AEDs Flashcards
“1st line” drugs for partial (focal) seizures
carbamazepine
lamotrigine
levetiracetam
oxcarbazepine
“1st line” drugs for primary generalized tonic-clonic seizures
lamotrigine
levetiracetam
valproate
“1st line” drugs for absence seizures
ethosuximide
valproate
“1st line” drugs for atypical absence, myoclonic, atonic seizures
lamotrigine
levetiracetam
valproate
when should one check [anti-seizure drug]
in AM before next dose
What is the leading cause of tx failure with AEDs
ADRs
titrate up to prevent severe ADRs
AEDs that affect Na+ channels
Carbamazepine oxcarbazepine/eslicarbazepine phenytoin/fosphenytoin lamotrigine lacosamide zonisamide rufinamide
CBZ (carbamazepine) indications
partial and mixed seizures, chronic pain syndromes (trigeminal neuralgia), acute manic/mixed episodes in bipolar I
what is the importance of dosing CBZ
it is an autoinducer so you want to check [CBZ] through 3, 6, 9 weeks (over time may need to increase dose)
cytochrome interactions of CBZ
inducer of 2C9 and 3A4
ADRs of CBZ
sedation/impaired cognition, dizziness/ataxia, blurred or double vision, HA --> may interfere with learning Rash (SJS/TEN/DRESS), vitamin D deficiency, hypocalcemia (osteomalacia) mild hyponatremia (elderly >)
who needs to undergo allelic screening before CBZ is given
- northern Europeans
- pts of Asian ancestry»_space;
CBZ and pregnancy
teratogen
neural tube defects!
Oxcarbazepine/Eslicarbazepine indications
partial seizures
bipolar disorders + neuropathic pain
monitoring for oxcarbazepine/eslicarbazepine
LFTS, serum Na
interactions of oxcarbazepine/eslicarbazepine
CNS depressants
ADRs of oxcarbazepine/eliscarbazepine
similar to CBZ (better tolerated)
more hyponatremia than CBZ
phenytoin/fosphenytoin indications
prevention of “early” seizures following TBI
what is important about dosing of phenytoin
autoinducer
check concentrations 2-3 weeks after initiation and 5-7 days after change
monitoring in phenytoin
VS, CBC, LFTs, Ca2+ and vitamin D
ADRs of phenytoin that are not related to the concentration
gingival hypertrophy**, rash (as with CBZ), vitamin D deficiency/hypocalcemia, drug fever, hepatotoxicity
(less common = hypertrichosis/werewolf, bone marrow suppression, peripheral neuropathy, drug-induced SLE)
ADRs of phenytoin that ARE related to concentration
nystagmus, ataxia, decreased mentation, death
phenytoin/fosphenytoin + pregnancy
teratogen (clefting)
Lamotrigine indications
newly diagnosed absence seizures, LGS, maintenance of bipolar disorder
lamotrigine interactions
VPA increases [lamotrigine] > 2x
lamotrigine ADRs
rash, aseptic meningitis
Lacosamide indications
monotherapy or adjunctive for partial-onset
monitoring of lacosamide
baseline ECG in pts with conduction problems/severe cardiac disease
lacosamide interactions
concomitant PR-prolonging drugs (B-blockers, CCBs)
lacosamide ADRs
neurotoxic - euphoria, small increase in mean PR interval
zonisamide indications
adjunctive for focal seizures
monitoring for zonisamide
BUN/Cr, baseline serum [HCO3]
Zonisamide ADRs
oligohidrosis, hyperthermia, heat stroke
skin reactions (SJS/TEN)
metabolic acidosis/renal stones
neurotoxic ADRs as with CBZ
Rufinamide indications
LGS