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Clinical Pharmacology > AEDs > Flashcards

AEDs Flashcards

1
Q

Ethosuximide

A
  • MOA: inhibits Ca++
  • Indications: tx of absence seizures
  • ADRs: Hyperactivity/psychotic behaviors
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2
Q

Gabapentin

A
  • MOA: analog of GABA
  • Indications: Adjunct for seizures, PHN, RLS
  • Interactions: not metabolized
  • ADRs: somnolence/dizziness
  • Pearls: may exacerbate myoclonic seizures, must taper to avoid withdrawal sx (anxiety, insomnia, pain, etc)
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3
Q

Pregabalin

A
  • MOA: modulates calcium–> affects release fo glutamate, NE, Substance P*
  • Indications: fibromyalgia, peripheral neuropathy (DM/PHN), RLS, off-label GAD
  • ADRs: weight gain (bad for fibro), euphoria with withdrawal (C-V)
  • Pearls: same as gabapentin
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4
Q

Phenobaribtal

A
  • Uncommon drug
  • MOA: Binds GABAa and hyperpolarizes neuron
  • Autoinducer
  • ADR: sedation
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5
Q

Clobazam

A
  • MOA: see BZD
  • Used in Lennox-Gastaut
  • ADR: like benzos, but less sedating
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6
Q

Clonazepam

A
  • MOA: see BZD

- Used in Lennox-Gastaut

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7
Q

Tiagabine

A
  • MOA: enhances GABA
  • ADR*: new-onset seizures and status epilepticus have been associated when taken for unlabeled indications (ex. bipolar, anxiety, neuropathic pain)
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8
Q

Vigabatrin

A
  • MOA: increases CNA GABA
  • Indications: monotherapy for infantile spasms (orphan drug)–> effective for infantile spasms r/t tuberous sclerosis
  • ADRs*: irreversible retinal toxicity
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9
Q

Perampanel

A
  • MOA: AMPA antagonist (glutamate receptor)

- ADRs: euphoria/abuse potential (C-III), BBW* for homicidal ideation/threats

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10
Q

Valproate

A
  • MOA: many, main one is inc GABA
  • Indications: Most are not for seizures–> bipolar and migraine prophy
  • Monitoring: Serum ammonia
  • Interactions: inhibits multiple enzymes (including 2D6)–> careful with lamotrigine
  • ADRs: Lethargy (hyperammonemia), Parkinsonism, weight gain, **hepatotoxicity/hepatic failure (kids)
  • MOST TERATOGENIC AED- ONLY USE IF PT HAS SEIZURES AND ABSOLUTELY NEEDS DRUG
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11
Q

Topiramate

A
  • MOA: enhances GABA at nonBZD GABAa receptor
  • Indications: Lennox-Gastaut, migraine prophy, chronic weight mgmt
  • Monitoring: HCO3 q2-4 mo
  • Systemic ADRs: wt loss, olioghidrosis/hyperthermia, heat stroke (kids), metabolic acidosis/kidney stones
  • Neurotoxic ADRs: “Dopamax,” blurred vision, eye pain
  • Teratogen
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12
Q

Felbamate

A
  • Indications: Lennox-Gastaut

- ADRs*: fatal aplastic anemia and hepatic failure–> written consent required prior to therapy

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13
Q

Levetiracetam

A
  • Indications: prevention after TBI/NS

- ADRs: suicidality, depression, agitation, aggression, anxiety, etc

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14
Q

Brivaracetam

A
  • Analog of levetiracetam

- ADRs: suicidality, depression, C-V

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15
Q

Cannabidiol

A
  • Dravet syndrome and Lennox-Gastaut

- Put some in your old fashioned

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16
Q

Drug-Induced Seizures

A
  • Bupropion
  • Tramadol
  • Antipsychotics (clozapine/chlorpromazine)
  • CPHs, PCNs, FQs
  • Tx: d/c drug and IV/IM lorazepam
17
Q

