AED second line meds Flashcards
indication for Zonisamide
adjunct treatment for focal seizures in adults
CI for Zonisamide
sulfonamide allergies
3 examples of Zonisamide warnings
SJS, blood dyscrasias, kidney stones
why are Zonisamide and Toperimiate similar?
both carbonic anhydrase inhibitors
MOA lacosamide
enhances slow inactivation of NA+ channels
lacosamide indications 3
focal seizures, neuropathy, fibromyalgia
3 warnings for lacosamide
DRESS, syncope, afib/aflutter
ADR of lacosamide
diplopia, HA, dizziness
MOA perampanel
noncompetitive glutamate receptor antagonists
is Perampanel a controlled substance?
YES CIII - potential for addiction
2 key drug interactions for perampanel
OCP less effective
additive effect with alcohol
what are 2 GABA barbiturate drugs?
phenobarbital, primidone
MOA of phenobarbital
prolongs GABA mediated choloride channel openings
some blockade of kainite receptors
phenobarbital anticonvulsant powers are _____ but many ____
strong , but many ADRs
3 warnings phenobarbital
pregnancy, alcohol use, respiratory depression
3 drug interactions of phenobarbital
corticosteroids - enhances metabolism
anticoagulants - decreases efficacy
CNS depressants - additive effects
Primidone is metabolized to ___ in the liver
phenobarbital
2 indications of primidone
generalized tonic clonic seizures and psychomotor seizures
benzodiazepines increase_____
frequency of GABA mediated chloride channel openings
3 examples of benzodiazepines
clonazepam, diazepam, lorazepam
diazepam’s long half life causes you to have _____
a long post icterus hangover.. so we use midazolam nad lorazepam for status epilepticus instead
Gabapentin indication
post herpetic neuralgia and focal seizures
how is gabapentin eliminated?
renal so dose adjust!
2 additional uses for gabapentin
peripheral neuropathy and bipolar disorder
pregabalin is indicated for..
DM peripheral neuropathy postherpetic neuralgia adjunctive therapy for adult pts with focal seizures fibromyalgia neuropathic pain with spinal cord injury
pregabalin is ___eliminated
renal - dose adjust
ADR of pregabalin
angioedema, peripheral edema, weight gain,
tiagabine MOA
interferes with GABA reuptake by binding to reuptake carrier
4 uses for tiagabine
anxiety, bruxism, migraine, neuropathic pain
tiagabine can cause…
new onset of seizure in pts without prior history of epilepsy
Tiagabine adr
depression dizzy nervousness tremor
vigabatrin
indicated for infantile spasms up to age 2
___ is associated with permannt vision loss
vigabatrin
what drugs are first line for status epilepticus
Diazepam lorazepam IV or Midazolam IV ..usually midazolam or lorazepam are used because diazepam gives you longer post ictus state
clonazepam is second line for
absence seizures
what are 4 main uses of gabapentin (Neurontin)
focal seizures, post herpetic neuralgia, peripheral neuropathy, and bipolar disorder
what are 2 warnings with gabapentin use?
pancreatic cancer - seen in rats
DRESS
what are some common gabapentin ADR?
sedation, dizzy, weight gain
what is brand of pergabalin
Lyrica
what did Switzerland study reveal about pregabalin
higher risk of birth defects and possible higher rate of miscarriage
what drug is a structural derivative of gaba and the son of gabapentin?
pregabapentin (lyrica_
tiagabine moa
interferes with GABA reuptake by binding uptake carrier
what drug can treat west syndrome aka infantile spasms up to age 2?
vigabatrin
how does ezogabine work?
opens potassium channels
ezogabine is similar to ___ in indication
lacosamide - both add ons for focal seizure in adults
3 weird ezogabine ADR
blue skin discoloration
retinal pigment changes
urinary retention
2 drug interactions of ezogabine
alcohol and dignoxin
ezogabine is a C–
5 substance
why is felbamate last line?
due to risk of aplastic anemia and acute liver failure
2 indications felbamate
refractory partial seizures, lennox-gaustaut syndrome
eslicarbazepine approved for __
mono or add on therapy for partial onset seizures
p450 and exlicarbazepine
3A4 inducer and 21C9 inhibitor: OCP, warfarin and statins
brivaracetam indicated __
partial onset seizures pts over 15 - new drug as of 2016!
ADR brivaracteam
sedation, dizzy, fatigue, N/V
5 examples of acute AED adr
Neuro: sedation/fatigue, diplopia, mood change
Gi: N/ heart burn
Lab: increases LFTs, leukopenia, thrombocytopenia
Weight loss
Weight gain: valproic, gaba pre gaa and vigabatrin
SJS more common in ____ pts that are also receiving ___ or aggressively titrated
lamotrigine
valproate
early sx of SJS
abdominal pain, jaundice, vomit
examples of long term AED us ADR
osteomalacia, osteoporosis, teratogenesis, altered connective tissue
sexual dysfunction: polycystic ovaries etc.
what are 2 AED safe with pregnancy
lamotrigine or levetiracetam
what AED had shown lower IQ fetal rates
valproate
