Status Epilepticus Medications Quiz
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Which mechanism is involved in the action of some anti-seizure drugs that prolong the inactivation of Na+ channels?

  • Inhibiting brain carbonic anhydrase enzyme
  • Blocking Ca++ currents
  • Increasing glutamate synaptic activity
  • Enhancing GABA-mediated neuronal inhibition (correct)

    • What is the role of NMDA receptor antagonists in the context of anti-seizure drugs?

  • Inactivating voltage-gated Na+ channels
  • Enhancing GABA-mediated neuronal inhibition
  • Blocking Ca++ currents
  • Increasing glutamate synaptic activity (correct)

    • How do some AEDs act on voltage-gated Na+ and Ca++ currents?

  • By inhibiting AMPA/kainate receptors
  • By enhancing glutamate synaptic activity
  • By blocking both currents (correct)
  • By increasing GABA re-uptake in neurons

    • What effect do AEDs that inhibit brain carbonic anhydrase enzyme have on neurons?

    <p>Increase Na+ channel inactivation</p> Signup and view all the answers

    Which combination of mechanisms do some anti-seizure drugs act through?

    <p>Enhancing GABA-mediated inhibition and increasing glutamate activity</p> Signup and view all the answers

    What is the initial therapy of choice for status epilepticus?

    <p>Lorazepam IV</p> Signup and view all the answers

    Which medication is recommended as the second therapy of choice for status epilepticus?

    <p>Fosphenytoin IV</p> Signup and view all the answers

    Why do neuromuscular blocking agents not stop seizures in status epilepticus?

    <p>They only affect the muscular response, not the brain's electrical activity</p> Signup and view all the answers

    What can happen when patients on chronic anticonvulsant therapy take drugs that are highly protein bound?

    <p>Increased plasma concentrations of AED medications</p> Signup and view all the answers

    Which side effects are considered dose-related in antiepileptic drugs?

    <p>Dizziness and ataxia</p> Signup and view all the answers

    How do antiepileptic drugs exert their anticonvulsant activity?

    <p>By modulating the brain's electrical activity</p> Signup and view all the answers

    What is the primary mechanism of action for oxcarbazepine?

    <p>It is primarily converted to its pharmacologically active 10-monohydroxy metabolite (MHD)</p> Signup and view all the answers

    What is a common adverse effect associated with chronic valproate therapy?

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

    What is the recommended monitoring for patients on valproate therapy?

    <p>Liver function tests</p> Signup and view all the answers

    Which of the following is a non-dose-related adverse effect of valproate?

    <p>Rash</p> Signup and view all the answers

    Why is valproate contraindicated in pregnancy?

    <p>It can increase the risk of neural tube defects in the fetus</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with chronic administration of phenobarbital?

    <p>Increased appetite</p> Signup and view all the answers

    What is the mechanism of action of ethosuximide in treating absence seizures?

    <p>It acts as a T-type calcium channel blocker in thalamic neurons.</p> Signup and view all the answers

    Which of the following is NOT a clinical use of valproate sodium or valproic acid?

    <p>Treatment of generalized anxiety disorder</p> Signup and view all the answers

    What is the primary route of metabolism for valproate sodium or valproic acid?

    <p>Hepatic UGT enzymes</p> Signup and view all the answers

    Which of the following statements about primidone is TRUE?

    <p>It is metabolized into phenobarbital and phenylethylmalonamide (PEMA).</p> Signup and view all the answers

    What is the primary mechanism of action of valproate sodium or valproic acid in treating seizures?

    <p>Increasing GABA production and inhibiting GABA metabolism</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of ethosuximide is TRUE?

    <p>It has a bioavailability of 100% and is not protein bound.</p> Signup and view all the answers

    Which of the following is a potential drug-drug interaction associated with valproate sodium or valproic acid?

    <p>It may decrease the metabolism of drugs metabolized by UGT and CYP450 enzymes.</p> Signup and view all the answers

    What is the approximate half-life of valproate sodium or valproic acid?

    <p>8-17 hours</p> Signup and view all the answers

    Which of the following statements about the absorption of valproate sodium or valproic acid is TRUE?

    <p>It is a gastrointestinal irritant and enteric-coated dosage forms help decrease GI side effects.</p> Signup and view all the answers

    What is the mechanism of action for phenobarbital?