AEDs and Suicide

A

-Must screen for depression/anxiety before initiation of AED

18
Q

AEDs and Bone Density

A
  • Prolonged used ass with decreased bone density

- Phenytoin, CBZ, phenobarbital, valproate

19
Q

AEDs and Child-Bearing Women

A
  • may induce OCPs
  • All women on AEDs of child-bearing age should be on 1 mg folic acid
  • Refer for preconception counseling
  • VALPROATE CATEGORY X FOR DISORDERS OTHER THAN SEIZURE
20
Q

AEDs and generic substitution

A
  • Bioequivalence with generics may not be true with epilepsy

- Pearl: if seizure occurs in otherwise controlled patient, ask about recent generic substitution

21
Q

Carbamazepine

A
  • chemically related to amitriptyline (cyclobenzaprine)
  • treatment of chronic pain syndromes (e.g. trigeminal neuralgia)
  • acute manic or mixed episodes of bipolar I disorder
22
Q

CBZ side effects / ADRs

A
  • may make absence or myoclonic seizures worse
  • do NOT store in humid conditions (concretion)
  • monitor concentration (autoinduction)
  • common neurotoxic ADRs
  • common ADR: SJS, vit D def, SIADH
  • severe ADR: leukopenia, aplastic anemia
  • teratogen: neural tube defects
23
Q

Oxcarbazepine / Eslicarbazepine

A
  • similar chemical structure to carbamazepine
  • may make absence or myoclonic seizures worse
  • ADRs: 20-30% of pt w/skin rxn to CBZ may react to Oxcarbazepine; more hyponatremia than CBZ (SIADH)
24
Q

Fosphenytoin compared to phenytoin

A
  • Fosphenytoin: phenytoin prodrug - faster admin, less complications, safer than phenytoin (esp w/cardiac), no in-line filter required
25
Q

Phenytoin / fosphenytoin

A
  • prevention of “early” seizures following TBI/NS*

- monitor levels (autoinduction)

26
Q

What’s “a huge pearl to remember” regarding phenytoin toxicity d/t high concentration?

A

Conduct EOM

  • lateral nystagmus
  • middle nystagmus

Must put patient on cardiac monitoring asap.

Can lead to death .

27
Q

Lamotrigine

A
  • tx newly dx absence seizures**
  • may be less effective than ethosuximide / VPA, but better tolerated
  • LGS
  • maintenance tx of bipolar disorder
28
Q

What’s the most important interaction to remember with lamotrigine?

A

Do not ever prescribe VPA and lamotrigine together - will induce SJS.

VPA increases lamotrigine concentration > 2x

29
Q

Phenytoin / fosphenytoin ADRs

A
  • ADRs: gingival hypertrophy, rash, drug fever
  • IV infusion ADR: venous irritation / thrombophlebitis (minimize w/fosphenytoin)
  • teratogen: fetal hydantoin syndrome (FLK Paxton)
30
Q

Lamotrigine ADRs

A
  • rash: SJS, TEN

- Aseptic meningitis*

31
Q

Lacosamide

A
  • rhythm / ECG monitoring (baseline ECG)

- interactions: concomitant PR-prolonging drugs (b-blocker, CCB)

32
Q

Lacosamide ADRs

A
  • euphoria (schedule V)

- small increase in mean PR interval

33
Q

Zonisamide

A
  • sulfonamide derivative
  • used for “really weird seizures”
  • monitor bicarb!!
34
Q

Zonisamide

A
  • oligohidrosis, hyperthermia, heat stroke

- metabolic acidosis, renal stones possible - from increased bicarb excretion

35
Q

Rufinamide

A
  • LGS

- monitor ECG - additive effect w/drugs that shorten QT interval

36
Q

Ezogabine

A
  • ECG monitor - concomitant QT prolonger interactions

- ADRs: psychiatric/hallucinations; urinary retention*; euphoria (schedule V)

Clinical Pharmacology (54 decks)

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