92 Questions
Which mechanism of action is NOT associated with anti-epileptic drugs?
Activation of ionotropic glutamate receptors
How do anti-epileptic drugs enhance GABA neurotransmission?
All of the above
Which protein do anti-epileptic drugs act on to modulate synaptic release?
SV2A
Which type of brain waves are associated with intense mental activity or fright?
Beta waves
Which electrolyte disorder can cause seizures?
Hypomagnesemia
Which type of seizure is characterized by a clouding of consciousness and strange, repetitious movements?
Complex partial seizure
Which condition is characterized by recurrent seizures and can have multiple underlying causes?
Epilepsy
Which type of seizure is also known as grand mal seizure and involves synchronous firing from all areas of the brain?
Generalized tonic-clonic seizure
Which factor can cause seizures?
CNS stimulant drugs
Which age group is absence seizure most commonly seen in?
Adolescents
Which type of seizure is characterized by lip-smacking and chewing automatisms?
Complex partial seizure
Which condition can be a potential underlying cause of epilepsy?
Stroke
Which brain activity is promoted by surgical anesthesia?
Delta waves
Which type of seizure originates in a discrete region of the brain and can develop into a generalized seizure?
Focal seizure
Which type of seizure is characterized by a momentary loss of consciousness and is not accompanied by auras or postictal periods?
Absence seizure
What can cause focal seizures?
All of the above
Which type of seizure is associated with widespread electrical activity involving both hemispheres simultaneously?
Generalized seizure
What is the postictal period?
The time from after the seizure to normal brain activity
Which type of seizure is characterized by lip-smacking and chewing automatisms?
Complex partial seizure
What is an aura preceding a seizure?
Light sensitivity
What is the term for nonconvulsive generalized seizures characterized by a momentary loss of consciousness?
Absence seizures
What can focal seizures develop due to?
All of the above
Which age group is typically affected by absence seizures?
Teenagers
Which genetic mutations can cause childhood absence epilepsy?
All of the above
Which type of seizure is precipitated by certain events like loud noises or flashing lights?
Primary generalized seizure
Which brain regions are involved in the rapid spread of generalized seizures?
Thalamus and cortex
What is the characteristic feature of generalized tonic-clonic seizures?
Post-seizure depression
What is the term used for the loss of control of visceral organ functions during a generalized tonic-clonic seizure?
Micturition
Which type of seizure is characterized by a clouding of consciousness and strange, repetitious movements?
Complex partial seizures
Which neurotransmitter receptor mutation can cause childhood absence epilepsy?
GABA receptor (GABRB3)
What is the term used for the former name of generalized tonic-clonic seizures?
Grand mal seizures
Which condition can lead to hyponatremia(low sodium level)?
Polydipsia
What is the major clinical manifestation of potassium disorders?
Muscle weakness
Which type of electrolyte disturbances are more likely to cause seizures?
Rapidly evolving
When should an electrolyte panel be done in patients with a first-time seizure?
Immediately
What can cause seizures to occur?
Water moving into neuronal cells
Which type of seizure may or may not cause the person to lose consciousness?
Focal seizure
What should focal seizures not be confused with?
Migraine headache
Which type of seizures have a high discharge rate due to localized reverberating circuits?
Focal seizures
What is the term for nonconvulsive generalized seizures characterized by a momentary loss of consciousness?
Absence seizures
Which neurotransmitter is the principal inhibitory brain neurotransmitter?
GABA
What is the principal excitatory brain neurotransmitter?
Glutamate
What is the overall mechanistic strategy of neurotransmitters in relation to seizure threshold?
To increase seizure threshold
Which type of channels are opened through increased GABA binding?
Chloride channels
What are the voltage-gated sodium and calcium antagonists used for?
Increasing seizure threshold
What is the mechanism of reuptake inhibitors for GABA and blocking GABA metabolism?
Increasing seizure threshold
Which part of the brain can Jacksonian seizures originate from?
Primary motor cortex
What is the characteristic progression pattern of Jacksonian seizures?
From fingers to the entire hand and arm/leg
What is the term used to describe the tonic and clonic contraction pattern of Jacksonian seizures?
Tonic-clonic contraction
Which direction do the head and eyes typically turn during a Jacksonian seizure?
Towards the convulsing side
Which type of ion channels do anti-epileptic drugs target to decrease seizure incidence?
Voltage-gated sodium and calcium channels
Which method of treatment for seizures involves opening chloride channels and inducing hyperpolarization of post-synaptic neurons?
Enhancing GABA neurotransmission
Which type of calcium channels are inhibited by ethosuximide?
T-type Ca2+ channels
What is the clinical indication for ethosuximide?
Management of absence seizures
Which type of neurons have hyperactive T-type Ca2+ channels?
Post synaptic neurons
What is the effect of ethosuximide on thalamocortical activity?
Decreases activity
Which type of muscle cells have L-type calcium channels?
Both smooth and cardiac muscle cells
What is the primary adverse effect of ethosuximide?
All of the above
What effect does ethosuximide have on seizure threshold?
Increases seizure threshold
What is the mechanism of action of ethosuximide?
Inhibition of T-type calcium channels
What is the volume of distribution of ethosuximide?
Low volume of distribution
What is the half-life of ethosuximide?
50-60 hours
Phenytoin is effective against which types of seizures?
Focal and tonic-clonic seizures
What is the mechanism of action (MOA) of phenytoin?
