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Epilepsy Borrowed Decks > AEDs > Flashcards

AEDs Flashcards

1
Q

Pregabalin:
- Mechanism of action
- Bioavailability
- Hepatic metabolism?
- Excretion

A

Pregabalin
- Mechanism of action: structural analog of Gaba, binds to alpha-2-deta subunit of voltage-gated calcium channel
- Bioavailability drops from 60%-33% when total daily dose increased form 900 to 3500 mg
- Not hepatically metabolized
>90% excreted unchanged in urine

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2
Q

Drugs to avoid in:
- Dravet Syndrome

A

Sodium channel agents (may worsen)

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3
Q

Primary side effects to consider: Phenobarbital (6)

A
  • sedation
  • rash
  • hepatotoxicity
  • aplastic anemia
  • osteopenia
  • CT d/o
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4
Q

Primary side effects to consider:
Phenytoin
General (6)
Dose dependent (5)

A
  • SJS
  • Blood dyscrasia
  • hepatotoxicity
  • gingival hyperplasia
  • hirsutism
  • osteopenia
    Dose-dependent
  • Nystagmus
  • Diplopia
  • ataxia / incoordination
  • dysarthria
  • Drowsiness
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5
Q

Primary side effects to consider:
Primidone

A

Same as phenobarbital (metabolized into phenobarbital)

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6
Q

Primary side effects to consider:
Ethosuximide

A

stomach upset
abdominal pain/cramps

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7
Q

Primary side effects to consider: clonazepam (4)

A
  • somnolence
  • lethargy
  • sexual dysfunction
  • tolerance (long term)
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8
Q

Primary side effects to consider:
Clorazepate (tranxene)

A
  • Somnolence
  • Lethargy
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9
Q

Primary side effects to consider:
Carbamazepine (8)

A
  • Sedation
  • Neutropenia
  • hyponatremia
  • bradycardia
  • SJS
  • Agranulocytosis
  • Hepatotoxicity
  • pancreatitis
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10
Q

Primary side effects to consider:
Valproate (7)

A
  • Weight gain
  • tremor
  • thrombocytopenia
  • pancreatitis
  • hepatotoxicity
  • hyperammonemia
  • Hair loss
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11
Q

Primary side effects to consider:
VIgabatrin (3)

A
  • permanent visual field deficit (older studies say 30-40%, likely less)
  • reversible subcortical edema
  • somnolence
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12
Q

Primary side effects to consider:
Zonisamide (5)

A
  • Cross-reacts with sulfa
  • hypohydrosis
  • nephrolithiasis
  • metabolic acidosis
  • weight loss
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13
Q

Primary side effects to consider:
Lamotrigine (4)

A
  • NON-sedating
  • insomnia
  • SJS
  • myoclonus
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14
Q

Primary side effects to consider: Felbamate (3 + 4)

A
  • aplastic anemia
  • liver failure
  • weight loss
  • Increases levels of phenytoin, valproate, phenobarbital, clobazam
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15
Q

Primary side effects to consider:
Gabapentin (3)

A
  • sedation
  • weight gain
  • myoclonus
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16
Q

Primary side effects to consider:
Topiramate (5)

A
  • weight loss
  • cognitive slowing
  • dysesthesia
  • Glaucoma
  • nephrolithiasis
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17
Q

Primary side effects to consider:
Tiagabine (3)

A
  • Sedation
  • cognitive slowing
  • worsens some generalized seizures (myoclonic, absence)
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18
Q

Primary side effects to consider:
Oxcarbazepine (4)

A
  • hyponatremia (per book only in elderly)
  • Decreases OCP levels
  • Sedation
  • Rash
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19
Q

Primary side effects to consider:
Levetiracetam (2)

A
  • Irritability
  • Depression
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20
Q

Primary side effects to consider: pregabalin (3)

A
  • Sedation
  • swelling in lower extremities
  • blurred vision
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21
Q

Primary side effects to consider:
Rufinamide (3)

A
  • Loss of apetite
  • aggravated seizures
  • Status epilepticus
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22
Q

Primary side effects to consider:
Lacosamide (7)

A
  • Dizziness / vertigo > vomiting
  • Ataxia
  • diplopia
  • Blurred vision
  • Fatigue
  • Rash
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23
Q

Primary side effects to consider:
Esclicarbazepine (aptiom) (4)

A
  • Nausea
  • Dizziness
  • Diplopia
  • hyponatremia (1-2%)
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24
Q

Primary side effects to consider:
Clobazam (3)

A
  • somnolence
  • lethargy
  • note less addictive potential than other benzo
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25
Q

Primary side effects to consider:
Ezogabine (potiga) (3)

A
  • Urinary Retention
  • Tremor
  • bluish skin discoloration
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26
Q

