Anti-Epileptics (Seizure Medications)

today we're going to be talking about the anti epileptic drugs also known as the seizure medications and this video is brought to you by dirty USMLE today's video is sponsored by our friends over at OMG OMG guys if you're an osteopathic medical student and you attend a do school we humbly suggest that you check out our friends at OMG OMG they are helping many of their subscribers score well above 600 on comlex in fact one user who actually was referred to OMG OMG by us here on this channel scored in the high seven hundredths on her complex OMG OMG features high-yield active engaging videos that tell you everything you need to know and nothing more they show you how to actually set up and position the high-yield techniques that comlex loves to ask you about they feature a full-length comlex exam that mimics the real day time constraints of your exam they have 24/7 online support and they are absolutely wonderful they are changing the game with how you study for complex so if you head on 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are a bitch to learn if you look in first aid there is a gigantic table that goes over all of the different drugs that they give patients when they're treating seizures and unfortunately there's such a laundry list of medications which you see here and all of these medications have different mechanisms different side effects different indications that it's honestly so confusing to get them straight so we're gonna create a video today that's gonna simplify everything for you of course there's gonna be pneumonic sin this video because it wouldn't be a dirty USMLE video if we didn't have some really really sick mnemonics but what I want you to take away from this video today as we move through all of these medications is the what I call the what you need to know right because at the end of the day all you care about is what do I need to know for us Emily or comlex so that I can crush my exam match into the residency program I want and if you guys want to never think about the mechanisms for these medications ever again so when we go through this we're gonna cover three main things now some drugs are not going to have an indication some drugs are not going to have a high-yield adverse drug reaction and if that's the case I'll point it out but when we go through these drugs we want to think about the mechanism the indication and the main side effects are adverse drug reactions so the main a DRS don't worry guys I want you to sit back take a deep breath and just follow my lead we're gonna simplify all of this in a really high yield fashion so let's start with valproate also known as valproic acid so the mechanism of valproate is that we're going to inhibit or decrease the activity at voltage-gated sodium channels in addition to that we're going to increase the activity of gaba so think of sodium in this lecture as like sort of excitatory so when you decrease voltage-gated sodium channels we decrease the excitation that causes seizures likewise gaba is an inhibitory neuron so if we increase activity of gaba we're increasing inhibitory activity which means we're getting inhibited which tones down the excitation in the brain that causes seizures so valproate decreases or inhibits the voltage-gated sodium channels and increases gaba valproate is really a first-line medication here and if you're taking your exam and they want you to pick what anti epileptic drug you're gonna give to somebody who has you know like a just a general seizure a partial or a tonic-clonic seizure and they don't specify a specific subtype of seizure and you'll understand what i mean as we go through this lecture but generically speaking if you have to pick a first-line medication valproate is usually your go to adverse drug reactions let's talk about a few the ones you should know are anemia hepatic toxicity pancreatitis and spina bifida right so how do you remember this well when you think of valproate I want you to think of all-pro so you take the ALP ro out of valproate so all-pro that reminds us of two things the if we drop one of the Elle's all-pro stands for anemia liver pancreatitis and then the little R big o reminds me of a hole that you get in the neural tube defect of spina bifida so the oh this is literally just the hole or the pouch through which you have the spina bifida occurring so all-pro from valproate all-pro anemia liver which is about a toxicity pancreatitis and then our big o is the little spina bifida the other reason that I think all-pro is because we need to have a way to memorize the mechanism of valproate and if you're not a sports fan I apologize but an all-pro athlete who is a very salty person is Dez Bryant the wide receiver for the Dallas Cowboys he's a salty son-of-a-bitch and because he's salty it reminds me of voltage gate voltage gated sodium channels because sodium is salt so all-pro an all-pro receiver who's very salty Dez Bryant he's an all-pro all-pro reminds me of anemia liver pancreatitis and spina bifida but it also reminds me that because Dez Bryant is such a salty son-of-a-bitch that salt are voltage-gated salt channels are being inhibited here so that's valproate all-pro from valproate now let's talk about phenytoin finito ins mechanism is that you have an inhibition or decrease activity at voltage-gated sodium channels so same exact mechanism – the gaba part there's really no main indication for phenytoin so the adverse drug reactions that you should know about our gingival hyperplasia and fetal hyde Anto and syndrome in addition to that I want you to know that this drug undergoes zero order kinetics which means just to refresh your memory that the drug is eliminated at a constant rate that does not change based on the amount of the drug it's the same amount per hour shall we say that gets eliminated and it's a p450 inducer that's also really high yield so how do we remember phenytoin well to remember finito and we're gonna think about tow truck because phenytoin you're gonna need tow in buy a tow truck so if they don't salt the roads your car will need a tow and right your car will need to be