions of which anti-epileptic?  Significant enzyme induction - CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4  Reduces blood levels of contraceptive hormonesPhenobarbital
  131. 131What are the drug-drug interactions of Phenobarbital? Significant enzyme induction
    - CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP3A4
     Reduces blood levels of contraceptive hormones
  132. 132The following are the contraindications / precautions of which anti-epileptic?  Do not use in patients with history of sedative addiction  Risk of dependence is high  Teratogenic riskPhenobarbital
  133. 133What are the contraindications / precautions of Phenobarbital? Do not use in patients with history of sedative addiction
     Risk of dependence is high
     Teratogenic risk
  134. 134The following are the adverse effects of which anti-epileptic? Sedation, tolerance, dependenceClonazepam
  135. 135What are the adverse effects of Clonazepam?Sedation, tolerance, dependence
  136. 136The following are the contraindications / precautions of which anti-epileptic? Caution in patients with history of sedative dependenceClonazepam
  137. 137What are the contraindications / precautions of Clonazepam?Caution in patients with history of sedative dependence
  138. 138The following are the drug-drug interactions of which anti-epileptic? Metabolized by CYP3A4Clonazepam
  139. 139What are the drug-drug interactions of Clonazepam?Metabolized by CYP3A4
  140. 140What anti-epileptic is described below?  Adjunctive therapy in children with focal seizures and generalized tonic clonic seizures  Monotherapy in >16 yr old for focal seizures  Also used in absence  Also used in bipolar disorderLamotrigine
  141. 141What are the uses of Lamotrigine? Adjunctive therapy in children with focal seizures and generalized tonic clonic seizures
     Monotherapy in >16 yr old for focal seizures
     Also used in absence
     Also used in bipolar disorder
  142. 142The following are the Pharmacokinetics for which anti-epileptic? Does not induce or inhibit CYP enzymes Metabolism induced by carbamazepine, phenobarbital, phenytoin Oral contraceptives can reduce ______ levels Metabolism inhibited by valproate ***Starting dosage and escalation schedule dependent upon concomitant therapyLamotrigine
  143. 143What are the Pharmacokinetics for Lamotrigine? Does not induce or inhibit CYP enzymes
     Metabolism induced by carbamazepine, phenobarbital, phenytoin
     Oral contraceptives can reduce ______ levels
     Metabolism inhibited by valproate
    ***Starting dosage and escalation schedule dependent upon concomitant therapy
  144. 144The following are the adverse effects of which anti-epileptic?  Dizziness, headache, nausea, insomnia  Skin rash (including Stevens-Johnson)  More common with higher starting dose, rapid escalation and concomitant valproate therapy;  Discontinue if rash occurs  Titration Schedule on new start (go slow)Lamotrigine
  145. 145What are the adverse effects of Lamotrigine? Dizziness, headache, nausea, insomnia
     Skin rash (including Stevens-Johnson)
     More common with higher starting dose, rapid escalation and concomitant
    valproate therapy;
     Discontinue if rash occurs
     Titration Schedule on new start (go slow)
  146. 146To which anti-epileptic does the following statement apply?  Fewer cognitive adverse effects vs. other commonly-used antiepileptic drugs (controversial)Lamotrigine
  147. 147Which anti-epileptic is described below?  Focal and generalized tonic clonic seizures  Also used for migraine prophylaxis, weight managementTopiramate
  148. 148What are the uses of Topiramate? Focal and generalized tonic clonic seizures
     Also used for migraine prophylaxis, weight management
  149. 149The following are the adverse effects of which anti-epileptic?  Somnolence, nervousness, confusion, difficulty with speech, impaired concentration and memory  Mild parasthesias  Reduces blood levels of contraceptive hormonesTopiramate
  150. 150What are the adverse effects of Topiramate? Somnolence, nervousness, confusion, difficulty with speech, impaired concentration and memory
     Mild parasthesias
     Reduces blood levels of contraceptive hormones
  151. 151For which anti-epileptic does the following statement apply? Weight loss common (80% patients; 3-4% bodyweight loss)Topiramate
  152. 152Which anti-epileptic is described by the following?  Focal seizures in adults (not approved for generalized tonic-clonic)  Off label use for bipolar disorderOxcarbazepine
  153. 153What are the uses of Oxcarbazepine? Focal seizures in adults (not approved for
    generalized tonic-clonic)
     Off label use for bipolar disorder
  154. 154Which anti-epileptic is described below?  Chemically similar to carbamazepine; possibly useful in patients who fail other therapies due to poor seizure control or adverse effects  Adverse effects similar to carbamazepine; higher incidence of hyponatremia; do not use in patients with severe hypersensitivity to carbamazepine  Less enzyme-inducing activity than carbamazepine  Affected by CYP3A4 inducersOxcarbazepine
  155. 155True or False Oxcarbazepine is possibly useful in patients who fail other therapies due to poor seizure control or adverse effects.True
