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Pharm 2 > AED second line meds > Flashcards

AED second line meds Flashcards

1
Q

indication for Zonisamide

A

adjunct treatment for focal seizures in adults

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2
Q

CI for Zonisamide

A

sulfonamide allergies

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3
Q

3 examples of Zonisamide warnings

A

SJS, blood dyscrasias, kidney stones

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4
Q

why are Zonisamide and Toperimiate similar?

A

both carbonic anhydrase inhibitors

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5
Q

MOA lacosamide

A

enhances slow inactivation of NA+ channels

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6
Q

lacosamide indications 3

A

focal seizures, neuropathy, fibromyalgia

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7
Q

3 warnings for lacosamide

A

DRESS, syncope, afib/aflutter

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8
Q

ADR of lacosamide

A

diplopia, HA, dizziness

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9
Q

MOA perampanel

A

noncompetitive glutamate receptor antagonists

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10
Q

is Perampanel a controlled substance?

A

YES CIII - potential for addiction

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11
Q

2 key drug interactions for perampanel

A

OCP less effective

additive effect with alcohol

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12
Q

what are 2 GABA barbiturate drugs?

A

phenobarbital, primidone

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13
Q

MOA of phenobarbital

A

prolongs GABA mediated choloride channel openings

some blockade of kainite receptors

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14
Q

phenobarbital anticonvulsant powers are _____ but many ____

A

strong , but many ADRs

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15
Q

3 warnings phenobarbital

A

pregnancy, alcohol use, respiratory depression

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16
Q

3 drug interactions of phenobarbital

A

corticosteroids - enhances metabolism
anticoagulants - decreases efficacy
CNS depressants - additive effects

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17
Q

Primidone is metabolized to ___ in the liver

A

phenobarbital

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18
Q

2 indications of primidone

A

generalized tonic clonic seizures and psychomotor seizures

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19
Q

benzodiazepines increase_____

A

frequency of GABA mediated chloride channel openings

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20
Q

3 examples of benzodiazepines

A

clonazepam, diazepam, lorazepam

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21
Q

diazepam’s long half life causes you to have _____

A

a long post icterus hangover.. so we use midazolam nad lorazepam for status epilepticus instead

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22
Q

Gabapentin indication

A

post herpetic neuralgia and focal seizures

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23
Q

how is gabapentin eliminated?

A

renal so dose adjust!

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24
Q

2 additional uses for gabapentin

A

peripheral neuropathy and bipolar disorder

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25
Q

pregabalin is indicated for..

A 
DM peripheral neuropathy 
postherpetic neuralgia 
adjunctive therapy for adult pts with focal seizures 
fibromyalgia 
neuropathic pain with spinal cord injury
26
Q

pregabalin is ___eliminated

A

renal - dose adjust

27
Q

ADR of pregabalin

A

angioedema, peripheral edema, weight gain,

28
Q

tiagabine MOA

A

interferes with GABA reuptake by binding to reuptake carrier

29
Q

4 uses for tiagabine

A

anxiety, bruxism, migraine, neuropathic pain

30
Q

tiagabine can cause…

A

new onset of seizure in pts without prior history of epilepsy

31
Q

Tiagabine adr

A

depression dizzy nervousness tremor

32
Q

vigabatrin

A

indicated for infantile spasms up to age 2

33
Q

___ is associated with permannt vision loss

A

vigabatrin

34
Q

what drugs are first line for status epilepticus

A

Diazepam lorazepam IV or Midazolam IV ..usually midazolam or lorazepam are used because diazepam gives you longer post ictus state

35
Q

clonazepam is second line for

A

absence seizures

36
Q

what are 4 main uses of gabapentin (Neurontin)

A

focal seizures, post herpetic neuralgia, peripheral neuropathy, and bipolar disorder

37
Q

what are 2 warnings with gabapentin use?

A

pancreatic cancer - seen in rats

DRESS

38
Q

what are some common gabapentin ADR?

A

sedation, dizzy, weight gain

39
Q

what is brand of pergabalin

A

Lyrica

40
Q

what did Switzerland study reveal about pregabalin

A

higher risk of birth defects and possible higher rate of miscarriage

41
Q

what drug is a structural derivative of gaba and the son of gabapentin?

A

pregabapentin (lyrica_

42
Q

tiagabine moa

A

interferes with GABA reuptake by binding uptake carrier

43
Q

what drug can treat west syndrome aka infantile spasms up to age 2?

A

vigabatrin

44
Q

how does ezogabine work?

A

opens potassium channels

45
Q

ezogabine is similar to ___ in indication

A

lacosamide - both add ons for focal seizure in adults

46
Q

3 weird ezogabine ADR

A

blue skin discoloration
retinal pigment changes
urinary retention

47
Q

2 drug interactions of ezogabine

A

alcohol and dignoxin

48
Q

ezogabine is a C–

A

5 substance

49
Q

why is felbamate last line?

A

due to risk of aplastic anemia and acute liver failure

50
Q

2 indications felbamate

A

refractory partial seizures, lennox-gaustaut syndrome

51
Q

eslicarbazepine approved for __

A

mono or add on therapy for partial onset seizures

52
Q

p450 and exlicarbazepine

A

3A4 inducer and 21C9 inhibitor: OCP, warfarin and statins

53
Q

brivaracetam indicated __

A

partial onset seizures pts over 15 - new drug as of 2016!

54
Q

ADR brivaracteam

A

sedation, dizzy, fatigue, N/V

55
Q

5 examples of acute AED adr

A

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

56
Q

SJS more common in ____ pts that are also receiving ___ or aggressively titrated

A

lamotrigine

valproate

57
Q

early sx of SJS

A

abdominal pain, jaundice, vomit

58
Q

examples of long term AED us ADR

A

osteomalacia, osteoporosis, teratogenesis, altered connective tissue
sexual dysfunction: polycystic ovaries etc.

59
Q

what are 2 AED safe with pregnancy

A

lamotrigine or levetiracetam

60
Q

what AED had shown lower IQ fetal rates

A

valproate

Pharm 2 (9 decks)

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