Anti Seizure Meds Flashcards
0
Q
Risk with all anti seizure drugs
A
- depression and increased suicidality
- microsomal enzyme interactions
~ CYP3A4 inducers: phenytoin (phospho), phenobarbital,
carbamazepine, oxcarbazepine and topiramate
~ CYP2C9 inhibitors: valproate
~ CYP2C1 inhibition: topiramate
1
Q
Absence trt
A
Treated with Ca channel drug (ethosuximide, valproic acid, clonezapam)
2
Q
Phenytoin: MOA, use, consideration
A
- 0th order kinetics (only fosphenytoin used anymore)
- used for all types sans absence
- MOA: prolong Na channel inactivation
- many CYP enzymes
- highly protein bound: hymoalbuminemic -> increased toxicity
4
Q
Azapines (carbam, oxam)
A
- MOA: decreases Na influx
- Indication: Tonic clonic, partial complex, neuropathic pain, bipolar disorder, paresthesia, PTSD
- SE: Diplopia, ataxia, cognitive dysfunction, rare aplastic anemia and hepatotoxicity
- carb: lots of microsomal interactions
- ox: CYP3A4 only
- ox can result in hyponatremia
5
Q
Lamotrigine
A
- MOA: Na + Ca channel
- partial, tonic-clonic, bipolar
- SE: dizziness, ataxia, visual disturbances, Stevens-Johnson’s
- lots of drug interactions
6
Q
Topiramate
A
- MOA: Na channel modulation, potentiates GABA/blocks AMPA
- partial, binge eating, PTSD
- SE: dizziness, drowsiness, ataxia, psychomotor slowing, memory impairment, weightloss, myopia
- weightloss SE exploited pharmacologically
- induces 3A4, inhibits 2C19 and excreted unchanged
7
Q
Valproic acid
A
- blocks t type Ca channels, and acts on Na
- treats everything but bipolar
- SE: hepatotoxicity, nausea, tremor, weight gain and hair loss
- inhibition of 2C9; induction of 2A6
- NOT for kids under 2 (caution in kids under 6)
- NTDs
8
Q
Gabapentin
A
- MOA: Voltage gaited Ca channel blockers
- adjunct: neuropathic pain, parasthesis, PTSD, mania
- excreted unchanged in urine, FEW INTERACTIONS
- SE: sedation, dizziness, ataxia, nystagmus, mood disorders in kids
9
Q
Pregabalin
A
- MOA: binds to N-type Ca channels
- adjunct for partial seizures; neuropathic pain, fibro
- similar to gabapentin with less interactions and side effects
10
Q
Levetiracetam
A
- MOA: not listed
- excreted in urine, few interactions
- SE: sedation, dizziness, weakness and ataxia
- rare side effects irritability, hallucinations, psychosis
11
Q
Benzodiazepines
A
- MOA: GABA enhancement
- IV or rectal benzos for STATUS EPTILEPTICUS
- SE: sedation (hyperactivity in kids) and tolerance
- Clonazepam for absence; less sedating at anticonvulsant doses
12
Q
Phenobarbital
A
- tonic/clonic, partial
- SE: Severely sedating, cognative dysfunction, tolerance, dependance, nystagmus, ataxia, osteomalacia (chronic use) decreased D and K,
- Cind: porphyrias
13
Q
Ethosuximide*
A
Specific for absence
14
Q
Lacosamide*
A
- cardiac effects
- C - V controlled substance
15
Q
Primidone*
A
Cognative impairment
CYP inducer
