Question 1

General mechanism of actions of antiepileptics (AED)?

Accepted Answer

- Decreased membrane excitability by altering Na+ and Ca2+ conductance during action potential - Enhance GABA neurotransmitters

Question 2

Carbamazepine is unsuitable for what type of seizures?

Accepted Answer

Absence seizures

Question 3

BZDs can be classified according to their duration of action: Short-acting, intermediate-acting and long-acting. Name an example of each and their usual oral dosage range

Accepted Answer

- Short-acting: Midazolam 15mg - Intermediate-acting: Clonazepam 0.5-1mg, Lorazepam 1-2mg - Long-acting: Diazepam 5mg ++ (should be multiples of 5 bah HAHa)

Question 4

Definition of epilepsy in terms of the number of seizure episodes?

Accepted Answer

≥2 unprovoked seizures occurring > 24h apart

Question 5

Treatment goals for epilepsy

Accepted Answer

- Absence of seizures - Absence of AED side effects - Improve QoL

Question 6

General principle for dosing AEDs?

Accepted Answer

Start low titrate slow

Question 7

According to ILAE 2013, three AEDs that are preferred for Generalised onset epilepsy?

Accepted Answer

1. Lamotrigine (LTG) 2. Topiramate (TPM) 3. Valproate (VAL)

Question 8

Which AEDs are preferred in epilepsy with concurrent migraine? State the dosing range of each AEDs

Accepted Answer

1. Topiramate (TPM): 50-200mg in OD-BD titrated weekly, then 100 mg weekly till max 400 mg/day (monotherapy dosing. If adjunct, initial dose is 25 mg) 2. Valproate (VAL): 10-15 mg/kg/day in OD-QDS, max 60 mg/kg/day. Increase by 10mg/kg/day weekly

Question 9

AED that should be used in caution in patients who have concurrent depression or anxiety? State dosing range of the AED.

Accepted Answer

Levetiracetam (LEV) 500 mg BD, increase by 1000 mg q2w until max 4000mg a day (2000 mg BD)

Question 10

AEDs that are preferred in women with childbearing potential? State their dosing range

Accepted Answer

1. Levetiracetam (LEV) 500 mg BD, increase by 1000 mg q2w until max 4000mg a day (2000 mg BD) 2. Lamotrigine (LTG) 25-500 mg/day (FYI: This LTG dosing: Generally if nothing interacts with it, initial dose is 25 mg OD. If lamotrigine metabolism is increased by other drugs, then initial dose is 25 mg BD. If lamotrigine metabolism is DECREASED by other drugs, initial dose is 12.5-25mg EOD. This is due to severe cutaneous reaction and is dose dependent)

Question 11

AEDs that are NOT SUITABLE in pregnancy due to established or possible teratogenicity

Accepted Answer

Valproate (most established), phenytoin, topiramate, carbamazepine

Question 12

What is the difference in terms of clearance between first generation AEDs and newer AEDs?

Accepted Answer

- 1st gen AEDs (CBZ, PHT, VAL) are hepatically cleared - Newer AEDs (e.g. Gabapentin, LTG, LEV) are mostly renally cleared (except TPM which is 33-50% R cleared)

Question 13

Newer AEDs that have no effects on CYP enzyme hence less drug interactions?

Accepted Answer

Gabapentin, levetiracetam and pregabalin

Question 14

AED that induces its own metabolism. How is it dosed?

Accepted Answer

Carbamazepine 100-200 mg/day in BD-QDS (or 2-3mg/kg/day)

Question 15

AEDs that are potent enzyme INDUCERS

Accepted Answer

Carbamazepine, Phenytoin

Epilepsy Flashcards

(28 cards)