towed the tow in from phenytoin and if they don't salt the road salt reminding us that this inhibits voltage-gated salt channels so voltage-gated salt channels if they don't salt the roads your car will need a tow in and this pneumonic goes beyond just the mechanism because let's think about these things gingival hyperplasia well i think about snow hyperplasia right snow everywhere just like there's gingival hyperplasia where the cells are growing out of control i think of salt or excuse me snow hyperplasia fetal head and toen syndrome is an easy one to remember because the word ends in toen and phenytoin also ends in toen so you don't even really need a mnemonic to remember that but fetal head and toe and syndrome just so you know and i and i do suggest that you google it is craniofacial abnormalities and limb problems in addition in addition to mental retardation so that if you take phenytoin when you're pregnant your baby could have fetal heightened toe and syndrome toe in and phenytoin but again the way that i remember the this by if they don't salt the roads your car will need a toe in salt for the voltage-gated salt channels if if there's a lot of snow out there there's gonna be zero order right there's gonna be absolutely no order on the roads it's a p450 inducer so if they don't salt the roads you're gonna be inducing tow trucks to come rescue the cars gingival hyperplasia i think about snow hyperplasia just snow everywhere which is why you're gonna need a tow in when they don't salt the roads and then fetal hide in tow and syndrome again easy to remember just because it ends in towing so that's everything you should know about finito and so close your eyes think about phenytoin and when you can't remember anything about this drug just remember toen like the tow truck why are you being towed well they didn't salt the roads which means there's snow everywhere there's snow hyperplasia zero order kinetics because there's zero order on the roads and it's a p450 inducer because we're gonna have to induce the tow trucks to come dig our cars out of the snow so that is funny telling now we're going to talk about etho sucks amide the mechanism of ethos EXA mised is that it inhibits the t-type calcium channels so just remember the word calcium if you see calcium that's the answer they're not going to make you pick T type any other type you're gonna see calcium and that's gonna be the answer the indication here and this is a really high yield one is absence seizures so absence seizures are always treated by ethos auxin ID the main adverse drug reaction to note is stevens-johnson syndrome so the mnemonic here is really really easy absence seizures suck there sucks absence reps on seizures and sucks for sucks an ID so absence seizures suck or absence seizures sucks the other thing that I really want you guys to memorize is I have this clever mnemonic to remember all of the anti-epileptics that cause Stephen Johnson syndrome so Stevens Johnson syndrome is a really really nasty rash that you can get and if you get it it can develop into something which is worse called toxic epidermal necrolysis and google what that looks like it's hideous but what you need to know is the drugs that cause the rash because if you put a patient on a drug and all of a sudden they get some nasty looking rash then you need to stop the drug so Stevens Johnson syndrome one of the drugs that causes it is etho sucks amide so the mnemonic that I have to remember the different drugs that cause it or I think about five male friends and their names are Ethan Carl Larry Stephen and Johnson this is actually a picture of the band in sync but that's the picture I always I've always used in my own notes so Ethan Carl Larry Stephen and Johnson and each of these names signifies a drug so etho sucks am i it is Ethan so if you give etho suck some ID you can call Stevens Johnson syndrome and etho suck some ID is represented in the group of friends by Ethan of course Stephen and Johnson are not drugs but they just tell you that Ethan Carl and Larry can cause Stephen and Johnson syndrome so Ethan is etho suck some ID and as we go through this lecture you'll you'll meet Carl and you'll meet Larry these are all drugs that cause stevens-johnson syndrome so now we're going to talk about carbamazepine so carbamazepine is mechanism is that it increases the refractory period of voltage-gated sodium channels and when you increase the refractory period of anything it means you're increasing the time that that receptor is not working and by doing that you're still blocking excitation and when you block excitation you treat seizures high yield indication here is trigeminal neuralgia really really high-yield that for some reason they the board's love to go after trigeminal neuralgia they're gonna describe a patient to you who has trigeminal neuralgia and they will ask you what drug do you give or what's the mechanism of that drug or what's the side effect of that drug all of this is tied together so so pay close attention here carbamazepine causes stevens-johnson syndrome and if you remember our boy band our friends Ethan Carl Larry Steven and Johnson carbamazepine is represented by Carl so Carl for carbamazepine let's talk about trigeminal neuralgia really quickly so trigeminal neuralgia is a problem in the distribution of the trigeminal nerve which supplies sensory innervation to various muscles of the face in the v1 v2 and v3 distribution you can see a picture of it right there but basically someone has sharp shooting lancinating pain over their cheek up back to just over the top of the ear that is trigeminal neuralgia and the pain is debilitating you will not miss this on an exam if they give this to you on us Emily or comlex it's gonna be sharp shooting stabbing lancinating pain and the distribution of the muscles that you see here and again they're in their innervated by the trigeminal nerve which is why this is called trigeminal neuralgia so when this happens you treat with carbamazepine and I told you that that's super high-yield so how do we remember this my pneumonic is that you chew carbs with your cheek so the the carbs for