Anti-epileptics Flashcard Supplement

Which of the following are First Generation anti-epileptics?

Which of the following are Second Generation anti-epileptics?

[blank_start]Epilepsy[blank_end] is chronic disorder characterized by recurring seizures.

Pharmacological treatment can control but not cure epilepsy.

Status epilepticus is a medical [blank_start]emergency[blank_end].

[blank_start]Generalized[blank_end] – no evidence of localized onset  [blank_start]Absence[blank_end] – 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  [blank_start]Tonic-clonic[blank_end] – 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  [blank_start]Tonic[blank_end] – increased tone of all muscles  [blank_start]Atonic[blank_end] – sudden loss of postural tone  [blank_start]Myoclonic[blank_end] – muscles spasm and limbs jerk; contractions and relaxations repeat rapidly

[blank_start]Focal (partial)[blank_end] – seizure initiates in a specific site  [blank_start]Secondarily generalized[blank_end] – focal seizure precedes a generalized tonic-clonic seizure  [blank_start]Simple[blank_end] – minimal spread within brain; often clonic jerking, no diminished awareness, 20-60 sec duration  [blank_start]Complex[blank_end] – localized onset but discharge spreads; alteration of consciousness (but not unconscious), automatisms (integrated motor behavior, e.g. lip smacking, button picking)

Classify the following seizures:  [blank_start]Generalized Tonic-Clonic Seizure[blank_end]: “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.”  [blank_start]Generalized Absence Seizure[blank_end] "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.”  [blank_start]Secondary Generalization Focal Seizure[blank_end] "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.”

What are the goals of therapy with anti-epileptics? Improve [blank_start]quality of life[blank_end] by:  Controlling [blank_start]seizures[blank_end]  Rarely are seizures eliminated; even occasional seizures are still a concern for patients  Minimizing [blank_start]adverse effects[blank_end]  Usually lifelong treatment

Which anti-epileptic drugs have the following mechanism of action? Inhibit voltage dependent Na+ channels

Which anti-epileptic drugs have the following mechanism of action? Inhibit glutamate receptors

Which anti-epileptic drugs have the following mechanism of action? Modulate glutamate release (putative)

Which anti-epileptic drugs have the following mechanism of action? Increase inhibitory neurotransmission  Enhance GABA-A activity (positive allosteric modulation)

Which anti-epileptic drugs have the following mechanism of action? Inhibit T-type Ca2+ channels  Depolarization of thalamic neurons activates cortical neurons

In a normal neuron (A), excitation and inhibition are [blank_start]balanced[blank_end] Neurons susceptible to seizure activity show [blank_start]decreased[blank_end] inhibition (B) or [blank_start]increased[blank_end] excitation (C) (D) [blank_start]Increasing[blank_end] GABA activity can [blank_start]decrease[blank_end] seizure activity in both situations (D) Similarly, [blank_start]decreasing[blank_end] Glutamate activity can also [blank_start]decrease[blank_end] seizure activity

Block voltage-activated calcium channels − Neurons in thalamus are dependent on calcium channel [blank_start]pacemaker[blank_end] currents for depolarization − Blocking these channels slows the [blank_start]pacemaker[blank_end] − Depolarization of [blank_start]thalamic[blank_end] neurons activates [blank_start]cortical[blank_end] neurons

Which four of the following are drugs of choice for Focal Epileptic Seizures?

Which five of the following are alternative drugs for Focal Epileptic Seizures?

Which three of the following are drugs of choice for Primary GTC Seizures?

Which two of the following are alternative drugs for Primary GTC Seizures?

Which two of the following are drugs of choice for Absence Seizures?

Which two of the following are alternative drugs for Absence Seizures?

Which five of the following are some of the adverse effects of Phenytoin?

Which six of the following are some of the adverse effects of Phenytoin?

Which five of the following are some of the adverse effects of Carbamazepine and Oxcarbazepine?

