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PHARM II, QUIZ 2 > Anti Epileptic Drugs > Flashcards

Anti Epileptic Drugs Flashcards

1
Q

Seizure treatment steps

A
  1. Determine type of seizure (Focal, Generalized/absence, tonic, clonic)
  2. Choose AED based one
    - Type of seizure
    - Side effect profile
    - Cost, Dosing preferences
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2
Q

Stopping AED Tx

A
  • When seizure free for 2-4 years
  • Normal neuro / EEG
  • Withdraw slowly over 6 months
  • 25-29% relapse in 1-2 yrs
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3
Q

Excitation seizure

A

Too Much Go - GLUTAMATE, ASPARTATE

Ionic Currents: Inward Na+& Ca++

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4
Q

Inhibition seizure

A

Not Enough Stop - GABA

Ionic Currents: Inward Cl-, Outward K+

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5
Q

Warning for All AEDs

A

Suicidal ideation, thoughts, action

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6
Q

1st Line Meds, Focal & Generalized (Tonic-Clonic)

A

Carbamazapine CYP3A4

Valproic Acid (Depakote)

Topiramate

Phenytoin (Dilantin)

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7
Q

2nd Line Meds, Focal

A
  • Lamotrigine
  • Zonisamide
  • Lacosamide
  • Perampanel

Barbituates - GABA enhancers

  • Phenobarbital
  • Primidone
  • Lyrica (Pregabalin)
  • Gabitril (Tiagabine)
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8
Q

2nd Line, General Tonic-Clonic

A

Perampanel
Primidone
Gabapentin

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9
Q

1st Line, Lennox Gastaut Syndrome

A
  • Lamotrigine
  • Valproic Acid
  • Topiramate
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10
Q

1st Line, Mixed

A
  • Carbamazepine CYP 3A4

- Valproic Acid

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11
Q

Absence Tx, 1st & 2nd

A

1st

  • Valproic Acid
  • Ethosuxamide
  • Lamotrigine

2nd
- Clonazepam

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12
Q

Myoclonic Tx

A

Keppra (Levetiracetam)

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13
Q

1st line, Status Epilepticus

A

Diazepam
Lorazepam
Midazolam

Phenobarbital

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14
Q

Carbamazepine, CYP 3A4

A

1st line for Focal, Generalized, Mixed

MOA: unclear - Na+ channel blocker

Also used for Trigeminal Neuralgia Pain

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15
Q

Alternative use for Carbamazepine?

A

Trigeminal Neuralgia Pain

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16
Q

Carbamazepine , CYP3A4

ADRs

A 
COMMON
Drowsiness
Headache
Dizziness
Ataxia (loss of control of body movements)

N/V/D

Leukopenia
Hyponatremia
Rash

SERIOUS
Aplastic Anemia
Hepatitis
Pancreatitis 
SJS
Preg D (spina bifida)
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17
Q

When is Carbamazepine CI?

A

Asian patients (increased SJS risk)

H/o bone marrow problems

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18
Q

Lamotrigine

A

Na+ Channel blocker

(originally adjunctive) but in practice used 1st line
Focal / GCT, Lennox Gastaut

2nd line mono therapy Focal Seizures

Alt:
2nd line Bipolar

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19
Q

Lamotrigine - Specific Warnings/ADRs

A

(Common ADRs same as Carba)

SJS in Pediatrics

Aseptic meningitis

Decreases OCP efficacy, progesterone

Valproate increases Lamotrigine effect

20
Q

Valproic Acid (Depakote)

A

aka Valproate

GABA Enhancer

Indicated for EVERYTHING
- 1st line for Focal, Generalized, Mixed, Absence, Lennox Gastaut

21
Q

Valproic Acid (Depakote) CI

A

Liver Disease

Pregnancy
- neural tube defects

22
Q

Valproic Acid (Depakote)

COMMON ADRs

A
  • N/V
  • Fatigue
  • Dizziness
  • Hair loss
  • Weight gain
  • Depression
  • Hyperammonemia
  • Irregular periods
  • Bone loss
23
Q

Valproic Acid (Depakote)

SERIOUS ADRs

A

Liver toxicity (esp Peds)

