AEDs

Question 1

ACTH FDA approved for which seizure types

Answer 1

first line: infantile spasms. Also used in lennox-gastaut, landau-kleffner, electrical status epilepticus in sleep

Question 2

brivaracetam fda approved for which seizure types

Answer 2

focal seizures, ages 4+

Question 3

mechanism of action brivaracetam

Answer 3

inhibits synaptic vesicle SV2A protein

Question 4

recommended initial dose brivaracetam and common maintenance dose

Answer 4

50mg BID, 25-100mg BID

Question 5

brivaracetam side effects

Answer 5

sedation, N/V, dizzy, SI, anger, psychosis

Question 6

contraindications for brivaracetam

Answer 6

bronchospasm, angioedema

Question 7

major side effects/risk factor for ACTH administration

Answer 7

INFECTION risk (contraindicated to give with recent surgery, live attenuated vaccines), HTN, salt/water retention, gastric ulcers, bowel perforation, wt gain, bleeding

Question 8

drugs that interact with brivaracetam

Answer 8

decrease efficacy w/ rifampin, EIADs. increased levels with phenytoin and CBZ-epoxide

Question 9

CBD FDA approved for use in

Answer 9

seizures associated with LGS or Dravet 2+

Question 10

CBD metabolism

Answer 10

CYP3A4

Question 11

starting dose CBD

Answer 11

10-20mg/kg/d divided BID

Question 12

CBD side effects

Answer 12

somnolence/sedation, elevated liver enzymes, decreased appetite/wt loss, insomnia, sleep disorder, irritability

Question 13

CBD contraindications

Answer 13

watch LFTs (test at 1,3,6 months of treatment) especially with concomitant use of VPA, may cause hypersensitivity reaction, may cause fetal harm

Question 14

carbamazepine FDA approved seizure types

Answer 14

focal; GTCs; mixed types

Question 15

mechanism of action CBZ

Answer 15

enhances Na+ channel rapid inactivation; blocks L type Ca+ channels

Question 16

initial dose CBZ and titration schedule

Answer 16

2-3 mg/kg/d divided BID or TID, increase q 2-3 wks up to 2400 mg/day BID for ER (TID-QID for IR)

Question 17

normal CBZ serum level range

Answer 17

4-12

Question 18

adverse side effects CBZ

Answer 18

sedation, diplopia, ataxia, dizziness, blurred vision, hyponatremia, low WBC counts, decreased T3/T4, increased LFTs, worsens GTCx in pts with absence seizures, SJS/TEN/DRESS

Question 19

CBZ contraindications

Answer 19

bone marrow suppression, hypersensitivity to TCAs, nefazadone, boceprevir, delviridine, MAOIs

Question 20

drug interactions CBZ

Answer 20

OCPs, warfarin, inhibited by macrolides, strict monitoring levels in hepatic impairment