Introduction to Seizures and Epilepsy
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Questions and Answers

Which of the following statements about benzodiazepines is true?

  • Benzodiazepines have a favorable teratogenic potential for pregnant women. (correct)
  • Benzodiazepines are first-line treatments for all types of seizures.
  • Benzodiazepines are preferred over barbiturates for managing seizures. (correct)
  • Benzodiazepines can cause medullary depression and coma at high doses.

What is a key characteristic of the drug Perampanel?

  • It causes significant medullary depression.
  • It is a type of benzodiazepine.
  • It is a first-line treatment for generalized seizures.
  • It is primarily an AMPA antagonist. (correct)

What might be a consequence of barbiturate overdose?

  • Lesser risk of respiratory depression compared to benzodiazepines.
  • Agitation and anxiety.
  • Medullary depression leading to respiratory arrest. (correct)
  • Increased activity level and hyperactivity.

Which drug is noted for having no significant drug interactions?

<p>Levetiracetam (D)</p> Signup and view all the answers

Which medications are categorized under the 'L medicines' suitable for pregnant women?

<p>Levetiracetam and Lacosamide (A)</p> Signup and view all the answers

What is the effect of AMPA/Kainate receptor antagonists on neurotransmission?

<p>Decrease fast excitatory neurotransmission (C)</p> Signup and view all the answers

How do NMDA receptor antagonists primarily affect excitatory neurotransmission?

<p>They decrease slow excitatory neurotransmission (C)</p> Signup and view all the answers

What is the role of SV2A protein ligands regarding neurotransmitter release?

<p>Decrease neurotransmitter release (C)</p> Signup and view all the answers

Which of the following drugs is associated with a suppressive effect on burst action potentials?

<p>Cenobamate (CNB) (C)</p> Signup and view all the answers

Which drug is classified as a calcium channel inhibitor?

<p>Gabapentin (GBP) (D)</p> Signup and view all the answers

Which effect is characteristic of positive modulation of potassium channels?

<p>Hyperpolarizes membrane potentials (B)</p> Signup and view all the answers

Which of the following is NOT an effect associated with Felbamate (FBM)?

<p>Activation of AMPA receptors (B)</p> Signup and view all the answers

What is a common side effect associated with the use of oxcarbazepine?

<p>Weight gain (B)</p> Signup and view all the answers

Which pharmacokinetic property is unique to lacosamide compared to other anti-seizure medications?

<p>Renal excretion (C)</p> Signup and view all the answers

In patients with cardiac conditions, which medication should be avoided due to the risk of prolonging the PR interval?

<p>Lacosamide (B)</p> Signup and view all the answers

What is the mechanism of action of oxcarbazepine?

<p>Fast sodium channel inhibitor (C)</p> Signup and view all the answers

What dosage is typically recommended for children using lacosamide?

<p>6-8 mg/kg (B)</p> Signup and view all the answers

Which of the following best describes the half-life of oxcarbazepine?

<p>1-5 hours (A)</p> Signup and view all the answers

What is a notable advantage of oxcarbazepine in terms of dosing compared to carbamazepine?

<p>Can be titrated upward at a more rapid rate (A)</p> Signup and view all the answers

Which metabolite is produced from oxcarbazepine?

<p>Eslicarbazepine (C)</p> Signup and view all the answers

Which condition can oxcarbazepine exacerbate in patients?

<p>Myoclonic seizures (B)</p> Signup and view all the answers

What is the favorable teratogenic profile of oxcarbazepine?

<p>Safe for use in pregnancy (C)</p> Signup and view all the answers

What is a characteristic of Gabapentin's absorption?

<p>It displays a dose-related absorption. (C)</p> Signup and view all the answers

Which anticonvulsants are known to be ionized in serum?

<p>Valproate, Gabapentin, Pregabalin (B)</p> Signup and view all the answers

How does protein binding influence drug distribution?

<p>Low protein binding allows for more free drug distribution. (A)</p> Signup and view all the answers

Which drugs are exceptions that undergo extensive metabolism?