Pancreatitis

Thrombocytopenia

Teratogenicity

24
Q

Topiramate

A

1st line Focal, General, Lennox Gastaut

Also for weight loss

Na+ channel

25
Q

Topiramate Warnings

A

Angle Closure Glaucoma

Hyperthermia, lack of sweating

Metabolic acidosis

Suicidal ideation

SJS

Cleft palate if used during pregnancy

26
Q

Topiramate ADRs

A

Somnolence

Ataxia (loss control body movements)

Speech / Psychomotor / Memory

Vision changes

27
Q

Topiramate Drug Interactions

A

P450, 3A4, 2C19

Topiramate concentration decreased by:
Valproic Acid
Phenytoin
Carbamazepine 
Lamotigrine

possible decrease in OCP efficacy

28
Q

Ethosuxamide (Zarontin)

A

Absence Seizures

Ca+ channel blocker

ADRs
GI: N/V/D, abdo pain, decreased appetite
CNS: drowsy, dizzy, headache,

pink-brown urine

29
Q

Ethosuxamide (Zarontin), serious ADRs

A

Liver, kidney, hemo problems

SLE

SJS

Neuropsych

30
Q

Phenytoin (Dilantin)

A

1st line Focal, GCT

Slows Na+ recovery

Very tight dosing, clearance decreases as dose increases

Interacts with all the drugs

31
Q

Phenytoin common ADRs

A

Sedation
Dizziness
Headache

Impaired cognition / Confusion
Slurred speech
Decreased coordination
Nystagmus

32
Q

Phenytoin serious ADRs

A

Osteomalacia (long term)
Lymphadenopathy
Dermatitis (SJS, SLE)

33
Q

Phenobarbital

A

Barbituate

Prolongs GABA

Use limited by side effects and drug interactions
- 1st line alternative for Status

  • short term sedative
34
Q

Phenobarbital Warnings

A

Addictive

Hyperalgesia (increased sensitivity to pain)

Respiratory depression

35
Q

Phenobarb drug interactions

A

induces hepatic microsomal enzymes

Decreases anticoagulant activity

Enhances metabolism of exogenous steroids

  • Doxycycline - reduces half life, even 2 weeks after pheno DC’d*
  • Decreases OCP efficacy*

CNS depressants ++

36
Q

Phenobarbital ADRs

A

CNS depressant:

  • decreased cognition
  • resp depress
  • brady
  • fatigue
  • ED / libido
  • Anemia
  • Bone loss
  • Rash
37
Q

Primidone

A

Barbituate - metabolized to phenobarbital in liver

38
Q

Benzodiazepines

A

More GABA (more stop)

Clonazepam (Klonopin) - Lennox Gastaut

Diazepam (Valium) - Status

Lorazepam (Ativan) - Status

Midazolam (Versed) - Status

39
Q

Gabapentin

A

Ca++ channel blocker - prevents presynaptic release

Pain control
(allodynia, hyperalgesia, peripheral pain, inflammatory pain)

Used for
peripheral neuropathy
Bipolar

40
Q

Gabapentin, Warnings / ADRs

A

Warnings

  • Pancreatic cancer, possible
  • Hypersensitivity

ADRs

  • Sedation
  • Somnolence
  • Dizziness
  • Weight Gain
41
Q

Pregabalin (Lyrica)

A

Son of Gabapentin > better absorbed, faster onset = lower dose and less side effects

diabetic peripheral neuropathy
postherpetic neuralgia
Adjunctive therapy for adult patients with focal seizures
fibromyalgia
neuropathic pain associated with spinal cord injury

42
Q

Pregabalin (Lyrica) ADRs

A

Dizziness
Somnolence
Weight gain

Angioedema
Peripheral Edema

43
Q

Tiagibine (Gabitril)

A

More GABA

  • 2nd line for Focal Seizures
  • Anxiety
  • Bruxism
  • Migraine
  • Neuropathic pain
44
Q

Tiagibine (Gabitril) Warnings / ADRs

A

Warnings
- new onset seizure in pts without h/o epilepsy

ADRs

  • Dizziness
  • Cognitive bleh
  • Depression
  • Aphasia
  • Asthenia (weakness)
  • Tremor
  • Nervousness
45
Q

Vigabatrin (Sabril)

A

More GABA

NOT REALLY USED BC
CAN CAUSE PERMANENT VISION LOSS

PHARM II, QUIZ 2 (3 decks)

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