Lecture 1 Concepts (Antiseizure Drugs (ASDs) I and II)

What is the primary physiological effect of GABA binding at its receptors? A. Inhibitory hyperpolarization B. Excitatory depolarization C. Neutral resting stabilization D. Direct calcium channel opening

A. Inhibitory hyperpolarization

What is the primary physiological effect of Glutamate binding at its postsynaptic receptors? A. Inhibitory hyperpolarization B. Excitatory depolarization C. Chloride-mediated suppression D. Potassium hyperpolarization

B. Excitatory depolarization

Which of the following receptor classes are classified as excitatory? A. GABA-A and GABA-B receptors B. Mu-opioid and Dopamine D2 receptors C. AMPA/Kainate and NMDA receptors D. Muscarinic M2 and M4 receptors

C. AMPA/Kainate and NMDA receptors

Which statement correctly describes the timing and etiology of seizures? A. Seizures only manifest during geriatric years due to vascular changes B. Seizures are exclusively congenital and present strictly at birth C. Alcoholism withdrawal only precipitates seizures in patients over age 65 D. Seizures can occur at any stage of life due to factors like genetics, trauma, or withdrawal

D. Seizures can occur at any stage of life due to factors like genetics, trauma, or withdrawal

Activation of the metabotropic GABA-B receptor (GPCR) directly leads to which cellular events? A. Closing of Ca2+ channels and opening of K+ channels B. Opening of Ca2+ channels and closing of K+ channels C. Influx of Na+ and massive efflux of Cl- D. Opening of both Ca2+ and Na+ channels simultaneously

A. Closing of Ca2+ channels and opening of K+ channels

Activation of the AMPA/Kainate receptor results in which ionic movement pattern? A. Influx of K+ and efflux of Na+ B. Influx of Na+ and efflux of K+ C. Influx of Ca2+ exclusively without sodium involvement D. Efflux of both Na+ and K+

B. Influx of Na+ and efflux of K+

Which substances can act to inhibit the AMPA/Kainate receptor? A. Caffeine and Nicotine B. Glycine and Phencyclidine C. Alcohol and Barbiturates D. Glutamate and Aspartate

C. Alcohol and Barbiturates

Co-activation of the NMDA receptor by Glutamate, Glycine, and Phencyclidine leads to which ionic shifts? A. Influx of K+, efflux of Na+ and Ca2+ B. Massive influx of Cl- ions C. Efflux of Ca2+, Na+, and K+ D. Influx of Ca2+ and Na+, and efflux of K+

D. Influx of Ca2+ and Na+, and efflux of K+

The opening of calcium channels across the neuronal membrane typically results in: A. Depolarization B. Hyperpolarization C. Membrane repolarization D. Complete electrical neutrality

A. Depolarization

In neural divergence, a single presynaptic neuron firing a train of action potentials can influence approximately how many postsynaptic neurons? A. 100 postsynaptic neurons B. 10,000 postsynaptic neurons C. 1,000 postsynaptic neurons D. 10 postsynaptic neurons

B. 10,000 postsynaptic neurons

During the absolute refractory period, what physiological or pharmacological mechanism stops further action potentials? A. Massive potassium influx overwhelming the cell B. Opening of GABA-B chloride channels C. Blocking of Na+ influx causing channel inactivation (such as via drug linker regions) D. Depolarization block via calcium overload

C. Blocking of Na+ influx causing channel inactivation (such as via drug linker regions)

What is the primary functional classification of pyramidal neurons in the cerebral cortex? A. Inhibitory interneurons B. Modulatory monoaminergic neurons C. Autonomic preganglionic neurons D. Excitatory projection neurons

D. Excitatory projection neurons

What is the primary functional classification of non-pyramidal cortical neurons? A. Inhibitory B. Excitatory C. Sensory-transducing D. Neurosecretory

A. Inhibitory

A focal seizure is characterized by abnormal electrical activity that originates in and affects: A. Both cerebral hemispheres simultaneously from deep subcortical nuclei B. Only 1 region of the cortex C. Exclusively the brainstem reticular formation D. The entire spinal cord and peripheral nerves

B. Only 1 region of the cortex

How does a secondary generalized seizure typically propagate? A. Begins in the thalamus and affects both hemispheres immediately B. Remains strictly localized to a single gyrus without spreading C. Starts in one region of the cortex, then spreads to subcortical areas D. Originates in the peripheral nervous system and ascends to the cortex

C. Starts in one region of the cortex, then spreads to subcortical areas

Primary generalized seizures typically originate and affect which structures? A. Start in the temporal neocortex and remain focal B. Start in the motor strip and spread to a single limb C. Start in the cerebellum and affect balance pathways only D. Start in the thalamus and affect both hemispheres, which can cause loss of consciousness

D. Start in the thalamus and affect both hemispheres, which can cause loss of consciousness

Status epilepticus is clinically defined by a continuous seizure lasting for at least: A. 5 minutes B. 30 seconds C. 2 minutes D. 15 minutes

A. 5 minutes

What is the hallmark etiology of febrile seizures? A. Hypoglycemia in geriatric patients B. A seizure caused by high fever, which is typical in children C. Severe head trauma in adolescents D. Chronic alcohol withdrawal in adults

B. A seizure caused by high fever, which is typical in children

An excessive accumulation of extracellular potassium (K+) outside of the cell can lead to: A. Hyperpolarization and suppression of neuronal firing B. Immediate cessation of all synaptic activity C. Depolarization and subsequent triggering of a seizure D. Upregulation of GABA synthesis