    <p>It binds to GABAA receptors and increases GABA-mediated chloride influx</p> Signup and view all the answers

    Which of the following is NOT a common adverse effect of phenytoin (Dilantin®)?

    <p>Agranulocytosis</p> Signup and view all the answers

    What is the primary advantage of fosphenytoin (Cerebyx®) over phenytoin?

    <p>All of the above</p> Signup and view all the answers

    Which of the following statements about carbamazepine (Tegretol®) is FALSE?

    <p>It is available as an oral and injectable formulation</p> Signup and view all the answers

    Which of the following statements about the interaction between phenytoin/carbamazepine and nondepolarizing neuromuscular blockers is TRUE?

    <p>All of the above</p> Signup and view all the answers

    Which of the following statements about phenobarbital is FALSE?

    <p>It has a short half-life of approximately 12 hours</p> Signup and view all the answers

    Which of the following statements about phenobarbital is TRUE?

    <p>All of the above</p> Signup and view all the answers

    Which of the following adverse effects is NOT associated with carbamazepine (Tegretol®)?

    <p>Fetal hydantoin syndrome</p> Signup and view all the answers

    What is the recommended rate of administration for the fosphenytoin loading dose?

    <p>No faster than 150 mg PE/min</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of carbamazepine is TRUE?

    <p>All of the above</p> Signup and view all the answers

    Oxcarbazepine undergoes auto-induction like carbamazepine.

    <p>False</p> Signup and view all the answers

    Lamotrigine is an inducer or inhibitor of the CYP450 enzyme system.

    <p>False</p> Signup and view all the answers

    Hyponatremia (SIADH) is more common with oxcarbazepine compared to carbamazepine.

    <p>True</p> Signup and view all the answers

    Levetiracetam belongs to the 'racetam' class of compounds and is available in both intravenous and oral formulations.

    <p>True</p> Signup and view all the answers

    Lamotrigine decreases the presynaptic release of inhibitory amino acids like GABA.

    <p>False</p> Signup and view all the answers

    Carbamazepine and oxcarbazepine are both sodium channel blockers with similar mechanisms of action.

    <p>True</p> Signup and view all the answers

    Valproic acid increases the metabolism and decreases the serum concentration of lamotrigine.

    <p>False</p> Signup and view all the answers

    The primary route of metabolism for valproate is via the liver's CYP450 enzymes.

    <p>False</p> Signup and view all the answers

    Oxcarbazepine is both an enzyme inducer of CYP3A4/5 and UGT, as well as an inhibitor of some CYP450 enzymes.

    <p>True</p> Signup and view all the answers

    Which mechanism of action involves enhancing GABA-mediated neuronal inhibition?

    <p>Inhibition of brain carbonic anhydrase enzyme</p> Signup and view all the answers

    What is the primary effect of agents that prolong the inactivation of Na+ channels?

    <p>Enhancing GABA-mediated neuronal inhibition</p> Signup and view all the answers

    Which type of drug is more likely to act through a combination of mechanisms?

    <p>AEDs inhibiting brain carbonic anhydrase enzyme</p> Signup and view all the answers

    What is the effect of inactivating either voltage-gated Na+ or Ca++ currents via blockade?

    <p>Reducing the ability of neurons to fire</p> Signup and view all the answers

    Which action is associated with AEDs that enhance Na+ channel inactivation?

    <p>Decreasing the likelihood of firing at high frequencies</p> Signup and view all the answers

    How do AEDs inhibiting brain carbonic anhydrase enzyme impact neuronal activity?

    <p>Reduction in neuronal excitability</p> Signup and view all the answers

    What is the primary mechanism of action of valproate sodium or valproic acid in treating seizures?

    <p>Increases GABA synthesis and inhibits GABA metabolism</p> Signup and view all the answers

    What is a common adverse effect associated with chronic valproate therapy?

    <p>Bone marrow suppression</p> Signup and view all the answers

    How do antiepileptic drugs exert their anticonvulsant activity?

    <p>By enhancing the activity of inhibitory neurotransmitters like GABA</p> Signup and view all the answers

    Which side effects are considered dose-related in antiepileptic drugs?

    <p>All of the above</p> Signup and view all the answers

    What will happen to the plasma concentrations of medications metabolized by UGT and CYP450 enzymes when co-administered with valproate sodium or valproic acid?

    <p>The plasma concentrations will increase due to enzyme inhibition</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of ethosuximide is TRUE?

