Anticonvulsants Flashcards
refractory epilepsy
after trying 2 AEDs, overall seizure-free rates with subsequent meds is reduced to 4%
33% of epilepsy patients fit this criteria
1st generation AEDs
Enzyme inducers:
- phenobarbital
- phenytoin
- carbamazepine
Enzyme inhibitor:
- valproate
phenytoin
most widely used AED
enzyme inducer
inhibits rapid firing Na+ channels
90% bound to plasma protein - but this can be disrupted and dramatically increase the free/active amount
AEs: CNS sedation - drowsy, ataxia, confusion, insomnia, nystagmus, gum hyperplasia, hirsutism
status epilepticus treatment
carbamazepine
use for neuropathic pain
causes hyponatremia, agranulocytosis, aplastic anemia
stimulates met of itself and other drugs
valproate/valproic acid
can use for bipolar and migranes
valproate/valproic acid
1st line for epilepsy
rare but severe hepatotoxicity
neural tube defects/spina bifida
can use for bipolar and migranes
ethosuximide
for ABSENCE seizures
blocks T type Ca++ channels in thalamus
gabapentin
use for neuropathic pain
benzodiazapines
increase the FREQUENCY of GABAa Cl- openings
rescue meds as IV in SE
Felbamate
AE: hepatic failure, aplastic anemia
Lamotrigine
AE: Stevens-Johnson syndrome!!!
safe in pregnancy
use for bipolar
Felbamate
3rd line, rare bc toxicity
AE: hepatic failure, aplastic anemia
Zonisamide
broad-spectrum
AEs: kidney stones (must drink a LOT of water)
Lyrica/Pregabalin
reduces NT release by acting on VGCa++C
use for neuropathic pain
AE: appetite increase, weight gain
vigabatrin
4th line
AE: significant, irreversible visual field constriction
Lacosamide
prolongs slow inactivation of Na channel opening
drugs that exacerbate epileptic seizures
tramadol
bupropion
venflaxine
cocaine
pregnancy outcomes
consequences of seizures during pregnancy is worse statistically than low-dose AEDs
