AEDs Flashcards

1
Q

what is the protocol for weaning people off AEDs?

A

SLOWLY + if person is on more than one AED, discontinue one at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 4 traditional AED prototypes?

A
  1. phenytoin
  2. fosphenytoin
  3. carbamezepine
  4. valproic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 2 newer agents for AEDs?

A
  1. gabapentin

2. pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

compare and contrast traditional AEDs and newer agents

A

EQUAL job of preventing SE

ACUTE (1st starting drug) side effects are equal

newer agents better tolerated, less drug drug interactions, safer with pregnancy

newer agents MORE EXPENSIVE (“the one con”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the most widely used traditional agent + mainstay of epilepsy tx?

A

phenytoin (dilantin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the therapeutic index for phenytoin?

KNOW THIS; NCLEX question

A

10-20 mcg/mL

VERY narrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe what “saturation kinetics” is with phenytoin therapy?

A

liver easily gets overwhelmed –> doesn’t take much for someone to get toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the s+s of phenytoin toxicity? (5)

A
  1. nystagmus
  2. sedation
  3. ataxia
  4. diplopia
  5. blurred vision

too much phenytoin = lookin’ like you drunk

(the usual s+s…just extra!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SE of phenytoin (3)

+ which one is worse @ start of therapy, but improves over time?

A
  1. drowsiness worse @ start; improves over time
  2. gingival hyperplasia
  3. GI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how can we educate pts on prevention/management of gingival hyperplasia with phenytoin therapy?

A

massage gums, flossing, brushing teeth, regular dental care, folic acid supplements

ORAL HYGIENE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how can we combat the GI upset with AED use?

A

give with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the rare but serious AE of phenytoin?

A

RASH:

  1. toxic epidermal necrolysis
  2. SJS

REPORT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

can preggos use phenytoin?

A

NOOOO - teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the administration parameters for IV phenytoin?

A
  1. SLOW

no faster than 50mg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how can we avoid purple glove syndrome in IV phenytoin?

A

NO subcutaneous or IM

NOT in hand veins (only large)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the AED that’s the prodrug? what is it converted to in the body?

A

prodrug: fosphenytoin

converted to phenytoin

“fosphenytoin is the foster brother to phenytoin, they’re similar but VERY different”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the dosing for fosphenytoin?

A

DIFFERENT than phenytoin - dosed in phenytoin equivalents (PE)!!!!

18
Q

what are the SE of IV fosphenytoin?

A

temporary paresthesia + itching in groin

(resolves ~ 10 mins after dose)

“the foster brother has crabs, but they get better in 10 mins”

19
Q

what CV SE can we see with fosphenytoin if given too quickly via IV?

A

severe hypotension + arrhythmias

20
Q

what are the SE of carbamezepine?

A

the usual

CNS (HA, ataxia, nystagmus, blurred vision, sedation)

21
Q

what are the rare AE of carbamezepine? + based on this, what should we educate patients to report?

A
  1. bone marrow suppression
    =leukopenia, anemia, thrombocytopenia
  • report sore throat, fever, bruising*
    2. life threatening rashes: SJS + TEN
22
Q

what genetic screening should certain patient populations undergo for carbamezepine therapy? why?

A

asian patients for HLA-B*1502

for increased risk of toxic epidermal necrolysis + SJS

23
Q

what are the severe AEs of carbamezepine

A

rash (TEN + SJS) + blood dyscrasisas

24
Q

what is the unique characteristic of carbamezepine re: half life?

A

this drug increases its own metabolism –> decreased half life over time

25
Q

what drug food interactions occur with carbamezepine?

A

grapefruit

+ LOTS of drug-drug interaxns

26
Q

what is most common SE of valproic acid?

A

GI upset

“acid burns the stomach!!”

27
Q

what are the (3) rare but serious AE of valproic acid?

A
  1. hepatotoxicity
  2. pancreatitis
  3. blood dyscrasias (leukopenia, anemia + thrombocytopenia)
28
Q

which AED is the MOST teratogenic?

A

valproic acid

“you shouldn’t give acid to babies”

29
Q

what is important teaching point for valproic acid (PO admin)?

A

don’t crush or chew tablets - swallow whole

can open + sprinkle capsules if if difficulty swallowing

30
Q

what is dosing like for gabapentin therapy for seizure tx?

A

HIGHER doses

31
Q

what are SE of gabapentin? what’s unique about them?

A

(CNS)
sedation, somnolence, dizziness, ataxia, fatigue, nystagmus

*especially pronounced when starting drug, like traditional AEDs, but IMPROVE OVER TIME ◡̈ *

32
Q

what are the SE of pregabalin?

2 are unique and different

A

(CNS)

sedation, dizziness, somnolence, blurred vision, WEIGHT GAIN + EUPHORIA

33
Q

pregabalin (Lyrica) is what schedule drug?

A

schedule 5 (due to euphoria)

34
Q

if someone is in active seizure, what drug therapy would you expect to give?

A

BENZOS (“calming down GABA”)

ex: lorazepam, diazepam, midazolam

35
Q

what is IV admin rate for lorazepam?

A

2mg/min

36
Q

what is IV admin rate for diazepam?

A

5mg/min

37
Q

which SE of AEDs is common when starting, but generally improves over time?

A

Sedation

38
Q

AEDs shouldn’t be taken with what other drug classes + why?

A

other CNS depressants (ETOH, opioids, antidepressants)

= SAFETY RISK

39
Q

what should be considered with pregnancy and AED therapy?

A

risk ratio - is it more harmful for person carrying fetus to have seizure? or is drug more harmful to fetus?

40
Q

what’s important teaching point to patients on AEDs re: oral contraceptives?

A

AEDs decrease the effectiveness of OCPs!!!