Antiepileptic Drugs Question And Answers

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Anti-Epileptic Drugs Important Notes

1. Anti-Epileptic Drugs Types of seizures and drugs used in it

Anti-Epileptic Drugs Types Of Seizures And Drugs Used In It

Read And Learn More: Pharmacology Question and Answers

2. Anti-Epileptic Drugs Classification of anti-anxiety drugs

Anti-Epileptic Drugs Classification Of Anti-Anxiety Drugs

3. Anti-Epileptic Drugs Phenytoin

  • It is the drug of choice for grand mal epilepsy and generalized seizures
  • Adverse effects
    • Insomnia, headache, giddiness
    • Gingival hyperplasia
    • Produces fetal hydantoin syndrome in pregnancy characterized by deft lip and palate and microcephaly
    • Hirsutism
    • Megaloblastic anaemia
  • Used to treat digitalis-induced ventricular arrhythmias

4. Anti-Epileptic Drugs Carbamazepine

  • Used in
    • Temporal lobe epilepsy
    • Grand mal epilepsy
    • Trigeminal neuralgia

5. Anti-Epileptic Drugs Diazepam

  • Useful in
    • Acute pain
    • Anxiety
    • Status epileptics
  • Has a high therapeutic index
  • Dose: 2-5 mg BID

Anti-Epileptic Drugs Long Essays

Question 1. Classify the drugs used in epilepsy. Write the mechanism of action and adverse effects of diphenylhydantoin sodium.

Answer:

Anti-Epileptic Drugs:

  • Anti-epileptic drugs are used during epilepsy.

Anti-Epileptic Drugs Classification:

  1. Barbiturate – phenobarbitone, mephobarbitone.
  2. Deoxybarbiturate – primidone.
  3. Hydration – Phenytoin, mephenytoin.
  4. Iminostilbene – Carbamazepine, oxcarbazepine.
  5. Succinimide – Ethosuximide.
  6. Aliphatic carboxylic acid – valproic acid.
  7. Benzodiazepine s- Clonazepam. Diazepam.
  8. Phenyltriazine – Lamotrigine.
  9. Cyclic – GABA analogue – Gabapentin, pregabalin.
  10. Newer drugs – Vigabatrin, topiramate.

Diphenylhydantoin/Phenytoin sodium:

  • It is a major antiepileptic drug.

Diphenylhydantoin/Phenytoin sodium Mechanism of action:

Anti-Epileptic Drugs Diphenylhydantoin Or Phenytoin Sodium

Diphenylhydantoin/Phenytoin sodium Adverse effects:

1. At therapeutic doses:

  • Gum hypertrophy – is common in younger patients.
  • Nausea, vomiting, epigastric pain, anorexia.
  • Diplopia, ataxia, nystagmus.
  • Peripheral neuropathy on prolonged use.
  • Hypersensitivity.
  • Endocrine disorders – hirsutism, acne, hyperglycaemia, decreased release of ADH, osteomalacia, hypocalcaemia.
  • Megaloblastic anaemia, pancytopenia, neutropenia.
  • Teratogenicity – causes foetal hydantoin syndrome.

2. At high doses.

  • Prominent cerebellar and vestibular effects.
  • Drowsiness, hallucinations, mental confusion, delirium, altered behaviour.

Question 2. Enumerate antiepileptic drugs. Mention the actions of phenytoin sodium. How do you manage a case of convulsion precipitated during tooth extraction?

Answer:

Anti-epileptic drugs:

Phenytoin sodium:

  • It is a major anti-epileptic drug.

Phenytoin sodium Actions:

  • It has CNS actions.
  1. Anti-seizure.
  2. Effective against generalised tonic-clonic seizures and partial seizures.
  3. Doesn’t cause generalised CNS depression.

Management of convulsion precipitated during tooth extraction:

1. Drugs used.

  • Diazepam 10 mg IV bolus injection followed by fractional doses every 10 min or slow infusion titrated to control the fits. Or.
  • Phenobarbitone 100 – 200 mg 1M/1V or.
  • Phenytoin 25 mg/min. IV.