<p>Gabapentin, Pregabalin, and Levetiracetam (A)</p> Signup and view all the answers

What is a primary characteristic of therapeutic drug monitoring?

<p>It takes into account factors such as sex, age, and comorbidities. (B)</p> Signup and view all the answers

Which anticonvulsants have >90% protein binding?

<p>Valproate, Phenytoin, and Carbamazepine (B)</p> Signup and view all the answers

Which drug is recognized as an inhibitor in the context of enzyme induction?

<p>Valproic acid (B)</p> Signup and view all the answers

What general rule is followed regarding the dosing of anticonvulsants?

<p>Initiate treatment at lower doses and titrate slowly. (C)</p> Signup and view all the answers

Which drug acts as a Slow Sodium Channel Inhibitor?

<p>Lamotrigine (D)</p> Signup and view all the answers

What common adverse drug reaction is associated with Gabapentin and Pregabalin?

<p>Somnolence (A)</p> Signup and view all the answers

Which drug is recommended as first-line for focal seizures?

<p>Lamotrigine (A)</p> Signup and view all the answers

What is the half-life of Pregabalin?

<p>15-60 hours (C)</p> Signup and view all the answers

What is the maximum daily dose for adults taking Gabapentin?

<p>3,600 mg (A)</p> Signup and view all the answers

Which condition is NOT indicated for Gabapentin as first-line treatment?

<p>Generalized seizures (D)</p> Signup and view all the answers

What is an important risk factor associated with Pregabalin use?

<p>HLA-B*1502 Haplotype (B)</p> Signup and view all the answers

Which symptom is a potential side effect of Gabapentin and Pregabalin?

<p>Ataxia (A)</p> Signup and view all the answers

What characterizes the pharmacokinetics of the medication linked to Glu release and SV2A?

<p>Nonlinear pharmacokinetics with a narrow therapeutic index (D)</p> Signup and view all the answers

Which of the following is a potential adverse drug reaction associated with Carbamazepine?

<p>Severe rash indicating risk of SJS-TEN (D)</p> Signup and view all the answers

Which condition is Carbamazepine primarily indicated for?

<p>First-line treatment for focal seizures (D)</p> Signup and view all the answers

Which factor primarily influences the pharmacokinetics of the medication related to GABA?

<p>Formulation and binding to albumin (D)</p> Signup and view all the answers

For pediatric patients, what is the recommended dosing range of the GABA-enhancing medication?

<p>20-30 mg/kg (A)</p> Signup and view all the answers

What is a significant side effect of Phenytoin that necessitates careful monitoring?

<p>Hyponatremia due to water retention (C)</p> Signup and view all the answers

Which mechanism underlies the action of Barbiturates and Benzodiazepines in relation to GABA?

<p>Activating GABA receptors (A)</p> Signup and view all the answers

What should be done if a patient develops a rash while taking Carbamazepine?

<p>Immediately stop the medication (B)</p> Signup and view all the answers

Flashcards

Valproic Acid (VPA)

A drug that modulates glutamate release and inhibits calcium entry, thereby suppressing neuronal activity.

AMPA/Kainate Receptor Antagonists

These drugs decrease fast excitatory neurotransmission and focal firing.

Eslicarbazepine (ESL)

A drug that's classified as an AMPA/Kainate Receptor Antagonist.

Rufinamide (RFM)

A drug that's classified as an AMPA/Kainate Receptor Antagonist.

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Zonisamide (ZNS)

A drug that's classified as an AMPA/Kainate Receptor Antagonist.

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Cenobamate (CNB)

A drug that's classified as an AMPA/Kainate Receptor Antagonist.

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Slow inactivation drugs

Drugs that slow down the deactivation of neurons.

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Lacosamide (LCM)

A drug categorized as a 'slow inactivation' drug

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Positive modulation of K⁺

This increases potassium ion levels, which often leads to hyperpolarization and reduction in neuronal firing.

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NMDA Receptor Antagonists

These drugs decrease slow excitatory neurotransmission and excitatory amino acid neurotoxicity.

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Felbamate (FBM)

A drug classified as an NMDA Receptor Antagonist.

