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Week 12 > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

Hydantoin
Phenytoin (Dilantin)
Indication and MOA

A

Phenytoin (Dilantin)

  • Used for tonic-clonic and partial complex seizures
  • MOA: inhibit and stabilize electrical discharges in the motor cortex of the brain by affecting the influx of sodium ions during generation of nerve impulses
  • Highly-protein bound
  • CYP 450 med
  • Least sedating seizure drug
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2
Q

Hydantoin
Phenytoin (Dilantin)
Cautions and Contraindications

A
  • Avoid in sinus bradycardia, 2nd and 3rd degree AV heart block, Stocks-Adams syndrome (syncope with heart block)
  • Caution in hypotension and myocardial insufficiency
  • Caution in renal and hepatic impairment
  • Rebound status epilepticus with sudden withdrawal
  • Narrow therapeutic range (monitor blood levels)
  • Avoid in pregnancy and lactation
  • Approved in pediatrics
  • Caution in elderly
  • Avoid alcohol
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3
Q

Hydantoin
Phenytoin (Dilantin)
Adverse Drug Effects

A
  • Agitation, ataxia, confusion, dizziness, drowsiness, headache, nystagmus, hypotension, tachycardia, n/v, anorexia, altered tase, gingival hyperplasia, discolored urine
  • Hypersensitivity reactions (rare), SI (rare), blood dyscrasias (rare)
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4
Q

Carbamazepine (Tegretol)

Indication and MOA

A
  • Used for focal and generalized onset seizures
  • MOA: exact MOA unclear; thought to affect sodium channels, slowing influx of sodium in the cortical neurons and slowing the spread of abnormal activity
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5
Q

Carbamazepine (Tegretol)

Caution and Contraindications

A
  • BBW: development of SJS and toxic epidermal necrolysis in Chinese patients
  • BBW: blood dyscrasias (can transiently lower WBCs)
  • BBW: dermatologic toxicity
  • Caution in renal and hepatic impairment
  • Can depress bone marrow and lead to pancytopenia and aplastic anemia (must get baseline CBC, CMP, TSH)
  • Avoid in pregnancy and lactation
  • Caution in elderly
  • Approved in pediatrics
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6
Q

Carbamazepine (Tegretol)

Adverse Drug Effects

A
  • drowsiness, dizziness, ataxia, n/v, skin rash, pruritus, constipation, tremors
  • behavior changes (rare), SI (rare), multi-organ hypersensitivity (rare), hepatoxicity (rare)
  • narrow therapeutic range; toxicity presents as HTN, tachycardia, stupor, agitation, respiratory depression, nystagmus, urinary retention, seizures, coma
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7
Q

Lamotrigine (Lamictal)

Indications and MOA

A
  • Used for partial seizures, primary generalized tonic-clonic seizures
  • MOA: thought to affect voltage sensitive sodium channels and inhibit presynaptic release of glutamate and aspartate in the neuron
  • check for drug-drug interactions
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8
Q

Lamotrigine (Lamictal)

Caution and Contraindications

A
  • BBW: serious skin reactions
  • rebound status epilepticus with sudden withdrawal
  • caution in renal and hepatic impairment
  • avoid in pregnancy and lactation
  • approved in children older than 2 years old
  • oral contraceptives can decrease levels
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9
Q

Lamotrigine (Lamictal)

Adverse Drug Effects

A
  • dizziness, headache, GI upset, diplopia, ataxia, insomnia, skin rash
  • SI (rare), blood dyscrasias (rare), multi-organ hypersensitivity reactions (rare)
  • immediately report any new onset of rash
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10
Q

Succinimides (Ethosuximide, Methosuximide)

Indications and MOA

A
  • used for absence seizures

- MOA: decrease nerve impulses and transmission in the motor cortex

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11
Q

Succinimides (Ethosuximide, Methosuximide)

Caution and Contraindications

A
  • do not take with alcohol
  • can decrease effectiveness of birth control
  • may continue in pregnancy with dose monitoring
  • avoid in lactation
  • rebound seizures can occur with withdrawal
  • caution in renal and hepatic impairment
  • approved for pediatrics older than 3 years old
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12
Q