2. Maintain patent airway, oxygen, fluid and electrolyte balance, BP, cardiac rhythm, and care of unconsciousness.

Question 3. Mention the clinical uses of dilantin sodium.

Answer:

Uses of dilantin sodium:

  • In generalised tonic-clonic seizures.
  • In simple and complex partial seizures.
  • Status epilepticus – 25 mg/min, slow IV. Used as an alternative to diazepam.
  • Trigeminal neuralgia – second choice of drug, next to carbamazepine.
  • Used in digitalis-induced cardiac arrhythmia – 100 mg IV every 10 min or 100 – 200 mg orally 2 – 6 hourly followed by 400 mg/day for maintenance.

Anti-Epileptic Drugs Short Essays

Question 1. Sodium valproate.

Answer:

Sodium valproate is a broad-spectrum anticonvulsant drug.

Sodium valproate Mechanism:

1. Enhances the level of GABA by.

  • Increasing its synthesis.
  • Decreasing its metabolism.

2. Blocks Na+ channels.

  • Delays its recovery from inactivated states.

3. Decreases low threshold Ca++ current in the thalamus.

Sodium valproate Uses:

  • In absence seizures – drug of choice.
  • Adjuvant drug for generalized tonic-clonic seizures, simple and complex partial seizures.
  • Myoclonic and atonic seizures.
  • As a mood stabilizer in bipolar mood disorders.
  • Tried as a prophylactic measure in migraine.

Sodium valproate Adverse Effects:

  • GIT symptoms – nausea, vomiting, epigastric pain.
  • CNS symptoms – Ataxia, drowsiness, tremors. Sedation.
  • Rashes, alopecia, curling of hair, increased bleeding.
  • Rarely fulminant hepatitis.
  • Teratogenicity-neural tube-defects in newborns.

Question 2. Enlist the advantages and disadvantages of tone sodium.

Answer:

Thiopentone sodium:

  • It is ultra short-acting thiobarbiturate.

Thiopentone sodium Advantages:

  • Highly soluble in water.
  • Produces unconsciousness within 15-20 sc.
  • Highly lipid soluble.

Thiopentone sodium Disadvantages:

  • Poor analgesic.
  • Weak muscle relaxant.
  • Produces CNS depression.
  • Causes respiratory depression.
  • Required to prepare freshly every time.
  • Extravasation of solution causes intense pain, necrosis and gangrene.

Question 3. Phenytoin sodium in grand mal epilepsy.

Answer:

Phenytoin prolongs the inactivated state of the voltage-sensitive neuronal Na+ channel and it also governs the refractory period of the neurons.

  • As a result, high-frequency discharges are inhibited with little effect on normal low-frequency discharges.
  • It has a stabilizing influence on the neuronal membrane and thus prevents repetitive detonation.
  • This stabilizing influence consists of a synchronous and unusually large depolarization over which action potentials are superimposed.
  • At high doses.
  1. Reduces Caz+ influx.
  2. Inhibits glutamate.
  3. Facilitates GABA responses.
  4. Prevents intracellular accumulation of Na+ occurring during repetitive firing.
  • Therefore, phenytoin sodium is used in grand mal epilepsy.

Question 5. BDZ (benzodiazepines) as anticonvulsants.

Answer:

  • Benzodiazepine have useful anticonvulsant property

Benzodiazepine Mechanism of Action:

  • Inhibits GABA metabolism
  • Enhances GABA-mediated inhibition
  • At large doses, high-frequency discharges are inhibited

Anti-Epileptic Drugs Short Question And Answers

Question 1. Phenobarbitone.

Answer:

Phenobarbitone is an important drug used in epilepsy.

  • It inhibits the neurotransmitter’s action by enhancing the GABA receptors thus facilitating them to open chloride ion channels.
  • It raises the seizure threshold and thus prevents epileptic attacks.
  • It is preferred due to its efficacy and low cost.

Phenobarbitone Uses:

  • Generalized tonic-clonic seizures.
  • Partial seizures.

Question 2. Carbamazepine.

Answer:

Carbamazepine is anti-epileptic drug.

Carbamazepine Uses:

  • Epilepsy – generalized tonic-clonic seizure and partial seizures.
  • Neuralgia – trigeminal and glossopharyngeal neuralgia.
  • Manic depressive illness and acute mania.
  • Chronic neuropathic pain.