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SV2A Protein Ligand

Drugs acting on this protein have an unknown effect on neurotransmitter release, potentially decreasing it.

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Levetiracetam (LEV)

A drug that is a SV2A Protein Ligand.

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Brivaracetam (BRV)

A drug that is a SV2A Protein Ligand.

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Ethosuximide (ESM)

A drug that inhibits calcium entry, affecting slow depolarization and spike-wave discharges.

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Lamotrigine (LTG)

A drug that inhibits calcium entry and may modulate glutamate release.

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Gabapentin (GBP)

A drug that likely inhibits calcium entry, slowing neuronal activity.

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SV2A

A protein that plays a role in the release of Glu (glutamate).

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Nonlinear Pharmacokinetics

Drug's effect on the body isn't proportional to the dosage change.

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Narrow Therapeutic Index

Small difference between therapeutic and toxic dosages.

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Zero-Order Kinetics

Drug elimination rate is constant, regardless of drug concentration.

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Carbamazepine (CBZ)

Fast sodium channel inhibitor used for focal seizures.

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First-line treatment for focal seizures

Drug chosen as the first treatment option.

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GABA

Inhibitory neurotransmitter in the brain.

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Tiagabine

Drug that reduces GABA reuptake.

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Viagabrin

Drug that decreases GABA breakdown.

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Phenytoin (Dilantin)

Fast sodium channel inhibitor for seizures (various).

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Half-life (Carbamazepine)

Time it takes for half of a drug to be eliminated from the body.

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Adverse Drug Reaction (ADR)

Negative effect of a medication.

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SJS-TEN

Severe skin reaction.

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HLA-B*1502

Genetic marker associated with increased risk of SJS.

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Titrate Slowly

Gradually increasing dosage for monitoring.

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Water Retention - Hyponatremia

Drug-induced fluid retention causing a decrease in blood sodium.

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Oxcarbazepine

A fast sodium channel inhibitor used to treat focal and unknown onset seizures.

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Lactosamide

A slow sodium channel inhibitor used to treat focal and status epilepticus.

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Oxcarbazepine Half-life

1-5 hours.

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Lactosamide Half-life

13 hours.

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Oxcarbazepine Dose (Children)

10-40 mg/kg.

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Oxcarbazepine Dose (Adults)

900-2400 mg/day.

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Lactosamide Dosage (Children)

6-8 mg/kg.

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Lactosamide Dose (Adults)

300-400 mg/day.

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Oxcarbazepine ADR

Similar to Carbamazepine; Some weight gain reported.

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Lactosamide ADR

Avoid in cardiac patients; potential for headache, diplopia, dizziness, and ataxia

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Oxcarbazepine Advantages

Faster titration, less hepatic enzyme induction.

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Lactosamide Advantages

Limited pharmacokinetic interactions, renal excretion, available IV.

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Oxcarbazepine Metabolite

Eslicarbazepine.

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Oxcarbazepine Drug Classification

Fast Sodium Channel Inhibitor (Second-generation).

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Lactosamide Drug Classification

Slow Sodium Channel Inhibitor.

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Oxcarbazepine Indication

First-line for focal and unknown onset seizures, third-line for generalized motor seizures.

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Lactosamide Indication

First-line for focal seizures and unknown onset seizures, useable for status epilepticus.

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Diazepam metabolite

Nordiazepam

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Barbiturates vs. Benzodiazepines

Barbiturates can cause significant respiratory depression (coma), while Benzodiazepines do not cause this.

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Benzodiazepines' safety in pregnancy

Generally considered safer for pregnant women than other medications.

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Barbiturate overdose symptom

Coma and medullary depression (potentially respiratory arrest).

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Perampanel Drug Class

AMPA antagonist

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Perampanel Indications

Second-line for focal and unknown onset seizures. Third-line for generalized/myoclonic seizures.

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L-medicines

Lamotrigine, Levetiracetam, and Lacosamide. Often used in pregnancy because they are typically associated with favorable teratogenic potential, not as risky as others.