Succinimides (Ethosuximide, Methosuximide)

Adverse Drug Effects

A
  • GI distress, sedation, ataxia, lethargy, headache, rash, pruritus, mood changes
  • SI (rare), blood dyscrasias (rare), dermatologic reactions (rare)
  • narrow therapeutic range; toxicity can present as CNS depression, respiratory depression, acute nausea/vomiting
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13
Q 
Valproic Acid (Depakote)
Indications and MOA
A
  • Used for focal (partial) onset seizures, generalized onset seizures, focal onset impaired awareness and absence seizures
  • MOA: increases GABA availability, enhances the action of GABA, mimics its actions at postsynaptic sites; also blocks voltage-dependent sodium channels, which results in suppression of high-frequency, repetitive neuronal firing
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14
Q 
Valproic Acid (Depakote)
Caution and Contraindications
A
  • BBW: hepatotoxicity
  • BBW: severe pancreatitis
  • avoid in pregnancy and lactation
  • avoid in children younger than 2 years old
  • caution in elderly patients; high risk of somnolence
  • rebound seizures can occur with sudden withdrawal
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15
Q 
Valproic Acid (Depakote)
Adverse Drug Effects
A
  • headache, drowsiness, dizziness, n/v, tremor, visual disturbance, weight gain, behavioral changes
  • hypersensitivity reactions (rare), SI (rare), brain atrophy (rare)
  • narrow therapeutic range; toxicity can present as CNS depression, confusion, jaundice
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16
Q

Gabapentin (Neurontin)

Indications and MOA

A
  • used for focal seizures
  • MOA: thought to be a GABA analogue that binds to unknown receptors in the brain
  • dose must be titrated up to reach goal dose
  • food increases absorption
  • not metabolized (hepatic impairment not an issue)
  • excreted primarily through urine
17
Q

Gabapentin (Neurontin)

Caution and Contraindications

A
  • only if benefits outweigh risks in pregnancy and lactation
  • avoid in children younger than 3 years old
  • caution in renal impairment
  • caution in elderly
  • caution in patients with substance abuse history
  • rebound seizures can occur with sudden withdrawal
18
Q

Gabapentin (Neurontin)

Adverse Drug Effects

A
  • dizziness, drowsiness, fatigue, ataxia, peripheral edema, abnormal thinking
  • neuropsychiatric event with 3-12 year old children (rare)
19
Q

Topiramate

Indications and MOA

A
  • used for focal seizures, primary generalized tonic-clonic seizures (can be used for migraines and cluster headaches)
  • MOA: unclear; may block sodium channels or potentiate GABA
  • not extensively metabolize; high amount of unchanged drug in urine
20
Q

Topiramate

Caution and Contraindications

A
  • avoid in pregnancy
  • only if benefits outweigh the risks in lactation
  • avoid in children younger than 3 months old
  • caution in renal and hepatic impairment
  • caution in elderly
  • rebound seizures with sudden withdrawal
21
Q

Topiramate

Adverse Drug Effects

A
  • ataxia, paresthesia, dizziness, somnolence, difficulty concentrating, mood changes, weight loss
  • SI (rare), decreased sweating and hyperthermia (rare)
22
Q

Levetiracetam (Keppra)

Indications and MOA

A
  • used for focal onset seizures, generalized onset seizures
  • MOA: unclear; may inhibit burst firing without affecting normal neuronal excitability
  • fewer drug-drug interactions (not metabolized by CYP450)
23
Q

Levetiracetam (Keppra)

Caution and Contraindications

A
  • caution in pregnancy
  • avoid in lactation
  • avoid in children younger than one month old
  • caution in renal impairment
  • caution in elderly
  • rebound seizures with abrupt withdrawal
24
Q

Levetiracetam (Keppra)

Adverse Drug Effects

A
  • somnolence, dizziness, nervousness, mood disturbances
  • SI (rare), dermatologic reactions (rare), blood dyscrasias (rare)
  • children at increased risk for psychiatric symptoms

Week 12 (8 decks)

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