Anti-epilectic Drugs (NEURO) Flashcards
Name 4 mechanisms for anti-epi drugs involving channels
Antagonists: Na, Ca and Glu
Agonist: GABA
Name 5 Na channel blockers
- Phenytoin
- Carbamazepine
- Valproate
- Topiramate
- Lamotrigine
Name the only Ca blocker and its use
Ethosuximade
Petit male seizure
Name 1 GABA agonist antiepleptic
• Topiramate
Name 2 glutamate antagonists
- Lamotrigine
* Topiramate
What 2 clearance systems are used by the liver to clear anti-epileptic drugs
CYP45
UDP-Glucuronosyltransferase (UGT)
Which anti-epeileptic is neither an CYP45 enzyme inducer nor inhibitor
Levetiracetam
Name 3 CYP45 enzyme inducers that are antiepleptics
- Phenobarbital
- Ethosuximide
- Phenytoin
- Carbamazepine
- Tobacco, cigarettes
Name 1 CYP45 enzyme inhibitors that is an antiepleptic
- Erythromycin
- Ca channel blockers
- Trimethoprim/sulfa
- Fluconazole
- Valproate
Between pregnant women, pediatric patient and the elder, which one receives a higher dose of anti-epileptic medications? The rest receive?
Pregnant - higher dose
Kids + elderly - lower dose
Which 2 drugs are not CNS depressants
phenytoin and lamotrigine
Which drugs are associated with polycystic ovaries
Which drug should be used instead
VPA, CBZ
Use LTG instead
Which 3 drugs are associated with osteoporsis
o Phenobarbital, phenytoin and carbamazepine
Anti-E Drugs associated with birth defect
What should you use instead
o Valproate is bad
o Carbamazepine safer than phenytoin and phenobarbital
Phenobarbital Class Use Metabolism Toxicity
Class
GABA agonist
Use
Everything but absence seizure
PO or Oral
Metabolism
Long half life so loaded
CYP450 inducers
Toxicity Children - Hyperactivity Adult - Sedative Joint problems Osteoporosis
Phenytoin Class Use Metabolism Toxicity
Class
Na channel blocker
Use
Everything but absence
IV or PO (PO not for children)
Metabolism
Hepatic
Inducer
0 order kinetics
Toxicity
Narrow therapeutic index
Vitamin depletion
Osteoporosis
Gum hyperplasia
Ethosuximide Class Use Metabolism Toxicity
Class
Ca channel blocker (T-type)
Use
Absense seizure
Use
Only oral
Metabolism
GI absorbtion
Hepatic inducer
Toxicity
Well tolerated, behavioral changes, Gi distress, sedation
Benzodiazepines (diazepam or lorazepam) Class Use Metabolism Toxicity
Status, explicit us, muscle relaxation, anterograde amnesia
Class
GABA agonist
Use
All seizure types
Metabolism
Hepatic
PO or IV
Toxicity
Sedation, depression, withdrawal seizures
Alpha 2 anxiolytic
Alpha 1 sleep and amnesia and addiction and muscle
Carbamazepine Class Use Metabolism Toxicity
Class
Na channel blocker
Use
Focal or 2ndarly generalized seizures
Metabolism
Only oral preparation
Hepatic
Levels increased by Ca channel blockers and macrlide antibiotics
Toxicity
Neutropenia
Weight gain blurred vision, sedation
Valproic Acid Class Use Metabolism Toxicity
Class
Na, Ca antagonists
GABA and K agonists
Use
All seizure types
Metabolism
Hepatic
Not an inducer
Toxicity Hepatic encephalopathy without elevated enzymes but elevated ammonia or carnatine deficiency Birth defects Menstrual changes Hair loss Low platelet count
Gabapentin Class Use Metabolism Toxicity
Class Increase GABA (unknown why)
Use
Focal and 2ndary generalized seizure
Metabolism
PO
Excreted unchanged
Toxicity Sedation GI distress Pedal edema O
Lamotrigine Class Use Metabolism Toxicity
Class
Na channel block
Use
All seizure types
Bipolar
Neuropathic pain
Metabolism
PO
Hepatic
Toxicity
Allergy
Rash
Insomnia
Sbm
Topiramate (Topamax) Class Use Metabolism Toxicity
Class
Na blocker, GABA agonist and glutamate antagonist
Use
All seizures but absense
Metabolism
Renal (mostly) & hepatic
Toxicity
Sedation, weight loss, aphasia, parathsias & kidney stones
Levetiracetam (Keppra) Class Use Metabolism Toxicity
Class
Ca channel blockers
Use
Generalized & focal
Metabolism
Renal unchanged
Toxicity
Cognitive & behavioral problems
Generalized seizure drugs for general pop and for child-bearing women
General population
- Valporate
Pregnant women
- Lamotrigine and levetiracetam
Focal seizure drugs for general pop and for child-bearing women
General population
- Carbamezapine
Gabapentine
Pregnant women
- Lamotrigine and levetiracetam
Absence seizures
Ethosuximide
In general as a patient “fails” more and more anti-E drugs it less likely
that you will find one that is effective
Which anti-E drug has 0 order kinetics and is poorly absorbed orally in children
Phenytoin
Which anti-E drug has to be loaded because of a long half life
phenobarbital
Drug that is only effective against absence seizures
Ethosuximide
Which anti-E drug has risk of withdrawal seizures
Benzodiazepines
Which anti-E drug is not a benzodizapine despite its name
Carbamazepine
Which anti-E drug’s levels increase in the presence of Ca blocker or macrolide antibiotic
Carbamazepine
Which anti-E drug causes weight gain and blurred vission
Carbamazepine
2 anti-E drugs that are also good for bipolar disorder , neuropathic pain i.e. trigeminal neurolgia
Carbamazepine
Lamotrigine
Gabapentin
Which anti-E drug has pedal edema as a side effect
Gabapentin