    <p>Ethosuximide is primarily eliminated unchanged in the urine</p> Signup and view all the answers

    What is the mechanism of action of ethosuximide in treating absence seizures?

    <p>Reducing the flow of Ca2+ through T-type Ca2+ channels</p> Signup and view all the answers

    Which of the following statements about primidone is TRUE?

    <p>Primidone acts similarly to phenobarbital in its mechanism of action</p> Signup and view all the answers

    Which adverse effect is MORE COMMON with oxcarbazepine compared to carbamazepine?

    <p>Hyponatremia</p> Signup and view all the answers

    What is a potential cross-reactivity percentage of patients with hypersensitivity to carbamazepine that will have hypersensitivity to oxcarbazepine?

    <p>25-30%</p> Signup and view all the answers

    Which enzyme system is oxcarbazepine an inducer of?

    <p>3A4/5 and UGT</p> Signup and view all the answers

    What is the primary clinical use of lamotrigine?

    <p>Monotherapy in partial seizures</p> Signup and view all the answers

    Which drug decreases the serum concentration and half-life of lamotrigine?

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

    Which anti-seizure drug is known for causing fatal or life-threatening hypersensitivity reactions like Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)?

    <p>Lamotrigine</p> Signup and view all the answers

    What is the main adverse effect associated with levetiracetam at high doses?

    <p>Tremor</p> Signup and view all the answers

    What is the mechanism responsible for the nonlinear (Michaelis-Menten) pharmacokinetics of phenytoin at higher plasma concentrations?

    <p>Saturation of the enzymes involved in phenytoin metabolism</p> Signup and view all the answers

    Which of the following patient populations is likely to have a higher free (unbound) fraction of phenytoin in the plasma?

    <p>Patients with hypoalbuminemia</p> Signup and view all the answers

    Which of the following statements regarding phenytoin's pharmacokinetics is correct?

    <p>It exhibits saturable metabolism at plasma concentrations above 10 mcg/mL</p> Signup and view all the answers

    Which of the following adverse effects of phenytoin is most likely to be dose-related?

    <p>Ataxia</p> Signup and view all the answers

    What is the primary reason for phenytoin's potent enzyme-inducing effects?

    <p>It induces the synthesis of CYP450 enzymes</p> Signup and view all the answers

    Which of the following statements regarding the excretion of phenytoin is correct?

    <p>Only a small fraction (&lt;2%) of unchanged phenytoin appears in the urine</p> Signup and view all the answers

    Which of the following factors is least likely to affect the therapeutic range of phenytoin?

    <p>Renal function</p> Signup and view all the answers

    Which of the following statements regarding the pharmacokinetics of phenytoin is false?

    <p>Its half-life is dose-independent at all plasma concentrations</p> Signup and view all the answers

    Which statement about benzodiazepines is correct?

    <p>They potentiate GABA-mediated neuronal inhibition by binding to the benzodiazepine receptor site on GABAA receptors</p> Signup and view all the answers

    What is the primary mechanism of action for phenytoin (Dilantin®)?

    <p>Blocking fast sodium channels</p> Signup and view all the answers

    Which of the following statements about lorazepam is true?

    <p>It has a longer elimination half-life and longer duration of antiepileptic action than diazepam</p> Signup and view all the answers

    Which statement about the teratogenic effects of antiepileptic drugs (AEDs) is correct?

    <p>VPA is generally considered to have the highest incidence of teratogenic malformations and should be avoided during the first trimester of pregnancy</p> Signup and view all the answers

    Which statement about the classification of antiepileptic drugs (AEDs) is correct?

    <p>First generation agents include phenobarbital, primidone, phenytoin, valproate, and carbamazepine</p> Signup and view all the answers

    Which statement about diazepam is true?

    <p>It is more lipophilic than lorazepam</p> Signup and view all the answers

    How do some anti-seizure drugs enhance GABA synaptic transmission?

    <p>By reducing the metabolism of GABA while others act at the GABA-A receptor enhancing chloride influx</p> Signup and view all the answers

    Which statement about the metabolism of benzodiazepines is correct?

    <p>Lorazepam is metabolized in the liver but does not have active metabolites</p> Signup and view all the answers

    What is the duration criterion for a seizure to be classified as status epilepticus?

    <p>More than 30 minutes of either continuous seizure activity OR two or more sequential seizures without full recovery of consciousness between seizures</p> Signup and view all the answers

    What is considered a neurologic emergency that requires prompt treatment to prevent permanent neurologic damage?

