PHRM 1203 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS
MECHANISM OF ACTION OF VALPORATE - ANSWER Prevents repetitive neuronal
discharge by blocking sodium channels. Enhances GABA, inhibits glutamate and blocks
calcium channels
VALPORATE INDICATIONS - ANSWER first line for generalised tonic-clonic seizures and
absence seizures. Second line for focal seizures.
VALPORATE CONTRADICTIONS - ANSWER Avoid if possible in hepatic impairment - risk
of valporate-induced hepatic failure is increased in patients taking multiple
anticonvulsants, family history of liver disease
VALPORATE ADVERSE EFFECTS - ANSWER Common: Nausea, vomiting, drowsiness,
weight gain, hair loss, ataxia
Rare: Hepatic failure, pancreatitis, blood dyscrasias, reduction in bone mineral density
Can also cause menstural irregularities, polycystic ovaries and hyperandrogenism in
females.
LEVETIRACETAM INDICATIONS - ANSWER Focal seizures as monotherapy
Adjunctive therapy for primary generalised tonic-clonic seizures
LEVETIRACETAM MECHANISM OF ACTION - ANSWER specific mechanism of action is
not confirmed. Potential mechansim of action is that it binds to the synaptic vesicle
protein 2A reducing neurotransmitter release
LEVETIRACETAM ADVERSE EFFECTS - ANSWER common: behavioural effects
including; depression, emotional lability, hostility, aggression, agitation, anxiety and
nervousness.
severe: Steven-Johns Syndrome (serious disorder of the skin and mucous membranes),
other hypersensitivity reactions such as angioedema.
LAMOTRIGINE INDICATIONS - ANSWER Focal Seizures (partial) and generalised
seizures as an adjunctive treatment or monotherapy
LAMOTRIGINE MECHANISM OF ACTION - ANSWER Stabilises presynaptic neuronal
membranes
Enhances the releases of GABA
Inhibits glutamate
, LAMOTRIGINE CONTRADICTIONS - ANSWER drug + Valporate can cause severe skin
reaction (Steven-Johns) due to increase in plasma concentration. TDm not routinely
done except in pregnancy
LAMOTRIGINE ADVERSE EFFECTS - ANSWER Common: diplopia, blurred vision,
diziness, ataxia, head ache, somnolence.
TDM FOR ANTIEPILEPTIC DRUGS - ANSWER Correlation between serum concentration
and efficacy or toxicity is poor, rarely undertaken
Exceptions:
- monitor for non-compliance
- provide evidence toxicity
- adjusting dosage in pregnancy
EPILEPSY + WOMEN - ANSWER - Risk congenital malformation vs epilepsy uncontrolled
Risk w/ individual agents - valporate
Preconception: carbamazepine, phenytoin, oxcarbazepine, barbiturates induce CXP3A4
enzyme
contraceptive meds may reduce effectiveness
Folic acid recommended
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS - ANSWER
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM - ANSWER Mechanism to control BP
and fluid volume.
Angiotensin II is a vasoconstrictor hormone that stimulates the secretion of aldosterone,
a mineral corticoid that increases sodium reabsorption and consequently, increases BP,
blood volume and urine output. Renin is released when there is a decrease in sodium
concentration in the body, or in response to hypotension. When the enzyme renin is
released into circulation - angiotensin II is produced. Angiotensin I is converted to
Angiotensin II via Angiotensin Converting Enzyme.
Angiotensin II is a hormone that acts on the cortex of adrenal glands and stimulates
secretion of aldosterone - increases sodium absorption.
Also acts on vascular smooth muscle causing vasoconstriction, increase in peripheral
vascular resistance (afterload), increases venous return (preload) - Results in an
increase in both BP and blood volume and a decrease in urine output.
ACEi MECHANISM OF ACTION - ANSWER Blocks the conversion of angiotensin I to
angiotensin II
CORRECT ANSWERS
MECHANISM OF ACTION OF VALPORATE - ANSWER Prevents repetitive neuronal
discharge by blocking sodium channels. Enhances GABA, inhibits glutamate and blocks
calcium channels
VALPORATE INDICATIONS - ANSWER first line for generalised tonic-clonic seizures and
absence seizures. Second line for focal seizures.
VALPORATE CONTRADICTIONS - ANSWER Avoid if possible in hepatic impairment - risk
of valporate-induced hepatic failure is increased in patients taking multiple
anticonvulsants, family history of liver disease
VALPORATE ADVERSE EFFECTS - ANSWER Common: Nausea, vomiting, drowsiness,
weight gain, hair loss, ataxia
Rare: Hepatic failure, pancreatitis, blood dyscrasias, reduction in bone mineral density
Can also cause menstural irregularities, polycystic ovaries and hyperandrogenism in
females.
LEVETIRACETAM INDICATIONS - ANSWER Focal seizures as monotherapy
Adjunctive therapy for primary generalised tonic-clonic seizures
LEVETIRACETAM MECHANISM OF ACTION - ANSWER specific mechanism of action is
not confirmed. Potential mechansim of action is that it binds to the synaptic vesicle
protein 2A reducing neurotransmitter release
LEVETIRACETAM ADVERSE EFFECTS - ANSWER common: behavioural effects
including; depression, emotional lability, hostility, aggression, agitation, anxiety and
nervousness.
severe: Steven-Johns Syndrome (serious disorder of the skin and mucous membranes),
other hypersensitivity reactions such as angioedema.
LAMOTRIGINE INDICATIONS - ANSWER Focal Seizures (partial) and generalised
seizures as an adjunctive treatment or monotherapy
LAMOTRIGINE MECHANISM OF ACTION - ANSWER Stabilises presynaptic neuronal
membranes
Enhances the releases of GABA
Inhibits glutamate
, LAMOTRIGINE CONTRADICTIONS - ANSWER drug + Valporate can cause severe skin
reaction (Steven-Johns) due to increase in plasma concentration. TDm not routinely
done except in pregnancy
LAMOTRIGINE ADVERSE EFFECTS - ANSWER Common: diplopia, blurred vision,
diziness, ataxia, head ache, somnolence.
TDM FOR ANTIEPILEPTIC DRUGS - ANSWER Correlation between serum concentration
and efficacy or toxicity is poor, rarely undertaken
Exceptions:
- monitor for non-compliance
- provide evidence toxicity
- adjusting dosage in pregnancy
EPILEPSY + WOMEN - ANSWER - Risk congenital malformation vs epilepsy uncontrolled
Risk w/ individual agents - valporate
Preconception: carbamazepine, phenytoin, oxcarbazepine, barbiturates induce CXP3A4
enzyme
contraceptive meds may reduce effectiveness
Folic acid recommended
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS - ANSWER
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM - ANSWER Mechanism to control BP
and fluid volume.
Angiotensin II is a vasoconstrictor hormone that stimulates the secretion of aldosterone,
a mineral corticoid that increases sodium reabsorption and consequently, increases BP,
blood volume and urine output. Renin is released when there is a decrease in sodium
concentration in the body, or in response to hypotension. When the enzyme renin is
released into circulation - angiotensin II is produced. Angiotensin I is converted to
Angiotensin II via Angiotensin Converting Enzyme.
Angiotensin II is a hormone that acts on the cortex of adrenal glands and stimulates
secretion of aldosterone - increases sodium absorption.
Also acts on vascular smooth muscle causing vasoconstriction, increase in peripheral
vascular resistance (afterload), increases venous return (preload) - Results in an
increase in both BP and blood volume and a decrease in urine output.
ACEi MECHANISM OF ACTION - ANSWER Blocks the conversion of angiotensin I to
angiotensin II