Primary side effects to consider:
Perampanel (fycompa)

A
  • Ataxia
  • Severe mood issues (hostility, homicidal ideation, aggression)
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27
Q

ASM’s to Consider:
Focal onset, +/- secondary generalization
- Main (5)
- Less preferred (4)

A

Main:
- Lamotrigine
- levetiracetam
- oxcarbazepine
- lacosamide
- topiramate
Less likely as 1st agent:
- Carbamazepine
- Valproate
- Esclicarobazapine
- phenytoin

28
Q

ASM’s to Consider:
Primary GTC (5)

A
  • Valproate
  • Levetiracetam
  • Lamotrigine
  • Topiramate
  • zonisamide
29
Q

ASM’s to Consider:
Absence (3)
Drugs to avoid: (5)

A

Consider
- Ethosuximide
- Valproate
- (less preferred) lamotrigine
AVOID
- phenytoin
- carbamazepine
- gabapentin
- tiagabine
- vigabatrin

30
Q

ASM’s to Consider:
Generalized myoclonic (3)
Drugs to avoid (6)

A

Consider
- levetiracetam
- valproate
- clonazepam
Avoid
- phenytoin
- carbamazepine
- gabapentin
- tiagabine
- vigabatrin
- pregabalin

31
Q

ASM’s to Consider
SeLECTS (2)

A
  • LEV
  • OXC
32
Q

ASM’s to Consider:
young women (3)
Avoid (1 + 2 others)

A

Consider
- levetiracetam
- lamotrigine
- lacosamide
Avoid
- Valproate (teratogen)
- Carbamazepine
- Phenytoin

33
Q

ASM’s to Consider:
Depressed patient (1)
Avoid (3)

A

Consider
- Lamotrigine
Avoid
- pheyntoin
- phenonbarbital
- primidone

34
Q

ASM’s to consider:
Emotionally labile person (5)
Avoid (1)

A

Consider (due to mood stabilizing effect)
- Valproate
- carbamazepine
- lamotrigine
- oxcarbazepine
- topiramate
Avoid
- Levetiracetam

35
Q

ASM’s to Consider:
Hepatic disease (3)
Avoid (3)

A

Consider:
- Levetiracetam
- lamotrigine
- pregabalin
Avoid
- valproate
- phenytoin
- carbamazepine

36
Q

ASM’s to Consider:
obesity (2)
avoid (3)

A

Consider (due to weight loss)
- Topiramate
- Zonisamide
Avoid
- Valproate
- Gabapentin
- Pregabalin

37
Q

ASM’s to Consider:
Chronic pain (4)

A
  • Gabapentin
  • pregabalin
  • carbamazepine
  • pregabalin
38
Q

ASM’s to Consider:
on many other meds (3)
Avoid (1)

A

Consider
- Levetiracetam
- pregabalin
- gabapentin
Avoid
Enzyme inducers

39
Q

ASM’s to Consider:
Han Chinese or Taiwanese

A

Carbamazepine
oxcarbazepine
Note: can use if you check HLA-B 1502)

40
Q

Patient on ASM develops rash, what cross-reactivities do you need to consider (4)

A

Carbamazepine <>Oxcarbazepine
Carbamazepine <>Phenytoin
Carbamazepine <>Phenobarbital
Phenytoin <>Zonisamide

41
Q

Enzyme Inducing ASMs:
strong (5)
Weak (1)

A

Strong
- Phenobarbital
- primidone
- phenytoin
- carbamazepine
- Oxcarbazepine (doses >900 mg)
Weak
- Lamotrigine (weak)

42
Q

Enzyme inhibiting ASM
Strong (1)
Weak (1)

A

Strong: Valproate
Weak: Topiramate

43
Q
A
44
Q

Phenobarbital lowers concentrations of which ASM (3 main + 1), and what 3 other non-asm drugs

A
  • valproate
  • ethosuximide
  • lamotrigine
  • may reduce carbamazepine, but increase carbamazepine epoxide
    Also reduces effectiveness of
  • warfarin
  • steroids
  • OCP
45
Q

Patient with epilepsy and Dupuytren’s Contracture.
- What medicine could they be on that could cause this?
- What other connective tissue conditions is this med also associated with?

A

Phenobarbital
Also associated with
- platar fibromatosis
- frozen shoulder

46
Q

Pregnancy risk: Phenobarbital
Category
Risks (2)

A

Category:
- D
Risks:
- cardiac malformations
- reduced cognitive abilities (in male offspring)

47
Q

Pharmacokinetics: phenytoin
oral bioavailability: adults
oral bioavailability: Neonates
Factors that reduce oral bioavailability (3)

A

Oral Bioavailability: adults - 90%
oral bioavailability: neonates - much lower
Also reduced with
- Nasogastric feedings
- calcium
- antacids

48
Q

Patient in ICU for breakthrough seizures treated with fosphenytoin has toxicity at an unexpectedly low dose. What medication could they be on and why did this happen?