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Gabapentin Mechanism

Slows sodium channels and regulates neuronal excitability, impacting calcium channels.

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Pregabalin Mechanism

A type of L-type calcium channel blocker that works through α2δ-1 receptors, regulating neuronal excitability.

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Lamotrigine Mechanism

Inhibits sodium channels to regulate neuronal excitability, impacting calcium channels. Considered first-line for focal/unknown onset seizures.

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Gabapentin Dose (Adults)

900-3,600 mg/day

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Pregabalin Dose (Adults)

150-600 mg/day

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Gabapentin Half-life

5-7 hours

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Pregabalin Half-life

15-60 hours(doubles with valproate)

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Lamotrigine Half-life

Unknown/Not stated

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Anticonvulsants First-line

Lamotrigine, recommended for focal, unknown onset seizures.

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Anticonvulsants Side effect

Somnolence, dizziness, ataxia, and fatigue. Increased risk SJS-TEN (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis) related to HLA-B*1502.

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Gabapentin Absorption

Gabapentin is absorbed extensively, and its bioavailability is high. Absorption is dose-dependent (increases with higher doses).

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ASM Lipid Solubility

Many anti-seizure medicines (ASMs) are lipid-soluble, allowing them to cross the blood-brain barrier (BBB) and be widely distributed throughout the body.

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Valproate, Gabapentin, and Pregabalin Ionization

Valproate, gabapentin, and pregabalin are ionized in the blood, and their distribution depends strongly on transport mechanisms.

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Anticonvulsant Medication Choice

The best anti-seizure medicine and the right dose depend on factors like patient sex, age, other medications, and pre-existing medical conditions (physical and mental health).

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Protein Binding & Side Effects

The amount of a drug that's attached to proteins in the blood affects the amount of free drug available to act on its target. Higher protein binding can mean fewer side effects.

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Extensive Anticonvulsant Metabolism

Most anti-seizure medications, except a few, are extensively metabolized, mainly by the liver enzymes CYP450 (phase 1) and UGT (phase 2).

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Exceptions to Anticonvulsant Metabolism

Levetiracetam, pregabalin, and gabapentin are exceptions, being primarily excreted by the kidneys without significant metabolism in the liver.

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Anticonvulsant Drug Inducers/Inhibitors

Some drugs can speed up the breakdown of other drugs (inducers), while others can slow it down (inhibitors). This is important to know when combining medications.

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Study Notes

Introduction to Seizures and Epilepsy

  • Seizures are transient symptoms caused by excessive or synchronous neuronal activity, potentially due to infections, conditions like
    • An imbalance in electrolytes - WEIRD transmitting electrical signals in the nervous system. Other underlying conditions that may lead to seizures include metabolic disorders, head injuries, or brain tumors.
  • Epilepsy is characterized by at least two unprovoked seizures occurring more than 24 hours apart. Unprovoked indicates the seizure wasn't triggered by a known cause like fever.

Anti-Seizure Medications

  • Anti-seizure medications (ASMs) function through various mechanisms, including inhibition of voltage-gated channels, enhancement of GABA synaptic transmission, and modulation of glutamate release. Specific ASMs influence GABA-A receptors, glutamate release, or sodium channels.
  • Several drugs are listed and categorized in this study resource.

Epilepsy Types

  • Focal seizures affect only one brain hemisphere.
  • Generalized seizures involve both hemispheres.
  • Myoclonic seizures involve sudden, jerking, involuntary movements.
  • Absence seizures cause brief loss of awareness and consciousness.

Seizure Generation

  • Excitatory neurotransmitter glutamate plays a critical role.
  • Inhibitory neurotransmitter GABA helps control neuronal activity

Neurotransmitter Flow

  • Glutamate is the primary excitatory neurotransmitter.
  • GABA is the primary inhibitory neurotransmitter.
  • Astrocytes are important in regulating glutamate levels in the synapse.

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Description

This quiz covers the basics of seizures and epilepsy, including definitions, types of seizures, and classifications. It also explores anti-seizure medications and their mechanisms of action. Test your knowledge on this important neurological topic.

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