    <p>Status epilepticus</p> Signup and view all the answers

    Which organ system can be significantly impacted when status epilepticus occurs due to its effect on ventilation?

    <p>Respiratory system</p> Signup and view all the answers

    What is the potential consequence when seizures last more than 30 to 60 minutes?

    <p>CNS damage</p> Signup and view all the answers

    Why is status epilepticus considered a neurologic emergency?

    <p>Due to the risks of permanent neurologic damage with prolonged seizures</p> Signup and view all the answers

    In what timeframe should treatment be initiated for status epilepticus?

    <p>Immediately to prevent permanent neurologic damage</p> Signup and view all the answers

    What is the mechanism by which some anti-seizure drugs enhance Na+ channel inactivation?

    <p>They prolong the inactivation of the Na+ channels, reducing the ability of neurons to fire at high frequencies.</p> Signup and view all the answers

    Which of the following statements accurately describes the mechanism of action of NMDA receptor antagonists?

    <p>They decrease glutamate synaptic activity.</p> Signup and view all the answers

    Which of the following mechanisms is NOT mentioned as a mode of action for anti-seizure drugs?

    <p>Inhibition of the brain's sodium-potassium ATPase pump.</p> Signup and view all the answers

    Which class of anti-seizure drugs acts by enhancing GABA reuptake?

    <p>GABA reuptake inhibitors</p> Signup and view all the answers

    What is the significance of the inactivated Na+ channel remaining open but blocked by the inactivation gate?

    <p>It allows for faster recovery of the channel once the drug is removed.</p> Signup and view all the answers

    Which of the following statements accurately describes the mechanism of action of AMPA/kainate receptor antagonists?

    <p>They decrease glutamate synaptic activity.</p> Signup and view all the answers

    What will happen to the plasma concentrations of medications metabolized by UGT and CYP450 enzymes when co-administered with valproate sodium or valproic acid?

    <p>Their plasma concentrations will increase due to enzyme inhibition</p> Signup and view all the answers

    Which anti-seizure drug has been associated with potentially fatal hypersensitivity reactions like Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)?

    <p>Carbamazepine</p> Signup and view all the answers

    How does valproate sodium or valproic acid enhance GABA-mediated neuronal inhibition?

    <p>By stimulating GABA synthesis and inhibiting GABA metabolism</p> Signup and view all the answers

    Which mechanism allows ethosuximide to specifically treat absence seizures?

    <p>Blockade of T-type calcium channels in thalamic neurons</p> Signup and view all the answers

    Which statement about the pharmacokinetics of primidone is TRUE?

    <p>It is metabolized to the active metabolites phenobarbital and PEMA</p> Signup and view all the answers

    What adverse effect is considered a serious but extremely rare side effect of ethosuximide?

    <p>Bone marrow suppression</p> Signup and view all the answers

    Which statement about the metabolism of oxcarbazepine is correct?

    <p>It is metabolized by the UGT enzyme system, which is a non-CYP450 pathway</p> Signup and view all the answers

    Which of the following adverse effects is more likely to occur with lamotrigine compared to carbamazepine?

    <p>Rash</p> Signup and view all the answers

    Which statement regarding the pharmacokinetics of lamotrigine is correct?

    <p>Its metabolism is decreased by carbamazepine, phenytoin, primidone, and phenobarbital</p> Signup and view all the answers

    Which of the following statements about levetiracetam (Keppra®) is correct?

    <p>It belongs to the 'racetam' class of compounds</p> Signup and view all the answers

    Which of the following adverse effects is NOT associated with oxcarbazepine (Trileptal®)?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of lamotrigine is correct?

    <p>Its plasma protein binding is approximately 55%</p> Signup and view all the answers

    Which mechanism is associated with some anti-seizure drugs in enhancing GABA synaptic transmission?

    <p>Reducing the metabolism of GABA</p> Signup and view all the answers

    Which of the following statements regarding the teratogenic effects of antiepileptic drugs (AEDs) is correct?

    <p>Neural tube defects and cleft lip/palate can occur with certain AEDs during pregnancy.</p> Signup and view all the answers

    What is the primary mechanism of action for benzodiazepines in their anticonvulsant effects?

    <p>Potentiating GABA-mediated neuronal inhibition</p> Signup and view all the answers

    Which statement accurately describes the difference between diazepam and lorazepam in the treatment of status epilepticus?

