Chapter·PharmacologyCNS drugs (antiepileptics, anesthetics)

Sodium channel blocking antiepilepticsDownloads

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1

A 7-year-old boy is brought to the physician because of spells of unresponsiveness and upward rolling of the eyes for 2 months. The episodes start abruptly and last a few seconds. During that time he does not hear anyone’s voice or make any purposeful movements. When the episodes end, he continues what he was doing before the spell. He does not lose his posture or fall to the ground. Episodes occur multiple times during the day. Physical examination shows no abnormal findings. An EEG following hyperventilation shows 3 Hz spike-and-slow-wave discharges. Which of the following is the most appropriate pharmacotherapy at this time?

ANo pharmacotherapy at this time

BEthosuximide

CSodium valproate

DOxcarbazepine

ELamotrigine

2

A 24-year-old man is brought to the emergency department because of violent jerky movements of his arms and legs that began 30 minutes ago. His father reports that the patient has a history of epilepsy. He is not responsive. Physical examination shows alternating tonic jerks and clonic episodes. There is blood in the mouth. Administration of intravenous lorazepam is begun. In addition, treatment with a second drug is started that alters the flow of sodium ions across neuronal membranes. The second agent administered was most likely which of the following drugs?

ALamotrigine

BPhenobarbital

CTopiramate

DCarbamazepine

EFosphenytoin

3

A 6-year-old boy is brought to the physician because of a 2-week history of frequent episodes of unresponsiveness. During these episodes, he stares blankly, rhythmically nods his head, and does not respond to verbal stimulation for several seconds. Hyperventilation for 30 seconds precipitates an episode of unresponsiveness and head nodding that lasts for 7 seconds. He regains consciousness immediately afterward. An electroencephalogram shows 3-Hz spikes and waves. Which of the following best describes the mechanism of action of the most appropriate pharmacotherapy for this patient's condition?

AInhibition of GABA reuptake into presynaptic neurons

BIncreased frequency of GABAA channel opening

CIrreversible inhibition of GABA transaminase

DIncreased duration of GABAA channel opening

EBlockade of thalamic T-type calcium channels

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