Carbamazepine Adverse effects:

  • Dose-related neurotoxicity – sedation, dizziness vertigo, diplopia and ataxia.
  • GIT disturbance, vomiting, diarrhoea.
  • Hypersensitivity reactions – rashes, photosensitivity agranulocytosis, aplastic anaemia.
  • Minor foetal abnormalities.

Question 3. Sodium valproate.

Answer:

Sodium valproate Uses:

  • In absence seizures – drug of choice.
  • Adjuvant drug for generalized tonic-clonic seizures, simple and complex partial seizures.
  • Myoclonic and atonic seizures.
  • As a mood stabilizer in bipolar mood disorders.
  • Tried as a prophylactic measure in migraine.

Sodium Valproate Adverse Effects:

  • GIT symptoms-nausea, vomiting, epigastric pain.
  • CNS symptoms – Ataxia, drowsiness, tremors. Sedation.
  • Rashes, alopecia, curling of hair, increased bleeding.
  • Rarely fulminant hepatitis.
  • Teratogenicity – neural tube defects in newborns.

Question 4. Phenytoin sodium/Dipbenyl hydantoin sodium.

Answer:

Diphenyihydantoin/Phenytoin sodium:

It is a major antiepileptic drug

Diphenyihydantoin/Phenytoin sodium Adverse effects:

1. At therapeutic doses:

  • Gum hypertrophy – is common in younger patients.
  • Nausea, vomiting epigastric pain, anorexia.
  • Diplopia, ataxia, nystagmus.
  • Peripheral neuropathy on prolonged use.
  • Hypersensitivity.
  • Endocrine disorders – hirsutism, acne, hyperglycaemia, decreased release of ADH, osteomalacia, hypocalcaemia.
  • Megaloblastic anaemia, pancytopenia, neutropenia.
  • Teratogenicity – causes foetal hydantoin syndrome.

2. At high doses.

  • Prominent cerebellar and vestibular effects.
  • Drowsiness, hallucinations, mental confusion, delirium, altered behaviour.

Question 5. Phenytoin sodium contra-indicated in pregnancy.

Answer:

Phenytoin sodium causes teratogenicity. When taken by the pregnant lady.

  • It produces foetal hydantoin syndrome.
  • It is characterized by.
  1. Hypoplastic phalanges.
  2. Cleft palate.
  3. Harelip.
  4. Microcephaly.

Question 6. Adverse effects of Phenytoin.

Answer:

1. Phenytoin At therapeutic doses

  • Gum hypertrophy
  • Nausea, vomiting epigastric pain
  • Diplopia
  • Ataxia, nystagmus
  • Hypersensitivity
  • Peripheral neuropathy
  • Endocrine disorders: hirsutism, acne, hyperglycaemia
  • Megaloblastic anaemia, pancytopenia, neutropenia
  • Teratogenicity

2. Phenytoin At high doses

  • Prominent cerebellar and vestibular effects
  • Drowsiness, hallucinations, mental confusion, delirium, altered behaviour

Question 7. Name three uses and three adverse effects of Diazepam.

Answer:

Diazepam Uses:

  • Status epilepticus
    • 5-10 mg IV every 10-15 min upto 30 mg
  • IV anaesthesia
    • Dose – 0.2-0.5 mg/kg IV
  • For conscious sedation
    • 1-2 mg IV is given in repeated doses or by slow infusion until the desired level of sedation is achieved
  • As sedative and hypnotic
  • Centrally acting skeletal muscle relaxant
  • Combined with analgesic
  • As antiepileptic

Diazepam Adverse Effects:

  • Drowsiness
  • Confusion
  • Amnesia
  • Impaired motor coordination
  • Blurred vision
  • Ataxia
  • Headache

Question 8. Enlist three adverse effects of Sodium Valproate.

Answer:

  • GIT symptoms – nausea, vomiting, epigastric pain
  • CNS symptoms – ataxia, drowsiness, tremors, sedation
  • Rashes, alopecia, curling of hairs, increased bleeding
  • Teratogenicity – neural tube defects in newborns

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