Which five of the following are some of the adverse effects of Carbamazepine and Oxcarbazepine?

Which six of the following are some of the adverse effects of Valproate?

Which six of the following are some of the adverse effects of Valproate?

Which four of the following are the adverse effects of Ethosuximide?

Which four of the following are the adverse effects of Phenobarbital?

Which three of the following are the adverse effects of Clonazepam?

Which six of the following are the adverse effects of Lamotrigine?

Which six of the following are the adverse effects of Topiramate?

Which three of the following are the adverse effects of Gabapentin and Pregabalin?

Which four of the following are the adverse effects of Levetiracetam?

Which two of the following are the adverse effects of Felbamate?

Which of the following are the drug-drug interactions of Phenytoin?

Which of the following are the drug-drug interactions of Valproate?

Which of the following are the drug-drug interactions of Ethosuximide?

Which of the following are the drug-drug interactions of Phenobarbital?

Which of the following are the drug-drug interactions of Clonazepam?

Which of the following are the drug-drug interactions of Lamotrigine?

Which of the following are the drug-drug interactions of Lamotrigine?

Which of the following are the drug-drug interactions of Gabapentin, Levetiracetam, and Pregabalin?

Which of the following are the drug-drug interactions of Carbamazepine?

Which of the following statements are true for Phenytoin?

Which of the following statements are true for Carbamazepine?

Which of the following statements are true for Valproate?

Which of the following statements are true for Phenobarbital?

Which of the following statements are true for Lamotrigine?

Which of the following statements are true for Topiramate?

Which of the following statements are true for Levetiracetam?

Principles of AED Therapy  Choose monotherapy agent on basis of seizure [blank_start]type[blank_end] (or epilepsy syndrome if known) & patient-specific considerations (usually [blank_start]adverse effect[blank_end] profile)  Increase to [blank_start]usual[blank_end] effective dose or to a serum level within the therapeutic range  If seizures not controlled - increase gradually to [blank_start]maximal[blank_end] tolerated dose (MTD) = highest dose a patient can tolerate without bothersome adverse effects  If monotherapy fails, choose alternate monotherapy agent and repeat process  If monotherapy fails with several drugs, try [blank_start]adjuvant therapy[blank_end]  Concern is management of [blank_start]adverse effects[blank_end] of two drugs

Which of the following drugs reduce blood levels of contraceptive hormone?

Antiepileptics are [blank_start]gradually[blank_end] increased to therapeutic concentrations to minimize [blank_start]adverse effects[blank_end] and are withdrawn [blank_start]gradually[blank_end] to reduce the risk of inducing [blank_start]seizures[blank_end].

 Enhanced vitamin [blank_start]D[blank_end] metabolism can cause osteomalacia (phenytoin, phenobarbital)  Enhanced vitamin [blank_start]K[blank_end] metabolism can cause bleeding disorders (phenytoin, phenobarbital)  Many anti-epileptics enhance [blank_start]metabolism[blank_end] of other anti-epileptics (phenytoin, carbamazepine, phenobarbital)  [blank_start]Valproate[blank_end] inhibits metabolism of some anti-epileptics

Pregnancy  Teratogenicity: Valproate, phenobarbital, phenytoin, carbamazepine  Prefer [blank_start]lamotrigine[blank_end] (or levetiracetam, oxcarbazepine)  Can increase drug metabolism, which can [blank_start]reduce[blank_end] seizure control  Need to switch drugs or increase dose?

Hepatic disease  Avoid [blank_start]hepatotoxic[blank_end] antiepileptic drugs (e.g., valproate) when possible  Monitor free (unbound) levels of phenytoin, valproate when [blank_start]albumin[blank_end] low

Which of the following are contraindications / precautions for Phenytoin?

Which of the following are contraindications / precautions for Carbamazepine?

Which of the following are contraindications / precautions for Valproate?

Which of the following are contraindications / precautions for Phenobarbital?

Which of the following are contraindications / precautions for Clonazepam?