carbamazepine and you eat or chew carbs with your cheek so imagine literally eating a sandwich you're gonna be using the facial muscles that are innervated from in the sensory distribution by the trigeminal nerve so you eat carbs or you chew carbs with your cheek that reminds me that trigeminal neuralgia is treated with carbamazepine so you chew carbs with your cheek and they don't forget carl is carbamazepine in our group of friends Ethan Carl Larry Steven and Johnson so Carl or carbamazepine will cause stevens-johnson syndrome now let's talk about lamotrigine so lamotrigine mechanism is that it inhibits voltage-gated sodium channels and it also has activity at glutamate receptors now lamotrigine also is one of the drugs that causes stevens-johnson syndrome so Larry is lamotrigine so we're done with our group of friends now we talked about Ethan which is eco sucks amide talked about Carl whose carbamazepine and now we're finishing with Larry who is lamotrigine so those three friends are those for three drugs will cause stevens-johnson syndrome so that's really really high yield how do we remember that this has activity not only at voltage-gated sodium channels but also at glutamate receptors this is really high yield as far as mechanisms go because it's the only drug that has activity at both voltage-gated sodium and glutamate receptors so from the perspective of the seizure and this is our cartoon seizure from the perspective of the seizure if you give somebody lamotrigine it has two mechanisms at two different receptors so the seizure who really wants you to keep seizing cuz seizures are just sick that occur in our brains the seizure looks at this double mechanism going on and says wow you're attacking me at two receptors that's lame-o lame-o for lamotrigine so from the perspective of the seizure the seizures like oh it's so lame you're turning me off at voltage-gated sodium and glutamate receptors lame-o for lamotrigine and then don't forget lamotrigine is Larry Stevens Johnson syndrome so we're flying guys I hope you're able to keep up here but it's not that bad if you get these mnemonics down let's quickly talk about some of the easier wants to remember now so these are benzodiazepines and barbiturates and really the only thing that you need to know about these guys is their mechanism so they increase the activity at the GABA a receptor and the way that they do this is that benzos increase the frequency of chloride channel opening and barbiturates increase the duration of chloride channel opening and this I wanna pause for a second because this is really really high yield it's not difficult to remember but it's high yield because exams love to go after the differences in these mechanisms because the only difference is the word frequency or the word duration and you will see a question on this in some question Bank maybe even on your USMLE or complex so let's talk about this how do you remember which ones frequency and which ones duration well instead of saying barbiturate I want you to say barbiturate barbiturate sodor for duration so barbiturates increase the duration of chloride channel opening and benzos increase the frequency of chloride channel things so if you remember the barbiturate just by process of elimination you'll know that benzos have to be frequency so that's barbiturate for dur for duration the only other thing is that you should know that benzos are used as a board of means of stopping a seizure so if someone's seizing on the table and you need to stop the seizure you give them a benzo that's really all you need to know about benzos and barbiturates as far as seizures are concerned we're gonna talk now about levity racetam so the mechanism is unknown and you may think that that's something that you won't be asked but I have seen the question come up and the answer is unknown mechanism or maybe in the clinical vignette they'll say a drug with an unknown mechanism blahdy blahdy blah what's the drug so you got to know that levity racetam is an unknown mechanism I know that sounds funny sounds stupid but just know it so how do we remember this I want you to think when you think of levity racetam I want you to think of a magician making somebody levitate how does he do the levitate trick I don't know that's I don't know reminds me that the mechanism is unknown so how do you levitate I don't know unknown mechanism I just don't know levitate for levity racetam I mean how simple can we get guys I'm really boiling this down let's talk about two of the lower yield drugs that I've included for completeness sake ty Agra beam and the gaba trend I'm probably butchering the pronunciation here but who cares mechanism gaba it has activity at gaba the way that you remember this is you look at the name ty at Gabon and vig gaba Trin so gab or gaba is in the name it's got activity at gaba that's literally all you need to know so if you see this drug they ask you the mechanism look at the name take the guess and take the easy point we're going to finish up with topiramate soto pyramids mechanism is that it it inhibits voltage-gated sodium channels just like a lot of the other drugs we've talked about today how do we remember this well with topiramate I want you to think of a toe pirate mate or a pirate ship here's our pirate ship and just so you know a pirate ship sails on salt water salt for voltage-gated salt channels so that's it guys that is all the anti epileptic drugs that is all of their mechanisms all with mnemonics all of the high-yield indications and adverse drug reactions some things in closing and in summary that I would like you to remember is Carl Larry Ethan Stephen and Johnson the five friends who called Stevens Johnson syndrome you can remember Ethan Larry and Carl as etho sucks amide lamotrigine and carbamazepine remember that carbamazepine treats trigeminal neuralgia remember that ethos aksumite treats absence seizures and remember some of the other stuff as far as mechanisms are concerned and when you're learning the mechanisms it's something that you just unfortunately have to memorize so go back and use these mnemonics because they're free points good luck