Slows the rate of recovery of voltage-gated sodium channels
What is the major adverse effect associated with chronic phenytoin treatment?
All of the above
What percentage of phenytoin is bound to albumin?
Around 90%
What is the elimination order of phenytoin at high concentrations?
Zero-order
What is the primary enzyme responsible for metabolizing phenytoin in the liver?
Hepatic CYPs
Which type of calcium channels are hyperactive in the absence of ethosuximide?
L-type calcium channels
What effect does ethosuximide have on T-type calcium channels?
Ethosuximide blocks T-type calcium channels
How does ethosuximide affect the activity in the corticothalamic pathway?
Ethosuximide decreases activity in the corticothalamic pathway
What is the consequence of hyperactive T-type calcium channels?
Increased glutamate release in the cortex
What effect does ethosuximide have on the seizure threshold?
Ethosuximide increases the seizure threshold
Which type of seizures can be treated with valproate?
All of the above
What is the mechanism of action of valproate?
All of the above
Which enzymes are involved in the metabolism of valproate?
Phase II conjugation and beta-oxidation
Which adverse effects are associated with valproate?
All of the above
Which drugs bind to the Ca2+ channel subunit α2δ1 and block voltage-gated calcium channels?
Gabapentin and pregabalin
What is the mechanism of action of gabapentin and pregabalin in the treatment of seizures?
Blocking voltage-gated calcium channels and increasing seizure threshold
Which benzodiazepines can be used to treat seizures?
Clonazepam, diazepam, lorazepam
What is the primary adverse effect associated with chronic use of benzodiazepines for seizures?
Tolerance development
Which factor determines the proper medical treatment for a patient with a seizure?
The patient's medical history
In which situation should a patient not be given chronic treatment of an anti-epileptic?
If the patient had a seizure due to alcohol withdrawal
What is the most common treatment approach for seizures?
Using a single agent
When will a second agent be added for seizure treatment?
When the patient is not properly controlled
What is the main mechanism of action for most anti-epileptic drugs?
Inhibiting voltage-gated sodium channels
How do anti-epileptic drugs decrease glutamate release?
By blocking calcium channels
What effect do anti-epileptic drugs have on GABA neurotransmission?
They enhance GABA neurotransmission
What is the role of GABA neurotransmission in relation to seizures?
It increases seizure threshold
Which type of channels do benzodiazepines increase the frequency of opening?
GABA type A channels
What is the effect of benzodiazepines on the membrane potential?
Make it more negative
Why are benzodiazepines given for acute events rather than chronically?
To prevent tolerance development
Study Notes
Mechanisms of Anti-Epileptic Drugs
- Not associated with anti-epileptic drugs: increasing the activity of the neurotransmitter aspartate
- Enhancement of GABA neurotransmission: increasing the activity of GABA, which is the principal inhibitory brain neurotransmitter
- Target of anti-epileptic drugs: GABA receptors and voltage-gated sodium and calcium channels
- Chloride channels are opened through increased GABA binding
Types of Seizures
- Associated with intense mental activity or fright: beta brain waves
- Characterized by a clouding of consciousness and strange, repetitious movements: complex partial seizures
- Also known as grand mal seizure, involves synchronous firing from all areas of the brain: generalized tonic-clonic seizures
- Can cause seizures: electrolyte disturbances, infection, head trauma
- Most commonly seen in: absence seizures in children
- Characterized by lip-smacking and chewing automatisms: complex partial seizures
- Can be a potential underlying cause of epilepsy: genetics, head trauma, infection, stroke
Brain Activity and Seizures
- Promoted by surgical anesthesia: delta brain waves
- Can develop into a generalized seizure: focal seizures
- Characterized by a momentary loss of consciousness and is not accompanied by auras or postictal periods: absence seizures
- Focal seizures can develop due to: scarring, tumor, infection
- Can cause focal seizures: scarring, tumor, infection
- Generalized seizures: widespread electrical activity involving both hemispheres simultaneously
Epilepsy and Seizures
- Condition characterized by recurrent seizures and multiple underlying causes: epilepsy
- Postictal period: period of confusion, disorientation, and fatigue following a seizure
- Characterized by lip-smacking and chewing automatisms: complex partial seizures
- Aura preceding a seizure: strange sensation or smell that warns of an impending seizure
- Term for nonconvulsive generalized seizures characterized by a momentary loss of consciousness: absence seizures
- Genetic mutations that can cause childhood absence epilepsy: genes that code for GABA receptor subunits and T-type calcium channels
Anti-Epileptic Drugs
- Target of ethosuximide: T-type calcium channels
- Mechanism of action of ethosuximide: blocking T-type calcium channels and reducing thalamocortical activity
- Clinical indication for ethosuximide: absence seizures
- Phenytoin is effective against: partial and generalized tonic-clonic seizures
- Mechanism of action of phenytoin: blocking voltage-gated sodium channels
- Valproate is effective against: absence, partial, and generalized tonic-clonic seizures
- Mechanism of action of valproate: increasing GABA levels and blocking voltage-gated sodium channels
- Gabapentin and pregabalin mechanism of action: increasing GABA levels and binding to the Ca2+ channel subunit α2δ1
Test your knowledge on the mechanisms of action (MOAs) for anti-epileptic drugs. Learn about how these drugs modulate cation channels, enhance GABA neurotransmission, inhibit GABA reuptake, and more. Challenge yourself with questions on the MOAs of anti-epileptics and enhance your understanding of these important medications.
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