    <p>Diazepam is more lipophilic than lorazepam, leading to a faster onset and shorter duration of action.</p> Signup and view all the answers

    What is the primary mechanism of action for phenytoin (Dilantin®) in its anticonvulsant effects?

    <p>Blocking voltage-gated sodium channels</p> Signup and view all the answers

    Which of the following statements accurately describes the classification of antiepileptic drugs (AEDs)?

    <p>First-generation AEDs include phenobarbital, primidone, phenytoin, valproate, carbamazepine, and ethosuximide, while second-generation AEDs are newer agents like lamotrigine and topiramate.</p> Signup and view all the answers

    What will happen to the plasma concentrations of medications metabolized by UGT and CYP450 enzymes when co-administered with valproate sodium or valproic acid?

    <p>The plasma concentrations will increase due to enzyme inhibition.</p> Signup and view all the answers

    What is the potential consequence when seizures last more than 30 to 60 minutes?

    <p>Increased risk of permanent neurological damage.</p> Signup and view all the answers

    Which adverse effect is considered a serious but extremely rare side effect of ethosuximide?

    <p>Bone marrow suppression.</p> Signup and view all the answers

    Which mechanism allows ethosuximide to specifically treat absence seizures?

    <p>Blocking T-type calcium channels in thalamic neurons.</p> Signup and view all the answers

    Which of the following is NOT a clinical use of valproate sodium or valproic acid?

    <p>Partial seizures.</p> Signup and view all the answers

    Which statement about the teratogenic effects of antiepileptic drugs (AEDs) is correct?

    <p>Phenobarbital may cause major fetal malformations.</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of primidone is TRUE?

    <p>Primidone is metabolized into two active metabolites, phenobarbital and PEMA.</p> Signup and view all the answers

    How do some AEDs act on voltage-gated Na+ and Ca++ currents?

    <p>They enhance the inactivation of voltage-gated Na+ and Ca++ channels.</p> Signup and view all the answers

    Which medication is recommended as the second therapy of choice for status epilepticus?

    <p>Phenytoin.</p> Signup and view all the answers

    Which organ system can be significantly impacted when status epilepticus occurs due to its effect on ventilation?

    <p>Respiratory system.</p> Signup and view all the answers

    What is a potential life-threatening adverse effect associated with valproate sodium or valproic acid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which of the following is a dose-related adverse effect of chronic valproate therapy?

    <p>Alopecia</p> Signup and view all the answers

    Why is valproate contraindicated during pregnancy?

    <p>Potential neural tube defects</p> Signup and view all the answers

    What is the primary pharmacologically active metabolite of Oxcarbazepine (Trileptal®)?

    <p>MHD</p> Signup and view all the answers

    Which of the following is a non-dose related adverse effect of Valproate Sodium or Valproic Acid?

    <p>Aplastic anemia</p> Signup and view all the answers

    What is a serious but extremely rare adverse effect associated with ethosuximide?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which enzyme system is affected by valproate sodium or valproic acid leading to potential interactions with other medications?

    <p>UGT inhibitor</p> Signup and view all the answers

    What is the main adverse effect that has been fatal in some cases associated with Oxcarbazepine (Trileptal®)?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What are the CNS-related adverse effects associated with Valproate Sodium or Valproic Acid?

    <p>Sedation/drowsiness, fine distal tremor, ataxia</p> Signup and view all the answers

    Study Notes

    • Tolerance can develop with chronic administration of anti-epileptic drugs like Primidone, leading to side effects like nystagmus, ataxia, cognitive impairment, and respiratory depression.
    • Phenobarbital, a metabolite of Primidone, can cause major fetal malformations.
    • Ethosuximide, a succinimide class anti-epileptic drug, is primarily used for absence seizures and acts as a T-type Ca2+ channel blocker in thalamic neurons.
    • Valproate Sodium or Valproic Acid, a broad-spectrum anti-seizure medication, is effective against various seizure types and is available in different formulations.
    • Valproate Sodium increases GABA production, inhibits GABA metabolism, and has numerous drug interactions due to its enzyme inhibition properties.
    • Benzodiazepines like Diazepam and Lorazepam potentiate GABA-mediated neuronal inhibition and are used for treating status epilepticus with different onset and duration of action.
    • Phenytoin, an anti-epileptic agent, acts as a fast Na+ channel blocker and regulates neuronal excitability to prevent seizure spread.

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