AED First line Meds

Question 1

First line for focal seizures

Answer 1

Carbamazepine (Tegretol)

Question 2

used for partial seizures

Answer 2

Oxcarbazepine (Trileptal)

Question 3

first line adjuvant option for pts 2+ with primary generalized seizures (Tonic clonic and absence) and Lennox gastuat syndrome

Answer 3

lamotrigine

Question 4

“broad spectrum” AED

Answer 4

Valproic Acid

Question 5

adjunct tx for focal seizures in 4+
myoclonic 12+
tonic clonic in 6+

Answer 5

levetiracetam (Keppra)

Question 6

2+ : focal, tonic clonic and Lennox Gastaut
migrane
weight loss

Answer 6

Topiramate

Question 7

absence seizures

Answer 7

ethosuximide (Zarontin)

Question 8

generalized tonic clonic and focal seizures

Answer 8

phenytoin

Question 9

only used when phenytoin isn’t available

Answer 9

Fosphenytoin ( the prodrug of phenytoin, given IV only)

Question 10

what med doesn’t work for absence or myoclonic?

Answer 10

carbamazepine

Question 11

what are 3 CI of carbamazepine

Answer 11

history of bone marrow depression
HLA-B 1502 (higher risk Asians SJS - genetic test)
if on a MAOI med

Question 12

why is carbamazepine preg D?

Answer 12

risk of spina bifida, .5% of fetus exposed week 4-6 early!

VERY teratogenic!

Question 13

Oxacarbazepine interacts with what AED?

Answer 13

carbamazepine - causes rash

Question 14

what AED is a strong CYP3A4 inducer

Answer 14

carbamazepine

Question 15

what AED can cause DRESS syndrome?

Answer 15

Lamotrigine

Question 16

what are some of the second line options for lamotrigine? 2

Answer 16

bipolar disorder for adults, and monotherapy focal seizures for adults

Question 17

what is a big drug interaction of lamotrigine?

Answer 17

OCP!! lowers progesterone component of OCP which is main contraceptive..pregnancy higher risk - switch to another option

Question 18

what are 3 box warnings of valproic acid?

Answer 18

hepatotoxicity, teratogenicity, pancreatitis

Question 19

topiramate off label uses (2)

Answer 19

neuropathic pain for DM, bipolar disorder

Question 20

examples of some topiramate warnings

Answer 20

acute myopia and secondary angle closure glaucoma 
metabolic acidosis 
cleft palate if used with pregnancy 
kidney stones 
suicidal ideation

Question 21

common ADR of topiramate

Answer 21

somnolence, ataxia, vision change, difficulty concentrating

Question 22

severe ADR of topiramate

Answer 22

SJS, pancreatitis, metabolic acidosis, hallucinations, osteoporosis etc.. TONS!

Question 23

is topiramate a 2C19 inhibitor and 3A4 inducer?

Answer 23

YES! inhibits 2C19: such as Clopidogrel (Plavix)

Other drug interactions: CNS depressant - makes drugs effects stronger

can decrease OCP efficacy - monitor for spotting

Question 24

ethosuximide (Zarontin) moa

Answer 24

T CCB

Question 25

pink brown urine seen with ?

Answer 25

ethosuximide

Question 26

serious ethosuximide ADR

Answer 26

SLE, rash, mood changes, SJS, blood dyscrasias

Question 27

is phenytoin kinetics nonlinear?

Answer 27

YES: small dose change leads to disproportionate changes in levels

Question 28

phenytoin is heavily ____

Answer 28

protein bound, low albumin conditions could change drug levels

Question 29

what is necessary for phenytoin?

Answer 29

check levels 7-10 days later to see how its working, phenytoin best for monotherapy

Question 30

some examples of meds phenytoin lowers levels of

Answer 30

AEDs: carbamazepine, clonazepam, lamotrigine
others: acetaminophen, amiodarone, digoxin, disopyramide, doxycycline

Question 31

common phenytoin ADR

Answer 31

sedation, slurred speech, nystagmus, low coordination, dizziness, HA

Question 32

serious phenytoin ADR

Answer 32

osteomalacia (when with other AED), lymphadenopathy, dermatitis

Question 33

fosphenytoin is given via___

Answer 33

IV

Question 34

fosphenytoin is used for____

Answer 34

status epilepticus