C. Depolarization and subsequent triggering of a seizure

A decrease in GABA-mediated inhibition can be precipitated by: A. Administration of benzodiazepines B. Upregulation of GABA transporter (GAT) clearance C. Increased density of postsynaptic GABA-A receptors D. Drugs and/or degeneration of GABA neurons and receptors

D. Drugs and/or degeneration of GABA neurons and receptors

Patients experiencing a secondary generalized seizure frequently report which phenomenon prior to losing consciousness? A. An aura B. Complete motor flaccidity C. Immediate retrograde amnesia of past years D. A sudden drop in core body temperature

A. An aura

During the tonic phase of a generalized tonic-clonic seizure, what muscular event occurs? A. Intermittent rhythmic jerking of isolated limbs B. Simultaneous contraction of most muscles – both agonist and antagonist muscles C. Complete muscular flaccidity throughout the body D. Selective relaxation of extensor muscles with preserved flexor tone

B. Simultaneous contraction of most muscles – both agonist and antagonist muscles

The clonic phase of a seizure involves direct activity of which brain region, resulting in specific symptoms? A. Cerebellar shutdown, causing loss of balance only B. Brainstem paralysis, causing immediate respiratory arrest C. Motor cortex involvement, causing uncontrolled shaking of body/limbs D. Frontal lobe inhibition, causing catatonic stupor

C. Motor cortex involvement, causing uncontrolled shaking of body/limbs

Which of the following describes the postictal period immediately following a seizure? A. Patient experiences hyper-alertness and high cognitive performance B. Patient enters a prolonged tonic muscular contraction phase C. Patient suffers permanent sensory blindness D. Patient becomes flaccid and remains unconscious until brain functions return to normal

D. Patient becomes flaccid and remains unconscious until brain functions return to normal

Thalamic relay neurons operate under normal physiological conditions in which two primary states? A. Transmission mode and Bursting mode B. Active and resting mode C. Excitatory and refractory mode D. Glycinergic and GABAergic mode

A. Transmission mode and Bursting mode

The transmission mode of thalamic relay neurons is characterized by: A. Being active during sleep (SWS) and blocking sensory input B. Being active during the awake state to provide faithful transmission of sensory information C. Random firing causing absence seizures D. Hyperpolarization-induced calcium oscillations

B. Being active during the awake state to provide faithful transmission of sensory information

When are thalamic relay neurons typically in "Bursting mode," serving to reduce or stop sensory input? A. During active wakefulness B. During high-stress physical exertion C. During the sleep (SWS) state D. During focal motor seizures

C. During the sleep (SWS) state

Under what cellular condition are T-type calcium channels activated during sleep (SWS)? A. When the neuron is depolarized past threshold B. In the complete absence of extracellular calcium C. When glutamate massively binds AMPA receptors D. When the neuron is hyperpolarized

D. When the neuron is hyperpolarized

Abnormal or random daytime activation of T-type calcium channels can precipitate which condition? A. Absence seizures B. Status epilepticus C. Tonic-clonic hyperpyrexia D. Focal motor paralysis

A. Absence seizures

Which of the following contributes to the onset of absence seizures during the awake state? A. Decrease in intracellular K+ and loss of GABAergic input B. Increase in intracellular K+, increase in GABAergic input to thalamus, and/or decrease/loss in excitatory input C. Massive upregulation of AMPA receptors and sodium influx D. Chronic hyperpolarization block via sodium channel stabilization

B. Increase in intracellular K+, increase in GABAergic input to thalamus, and/or decrease/loss in excitatory input

Which medications act as T-type calcium channel blockers useful in treating absence seizures? A. Phenytoin, Carbamazepine, and Lamotrigine B. Diazepam, Lorazepam, and Midazolam C. Zonisamide, Ethosuximide, and Valproic Acid D. Baclofen, Gabapentin, and Pregabalin

C. Zonisamide, Ethosuximide, and Valproic Acid

In the pharmacotherapeutic management of seizure disorders, what is a primary therapeutic goal regarding GABA? A. Decrease GABA synthesis B. Block GABA receptors C. Convert GABA into glutamate D. Increase GABA in those patients

D. Increase GABA in those patients

What is the primary therapeutic goal regarding glutamate in patients with seizure disorders? A. Decrease glutamate in those patients B. Increase glutamate release C. Upregulate NMDA receptor sensitivity D. Promote glutamate excitotoxicity

A. Decrease glutamate in those patients

Pharmacologically, to counteract the pathophysiology of seizures, clinicians aim to utilize: A. GABA antagonists and Glutamate agonists B. GABA agonists and Glutamate antagonists C. Both GABA and Glutamate antagonists D. Both GABA and Glutamate agonists

B. GABA agonists and Glutamate antagonists

Which of the following correctly lists Phase 1 drug metabolism reactions? A. Glucuronidation, Sulfation, Acetylation B. Conjugation, Methylation, Amination C. Oxidation, Reduction, Hydrolysis D. Decarboxylation, Phosphorylation, Esterification

C. Oxidation, Reduction, Hydrolysis

Which of the following represents classic Phase 2 conjugation metabolic pathways? A. Oxidation, Reduction, Hydrolysis B. Dealkylation, Hydroxylation, Deamination C. Transamination and Isomerization D. Glucuronidation, Sulfation, Acetylation

D. Glucuronidation, Sulfation, Acetylation