AED adverse effects Flashcards
What are the most common dose-dependent adverse effects
somnolence, fatigue, dizziness, visual changers, nystagmus, ataxia, nausea, behavioral changes
How should dosing for AEDs be done
Start low and then titrate up slowly
T/F: For AEDs a patient should only be given one if possible because polytherapy is more likely to cause in tolerable side effects
True
What are options that can be done if there are too many adverse effects of AEDs
Switch to extended release of tablets, more frequent dose administration, administer with food, reduce total daily dose
What should be done if VPA capsules or VPA enteric coated tablets are switched to extended release tablets
Dosing should be increased by 20% due to decreased bioavailability
What are cognitive problems from AEDs
difficulty thinking, impaired memory or comprehension, word finding difficulties, slowed thinking
What are behavioral changes from AEDs
Anxiety,hyperactivity, irritability, aggressiveness, altered mood, depression
Which newer AEDs are less likely to cause effects on behavior and cognition
Lamotrigine, oxacarbemazepine, Lacosamide
Which newer AEDS have minimal effects on cognition but may alter behavior
Levitracetam and Vigabatrin
T/F: AEDs are more likely to cause suicide
False: Though there is labeling for it there are more factors to suggest a link between epilepsy and sucide
What is the primary risk factor for suicidality with AEDs, what should be monitored for
Prior or family history of psychiatric disorders, monitor for depression or unusual changes in behavior (anxiety,agitation, loss of interest, hostility, mania)
What AEDs are not associated with serious hypersensitivity adverse effects
Gabapentin, levitracetam, topiramate, vigabatrin
What is the only AED that can cause pancreatitis and has low risk of causing hepatoxicity
Valporic acid
What is the mechanism that is believed to cause hypersensitivity reaction to AEDs, what is the drug associated withmechanism of direct toxic effect of metabolies
Delayed Hypersensitivity reaction for Aromatic Ring AEDs, Valporic Acid
What is the believed mechanism of Aromatic ring AEDs, what are symptoms,
Drug-specific activation of cytotoxic T-cells increasing of cytotoxic T-cells/ rash, fever, high eosinophils
What are AEDs that are theorized to cause aromatic Ring delayed hyper
Carbazmezapine, lamotrigine, oxacarmezapine, phenytoin
Which HLA alleles are associated with hypersensitivity reactions, what are the drugs associated
HLA-B 1502/ Carbamazepine, lamotrigine, oxacarbazepine, phenytoin
What risk factors make it more likely that a patient will have a hypersensitive reaction to Valporic acid
fatty acid or amino acid metabolism, concurrent treatment with enzyme inducing AEDS
What AED drug-drug interaction should be watched for closely
Lamtrogine and Valporic Acid
What group of people is more likely to react badly to AEDs
Asians
T/F: Baseline labs should betaken before a patient is given AEDs
True
What symptoms indicating a possible serious AED reaction
ash, fever or swollen lymph nodes/ nausea, vomiting,lethargy, jaundice/ excruciating abdominal pain and nausea/ abnormal bruising or bleeding with persistent infection
What AEDs are associated with severe skin rashes
carbamezapine, lamotrigine, oxcarbamazepine, phenytoin, phenobarbital
What AEDs are associated with aplastic anemia (abnormal bleeding with persistent infection)
Carbamazepine and phenytoin
What is the management if a patient has an AED induced skin rash
Stop AED, administer antihistamines for symptomatic relief, re-examine within 24 hours, AEDs should be avoided that cause skin rash
T/F: If an AED causes a skin rash a new one should be started immediately to control epilepsy symptoms
False: There should be a delay in starting a new AED for 3-7 days because the body hasn’t fully cleared the drug yet
What AEDs can be given as alternatives AEDs that cuase skin rash
Levitracetam, Valporic acid, Topiramate
T/F: Vigabatrin causes ocular toxicity
True
Which AED is most likely to cause birth defects (spina bifida), what other AEDs can be teratogenic
Valporic acid/ Lamotrigine Leveitracetam, phenytoin, carbamezapine, topiramate, phenobarbital
T/F: pregnant women should never take AEDs
False: Pregnant women are less likely to have problems with their babies after the first trimester of pregnancy
Which AEDs are known to cause metabolism of hormonal contraception quicker, which AED has its metabolism induced by ethinyl estradiol
Carbamezapine,oxcarbemezapine, phenytoin, topiramate/ Lamotrigine