  1. You saved my life ❀️❀️❀️❀️❀️❀️ this shit is amaaaaazing

  2. Oooh if you could do a video on antibiotic/antiviral/antifungal pharm that would be sensational πŸ™πŸΏ

  3. I always remember Benzo: pam/lam going in a fast car (think Benz car is fast and fast acting) and Barbs: barb is in jail for long duration (jail- long term and barbitol so it has -tol ending)


  5. I was taught the Benzo's vs Barbiturates by remembering that "BEN like's it more frequently" and "BARB like's it for longer duration" so I figured i'd pass that one along. Thanks for these videos!

  6. Thank you for all your vids! Request for future video: CYP inducers and inhibitors mnemonic (or song) please! FA list isn't cutting it

  7. Thanks again for another awesome Video.

    One addition to Phenytoin: It is the first line therapy (FLT) for status epilepticus and for recurrent seizure prophylaxis.

  8. Hi, DirtyUSMLE. Just wanna say, you're absolutely awesome. I dedicate my USMLE step 1 to you because you literally have saved my ass.
    I wanted to ask is it possible to make videos on diseases of Myelination and some other things like Myasthenia Gravis, Lambert Eaton Syndrome, cause some of these diseases look kinda similar, but on the test made me feel confused.
    Thank you a lot.
    Hope my $5 will help this channel to keep improving. Waiting for your website. Never stop never stopping XD

  9. Benzodiazepines β€œBen” name of boy
    Barbiturates β€œBarb” name of girl
    Boys like frequency – benzo
    Girls like Duration – Barb
    Full credits go to Dr.Harris

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