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Pharmacology PaxFlan > AEDs > Flashcards

AEDs Flashcards

1
Q

“1st line” drugs for partial (focal) seizures

A

carbamazepine
lamotrigine
levetiracetam
oxcarbazepine

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2
Q

“1st line” drugs for primary generalized tonic-clonic seizures

A

lamotrigine
levetiracetam
valproate

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3
Q

“1st line” drugs for absence seizures

A

ethosuximide

valproate

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4
Q

“1st line” drugs for atypical absence, myoclonic, atonic seizures

A

lamotrigine
levetiracetam
valproate

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5
Q

when should one check [anti-seizure drug]

A

in AM before next dose

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6
Q

What is the leading cause of tx failure with AEDs

A

ADRs

titrate up to prevent severe ADRs

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7
Q

AEDs that affect Na+ channels

A 
Carbamazepine 
oxcarbazepine/eslicarbazepine 
phenytoin/fosphenytoin 
lamotrigine 
lacosamide
zonisamide
rufinamide
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8
Q

CBZ (carbamazepine) indications

A

partial and mixed seizures, chronic pain syndromes (trigeminal neuralgia), acute manic/mixed episodes in bipolar I

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9
Q

what is the importance of dosing CBZ

A

it is an autoinducer so you want to check [CBZ] through 3, 6, 9 weeks (over time may need to increase dose)

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10
Q

cytochrome interactions of CBZ

A

inducer of 2C9 and 3A4

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11
Q

ADRs of CBZ

A 
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 >)
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12
Q

who needs to undergo allelic screening before CBZ is given

A
  • northern Europeans

- pts of Asian ancestry&raquo_space;

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13
Q

CBZ and pregnancy

A

teratogen

neural tube defects!

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14
Q

Oxcarbazepine/Eslicarbazepine indications

A

partial seizures

bipolar disorders + neuropathic pain

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15
Q

monitoring for oxcarbazepine/eslicarbazepine

A

LFTS, serum Na

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16
Q

interactions of oxcarbazepine/eslicarbazepine

A

CNS depressants

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17
Q

ADRs of oxcarbazepine/eliscarbazepine

A

similar to CBZ (better tolerated)

more hyponatremia than CBZ

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18
Q

phenytoin/fosphenytoin indications

A

prevention of “early” seizures following TBI

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19
Q

what is important about dosing of phenytoin

A

autoinducer

check concentrations 2-3 weeks after initiation and 5-7 days after change

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20
Q

monitoring in phenytoin

A

VS, CBC, LFTs, Ca2+ and vitamin D

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21
Q

ADRs of phenytoin that are not related to the concentration

A

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)

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22
Q

ADRs of phenytoin that ARE related to concentration

A

nystagmus, ataxia, decreased mentation, death

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23
Q

phenytoin/fosphenytoin + pregnancy

A

teratogen (clefting)

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24
Q

Lamotrigine indications

A

newly diagnosed absence seizures, LGS, maintenance of bipolar disorder

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25
Q

lamotrigine interactions

A

VPA increases [lamotrigine] > 2x

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26
Q

lamotrigine ADRs

A

rash, aseptic meningitis

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27
Q

Lacosamide indications

A

monotherapy or adjunctive for partial-onset

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28
Q

monitoring of lacosamide

A

baseline ECG in pts with conduction problems/severe cardiac disease

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29
Q

lacosamide interactions

A

concomitant PR-prolonging drugs (B-blockers, CCBs)

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30
Q

lacosamide ADRs

A

neurotoxic - euphoria, small increase in mean PR interval

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31
Q

zonisamide indications

A

adjunctive for focal seizures

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32
Q

monitoring for zonisamide

A

BUN/Cr, baseline serum [HCO3]

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33
Q

Zonisamide ADRs

A

oligohidrosis, hyperthermia, heat stroke
skin reactions (SJS/TEN)
metabolic acidosis/renal stones
neurotoxic ADRs as with CBZ

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34
Q

Rufinamide indications

A

LGS

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35
Q

monitoring for rufinamide

A

ECG

36
Q

rufinamide interactions

A

additive effect with other drugs that shorten QT interval

37
Q

AEDs that affect K+ channels

A

ezogabine

38
Q

Ezogabine indications

A

partial-onset seizures (adjunctive)

39
Q

monitoring of Ezogabine

A

ECG for QT interval

40
Q

interactions of Ezogabine

A

concomitant QT prolongers

41
Q

ADRs of ezogabine

A

neuropsychiatric - dizziness, hallucinations
urinary retention - cath?
euphoria

42
Q

AEDs that affect Ca2+ channels

A

Ethosuximide
Gabapentin
Pregabalin

43
Q

Ethosuximide indications

A

tx of absence seizures

44
Q

monitoring of ethosuximide

A

CBC, LFTs

45
Q

interactions of ethosuximide

A

CNS depressants

46
Q

ADRs of ethosuximide

A

neuropsych - drowsiness, hyperactivity (psychotic behavior)

