Anti-seizure drugs

Question 1

Carbamazepine (Tegretol)

Iminostilbene derivatives

Answer 1

Anticonvulsants

• treat refractory seizures, not respond to others
• Grand-mal and partial seizure.
• Psychiatric disorder
• Trigeminal neuralgia (chronic pain at face and trigeminal nerve).
• Alcohol withdrawal
• CNS: ataxia, dizziness, drowsiness, vertigo, worsening of seizures, confusion, fatigue, headache, depression including suicidal ideation, speech disorder.
• CV: arrhythmias, HF, aggravation of CAD, HTN.
• GI: nausea, vomiting, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia.
• GU: albuminuria, flycosuria, erectile dysfunction, urinary frequency, urine retention.
• Hematologic: agranulocytosis, aplastic anemia, thrombocytopenia, eosinophilia.
• Hepatic: Hepatitis
• Metabolic: hyponatremia.
• Musculoskeletal: leg cramps.
• Respiratory: pulmonary hypersensitivity.
• Skin: erythema multiforme, SJS, excessive diaphoresis, rash, urticaria, pruritus.

Question 2

Diazepam (Valium)

Benzodiazepines

Answer 2

Anxiolytics
Controlled substance schedule IV
-acute treatment of intermittent, stereotypic episodes of frequent seizure activity (seizure clusters, acute repetitive seizures).

• IV to achieve response
• Short-term effect, other AED need to give immediately after.
• CNS: drowsiness, dysarthria (muscles you use for speech are weak or you have difficulty controlling them), slurred speech, tremor, ataxia (lack of muscle control), headache, hallucinations, pain, vertigo, confusion.
• CV: bradycardia, hypotension.
• EENT: diplopia, blurred vision, nystagmus.
• GI: N, D, dry mouth, constipation.
• GU: incontinence, urine retention.
• Hematologic: neutropenia
• Hepatic: jaundice.
• Respiratory: respiratory depression, apnea, hiccups.
• Skin: rash, phlebitis at injection site.
• Other: altered libido, physical or psychological dependence.

Question 3

Phenytoin
(Dilantin)

Hydantoin derivatives

Answer 3

Anticonvulsants

• CNS: ataxia, decreased coordination, mental confusion, slurred speech, dizziness, headache, twitching, peripheral neuropathy, vertigo.
• CV: bradycardia, hypotension, periarteritis nodosa ( systemic necrotizing inflammation of blood vessels).
• EENT: diplopia, nystagmus, blurred vision, thickening of facial features.
• GI: Gingival hyperplasia, nausea, vomiting, constipation.
• Hematologic: agranulocytosis, leukopenia, pancytopenia, thrombocytopenia.
• Hepatic: toxic hepatitis.
• Metabolic: hyperglycemia.
• Musculoskeletal: osteomalacia.
• Skin: SJS, toxic epidermal necrolysis, exfoliative dermatitis, necrosis, pain, rash.
• Other: lymphadenopathy (lymph nodes become swollen in response to illness), SLE

Question 4

Levetiracetam (Keppra)
(lee-vah-tih-RACE-ah-tam)
Pyrrolidines derivative

Answer 4

Anticonvulsant

• Adjuvant
• complex and partial seizure
• given after neurosurgery or post head surgeries

*Block sodium influx
Enhances effectiveness of GABA, and block receptors for glutamate

• CNS: asthenia, headache, anxiety, ataxia ( loss of full control of bodily movements, depression, dizziness, hostility, confusion, abnormal gait, incoordination.
• EENT: diplopia, conjunctivitis, ear pain, rhinitis, sinusitis, nasal congestion.
• GI: anorexia, vomiting, upper abdominal pain, D, constipation, gastroenteritis.
• Hematologic: leukopenia, neutropenia.
• Musculoskeletal: neck pain, joint pain.
• Respiratory: cough
• Skin: contusion (blood capillaries have been ruptured; a bruise)

Question 5

Topiramate (Topamax)

Sulfamate-substituted monosaccharides

Answer 5

Anticonvulsants

CNS: anxiety, asthenia, ataxia, confusion, difficult with memory, dizziness, fatigue, somnolence (sleepy, drowsy), generalized tonic-clonic seizures, suicide attempts, aggressive reaction, agitation, emotional lability, euphoria, malaise, psychosis, difficult to concentration.

• CV: chest pain, edema, palpitations, vasodilation, flushing.
• EENT: abnormal vision, diplopia, nystagmus, conjunctivitis, hearing problems, tinnitus, epistaxis, pharyngitis, sinusitis, rhinitis.
• GI: amenorrhea, dysuria, dysmenorrhea, hematuria, impotence (Erectile dysfunction) intermenstrual bleeding, menstrual disorder, menorrhagia (abnormally heavy or prolonged bleeding), urinary frequency, renal calculi, UTI, vaginitis, vaginal hemorrhage, cystitis.
• Hematologic: leukopenia, anemia
• Metabolic: decreased weight, increased weight
• Musculoskeletal: arthralgia, back and leg pain, muscle weakness, myalgia, rigors.
• Respiratory: URI, bronchitis, coughing, dyspnea, pneumonia.
• Skin: acne, alopecia, increased sweating, pruritus, rash.
• Other: body odor, breast pain, decreased libido, flulike syndrome, hot flashes, lymphadenopathy, infection

Question 6

Gabapentin (Neurotin)

GABA structural analogues

Answer 6

Anticonvulsants
-nerve pain treatment, neurologic pain, diabetic peripheral neuropathy.

*Gabapentin is a drug which mimics the effects of GABA neurotransmitter which is released by preganglionic neurons of both the somatic and autonomic nervous system.

CNS: ataxia, dizziness, fatigue, somnolence, abnormal thinking, depression, fever, dysarthria ( speech disorder caused by muscle weakness), headache, drowsiness.

• CV: peripheral edema, vasodilation.
• EENT: amblyopia ( lazy eye) i s a type of poor vision that happens in just 1 eye)) diplopia, nystagmus, pharyngitis, dry throat, nasopharyngitis.
• GI: Constipation, dry mouth, dyspepsia, increased appetite, flatulence, N, V, D.
• GU: erectile dysfunction.
• Hematologic: leukopenia.
• Metabolic: weight gain.
• Musculoskeletal: back pain, fracture, myalgia, limb pain.
• Respiratory: coughing, bronchitis, URI.
• Skin: abrasion, pruritus.
• Other: dental abnormalities, viral infections.