  156. 156True or False Oxcarbazepine should be used for patients with severe hypersensitivity to carbamazepineFalse
     Adverse effects similar to carbamazepine; higher incidence of
    hyponatremia; do not use in patients with severe hypersensitivity to carbamazepine
  157. 157What are the uses of Gabapentin? Adjunct for Focal Seizures in adults and
    children
     Modest efficacy
     Also used for neuropathic pain
  158. 158What are the uses of Pregabalin? Adjunct for Focal Seizures in adults
     Modest efficacy
     Also used for neuropathic pain
  159. 159The following describes which anti-epileptic?  Adjunct for Focal Seizures in adults  Modest efficacy  Also used for neuropathic painPregabalin
  160. 160The following describes which anti-epileptic?  Adjunct for Focal Seizures in adults and children  Modest efficacy  Also used for neuropathic painGabapentin
  161. 161The following are the pharmacokinetics for which drug? 100% renal eliminationGabapentin and Pregabalin
  162. 162What are the pharmacokinetics for Gabapentin?100% renal elimination
  163. 163What are the pharmacokinetics for Pregabalin?100% renal elimination
  164. 164The following are the adverse effects for which anti-epileptic? Mild drowsiness, weight gain (modest), lower extremity edemaGabapentin, Pregabalin
  165. 165The following are the drug-drug interactions of which anti-epileptic? No significant drug interactionsGabapentin and Pregabalin
  166. 166What are the uses of Levetiracetam? Adjunct for Focal and generalized tonic-clonic seizures
     Commonly used in monotherapy as well
  167. 167What are the drug-drug interactions of Levetiracetam?No clinically significant drug interactions
     Not an inhibitor or inducer of CYP enzymes
  168. 168The following are the adverse effects of which anti-epileptic? CNS disturbances (irritability, depression, aggression, hallucinations) more common than with other anti-epileptic drugsLevetiracetam
  169. 169What are the adverse effects of Levetiracetam?CNS disturbances (irritability, depression, aggression, hallucinations) more common
    than with other anti-epileptic drugs
  170. 170The following are the Pharmacokinetics of which anti-epileptic? Renal elimination (>70%)Levetiracetam
  171. 171What are the Pharmacokinetics of Levetiracetam?Renal elimination (>70%)
  172. 172The following describes which anti-epileptic?  Indication: Focal and generalized tonic-clonic seizures  Reserved for failure of alternate anti-epileptic drugs due to severe idiosyncratic reactionsFelbamate
  173. 173What are the uses of Felbamate? Indication: Focal and generalized tonic-clonic seizures
     Reserved for failure of alternate anti-epileptic drugs due to
    severe idiosyncratic reactions
  174. 174The following are the adverse reactions of which anti-epileptic?  Aplastic anemia – 1:5,000 incidence; occurs within 1 year of initiation; 30% mortality  Hepatic failure – 1:30,000 incidence; occurs within 1 year of initiation; 50% mortalityFelbamate
  175. 175What are the adverse reactions to Felbamate? Aplastic anemia – 1:5,000 incidence; occurs within 1 year of
    initiation; 30% mortality
     Hepatic failure – 1:30,000 incidence; occurs within 1 year of
    initiation; 50% mortality
  176. 176What is described below?  Significant interest in the epilepsy community  Anecdotal reports of efficacy; safety and efficacy data are limited  Small trials with oral _______ indicate short-term use is safe but study design prevents conclusions on efficacy  Concerns with negative effects on brain development with long term ________  More studies are currently underwayCannabinoids – fyi (not testable)
  177. 177What should be done if monotherapy fails?Choose alternate monotherapy agent and repeat process
  178. 178What should be done if monotherapy fails with several drugs?Try adjuvant therapy
     Concern is management of adverse effects of two drugs
  179. 179Which AEDs reduce blood levels of contraceptive hormone?Carbamazepine, phenobarbital, phenytoin, felbamate, lamotrigine, oxcarbazepine,
    topiramate
  180. 180True or False Status epilepticus is a medical emergency; IV lorazepam is used to stop the seizures. IV phenytoin is then initiated for longer term controlTrue
  181. 181What is done for status epilepticus?Status epilepticus is a medical emergency; IV lorazepam is used to stop the seizures. IV phenytoin is then initiated for longer
    term control
  182. 182True or False Antiepileptics are gradually increased to therapeutic concentrations to minimize adverse effects and are withdrawn gradually to reduce the risk of inducing seizuresTrue
  183. 183True or False Blood level monitoring is often required to maintain therapeutic levels.True
    Especially for drugs that affect drug metabolizing enzymes

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Der Nutzer hat seine Fachbereichs-Information gelöscht. Karteikarten am Anti-epileptics, erstellt von Gelöschter Nutzer am 22/03/2017.
Erstellt von
Gelöschter Nutzer · Mär 2017
Aktualisiert
22 Mär 2017
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  • Erstellt von Victoria Wright · 19 Mär 2017
  • Kopiert von Victoria Wright · 22 Mär 2017
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