Anti-epilepsy drugs Flashcards
4 general treatments of epilepsy
- drugs
- surgery
- diet
- vagal stim
who is main treater of epileps
family doc
what active pathologies must be ruled out
infections, tumors, metabolic probs
what is anti-convulsant hypersensitivity treatment
PT presents with fever then rash in 1-8 weeks of new treatment
what causes AHS
aromatic amine drugs - need to find a new one
what is seizure success stats
2/3 never have another
1/3 will never get drug control
what to do with intractable PTs
send for surgery, diet etc
what are 2 most commonly intractable seizures
- complex partial - also most common type
2. West’s and Lennox-Gastaut
what are 3 common comorbidities
- anxiety
- depression
- suicide (3x)
common AED side effects
stomach upset and sedations
what is problem with theray
compliance, but not abuse
what is best type of therapy
monotherapy, if doesn’t work switch - not multi-drugs
why not poly-drugs
often interact and involve the liver
how does valproate interact
increases blood levels of other drugs
how do phenobarbital, phenytoin, and carbamazepine interact
lower blood levels of other drugs
what is a well known interaction
AEDs and warfarin and birth control pills
how to stop AEDs
slowly and be aware that can lose license
what about AEDs in preg
can maintain, because seizures are worse than the drugs
2 known tertogens
valproate and phenytoin
3 major mechs of AEDs
- inhib of voltage gated sodium channels (VDSCs)
- enhance GABA
- inhibit voltage gated potassium channels
2 VDSC drugs
- phenytoin
2. carbamazepine
how does VDSC work
keep the Na channel in inactive state a little longer so doesn’t fire at very rapid rates
what are 2 GABA drugs
- barbituates
2. benzos
1 Ca channel drug
ethosuxamide
where do Ca channel blockers work
in thalmus
1 drug for absence seizure only
ethosuxamide
drug used only for tonic-clonic and partial (4)
- phenobarbital - GABA
- phenytoin - VDSC
- carbamazepine - VDSC
- Levitiracetam - not sure
what is major issue with phenytoin
switches to zero order metabolism and can lead to long half life and therfore toxicity
4 broad spectrum drugs
- vaproate - watch out for hepatitis
- clobazam - GABA - sedation
- lamotragine - VDSC -
- topiramate -topamax - sedation and weight loss
drugs for stat. epilepticus
- ativan - benzo
2. phenytoin IV