N/V, bone marrow suppression

47
Q

Gabapentin indications

A

partial seizures (adjunct), management of postherpetic neuruopathy, restless leg syndrome

48
Q

dosing of Gabapentin

A

300 mg TID with titration

49
Q

ADRs of gabapentin

A

somnolence, dizziness (otherwise well-tolerated)

50
Q

pregabalin indications

A

fibromyalgia, management of peripheral neuropathies, RLS, off-label for GAD

51
Q

ADRs for pregabalin

A

weight gain, euphoria/withdrawl

schedule V

52
Q

AEDs that modulate GABA activity

A 
phenobarbital 
clobazam 
clonazepam
tiagabine
vigabatrin
53
Q

phenobarbital indications

A

partial and secondarily generalized but now has limited use d/t sedating effect

54
Q

monitoring in phenobarbital

A

CBC, LFTs, Ca2+ + vitamin D

55
Q

phenobarbital interactions

A

induces 2C9 and 3A4

CNS depressants

56
Q

phenobarbital ADRs

A

sedation, rash, bone marrow suppression

57
Q

clobazam indications

A

LGS (adjunctive)

58
Q

clonazepam indications

A

LGS (adjunctive)

59
Q

tiagabine indications

A

adjunct for partial seizures

60
Q

monitoring for tiagabine

A

CBC, CMP

61
Q

tiagabine ADRs

A

new-onset seizures & status epilepticus have been associated with taken for unlabeled indications

62
Q

Vigabatrin indications

A

infantile spasms r/t tuberous sclerosis

orphan drug

63
Q

vigabatrin ADRs

A

irreversible retinal toxicity

64
Q

glutamate receptor antagonist AED

A

perampanel

65
Q

perampanel indications + ADRs

A

no vital indications

Schedule III - homicidal ideation/threats

66
Q

valproate MOA

A

blocks Na+ channels, acts against T-type Ca2+ currents, increase GABA at clinical doses

67
Q

valproate indications

A

mania associated with bipolar depression

migraine prophylaxis

68
Q

valproate monitoring

A

LFTs, CBC, serum ammonia

69
Q

valproate interactions

A

lamotrigine

70
Q

valproate ADRs

A

lethargy, dizziness, tremor, parkinsonism syndrome & cognitive decline
weight gain, hepatotoxicity / hepatic failure (kids have increased risk)

71
Q

valproate and pregnancy

A

teratogenicity (*most teratogenic over carbamazepine, phenytoin)
*use only for seizures/bipolar, not migraines

72
Q

topiramate MOA

A

blocks Na channels, enhances GABA at a nonBZD on GABA receptors, antagonizes NMDA-glutamate receptor

73
Q

topiramate indications

A

migraine prophylaxis, chronic weight management

74
Q

topiramate monitoring

A

serum [HCO3] at baseline & q2-4 months recommended

75
Q

topiramate ADRs

A

wt loss
oligohidrosis, hyperthermia, heat stroke
carbonic anhydrase inhibitor –> metabolic acidosis/renal stones
dizziness/ataxia, blurred vision/visual disturbances, reversible memory or concentration difficulties

76
Q

Felbamate indications

A

LGS

monotherapy & adjunctive therapy for partial seizures & secondarily generalized seizures

77
Q

felbamate ADRs

A

fetal aplastic anemia & hepatic failure –> written consent required before therapy

78
Q

Levetiracetam indications

A

prevention of early seizures following TBI/NS (replaced phenytoin as gold standard)

79
Q

levetiracetam monitoring

A

psychiatric effects (suicidal thoughts, depression)

80
Q

brivaracetam indications

A

adjunctive tx of partial onset seizures

81
Q

brivaracetam monitoring

A 
psychiatric effects (same as levetiracetam) 
CBC, CMP
82
Q

cannabidiol indications

A

seizures associated with dravet syndrome or LGS in pts >2 yrs

83
Q

cannabidiol interactions

A

inhibitor of 2C9 & 2C19

84
Q

cannabidiol ADRs

A

somnolence, decreased appetite, diarrhea, serum transaminase elevations

85
Q

monitoring of CBZ

A 
CBC
CMP (Na, LFTS, BUN) 
lipid panel 
Vit D, calcium 
UA
TFTs
pregnancy test

Pharmacology PaxFlan (12 decks)

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