A

Valproate - competes for protein binding sites, which leads to higher Free levels of phenytoin

49
Q

ASM metabolization,Carbamazepine:
- Non-ASMs that can affect concentrations (4)
- Metabolite affected by what 4 ASM

A

Affects concentration d/t CYP3A4
- Macrolide antibiotics (other than azithromycin)
- Fluoxetine
- Propoxyphene
- Grapefruit juice
Metabolite (epoxide) affected by
- valproate
- felbamate
- oxcarbazepine
- zonisamide

50
Q

ASM metabolization, Carbamazepine:
- Important factor about dosing
-What 4 drugs do you need to be especially notable for and why?

A

Dosing:
- Auto-inducer (takes 2-4 weeks to reach steady state)
Strong inducer of cytochrome P450, increases clearance of:
- OCPs
- Warfarin
- Valproate
- lamotrigine

51
Q

Oxcarbazpine:
- Bioavailability
- half-life (main drug)
- half-life (active metabolite)
- Big reasons why it replaced carbamazepine (2)

A
  • bioavaibility- 90%
  • half-life (main drug) 1-3.7h
  • half-life (metabolite) 8-10 h
    Replaced carbamazepine due to
  • Not affected by 3A4 inhibitors (fluoxetine, erythromycin, grapefruit juice)
  • No auto-induction
52
Q

What condition is Felbamate approved by the FDA to treat specifically?

A

Lennox-Gastaut Syndrome

53
Q

Patient with Absence seizures presents with fever, arthralgia, malar rash?
- What two should you get?
- What two organs can also be involved
- What other two ASMs can cause this

A

Lupus-like syndrome (Ethosuximide, Phenytoin, Carbamazepine)
Labs:
- Elevated ANA
- Elevated anti DS DNA antibodies
Other organ systems
- Pleural effusion
- Myocarditis

54
Q

Why does topirimate cause kidney stones?

A

inhibits carbonic anydrase
- Increased urinary citrate
- Alkalinized urine

55
Q

risk factors for aplastic anemia when starting felbamate (6)

A
  • female sex
  • caucasian race
  • Adult age
  • history of cyotopenia
  • allergy / toxiticy to other ASM
  • diagnosis / serological evidence of an autoimmune disorder
56
Q

Mechanism of action: felbamate

A

binds to NR2B subunit of NMDA receptor (selective inhibition)

57
Q

factors that increase risk of VPA-induced hyperammonemia (6)

A
  • urea cycle defects
  • carnitine deficiency
  • protein rich diets
  • hypercatabolic states
  • phenobarbital
  • topiramate
58
Q

Why does levocarnitine help with VPA-induced hyperammonemia?

A
  • Carnitine required for beta-oxidation
  • VPA depletes carnitine
  • this shifts to OMEGA-oxidation > toxic metabolites > ammonia
59
Q

Which other AED, when taken with VPA, can increase risk of valproate-induced encephalopathy?
Why?

A
  • Topiramate
  • synergistic action on Ornithine metabolism > hyperammonemia
60
Q

medication known to case spike-wave-stupor

A

Tiagabine (either for seizures or insomnia)

61
Q

Side effects of AcTH
- Leading causes of death (2)
- Other symptoms (4)
- MRI findings (onset, peak, resolution)

A

Leading causes of death:
- cardiomyopathy
- infection
others:
- hypertension
- proteinuria
- bleeding
- neuropsych (agitation, apathy, insomnia)
MRI:
- onset: within first week
-maximum 4 weeks
- resolves 1-4 weeks following completion of treatment

62
Q

mechanism of action: Esogabine

A

potassium channel opener

63
Q

Name two differences between visual changes that happen with Vigabatrin versus Esogabine

A

1: cause
- Ezogabine: due to pigmentary abnormalities
- Vigabatrin: damage to the nerve
2: Reversibility
- Ezogabine: reversible
- Vigabatrin: Irreversible

64
Q

HLA alleles and what they’re associated with:
HLA-B1502 (2)
HLA-A3101 (2)

A

HLA-B1502: CBZ-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
HLA-A3101: CBZ_induced Hypersensitivity syndrome (HSS) and Maculopapular exanthema (MPE)

65
Q

Felbamate drug interaction:
What enzyme?
What ASMs can increase (2)
What ASMs can decrease (1)

A

Enzyme: CYP2C19
Increases:
- phenytoin
- valproate (but due to metabolism by beta-oxidation)
Decreases:
- carbamazepine (and epoxide)

66
Q
A

Epilepsy Borrowed Decks (57 decks)

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