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Therapeutics > Anticonvulsants > Flashcards

Anticonvulsants Flashcards

1
Q

Lamotrigine (Lamictal) Dosing

A

Normal:
25mg QD x14, 50mg QD x14, 100mg QD x7, 200mg QD
Inducer:
50mg QD x14, 100mg QD x14, 200mg QD x7, 400mg QD
Inhibitor:
25mg QOD x14, 25mg QD x14, 50mg QD x7, 100mg QD

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2
Q

Lamotrigine (Lamictal) Adverse Effects

A

Stevens-Johnson Syndrome

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3
Q

Lamotrigine (Lamictal) Monitoring/Clinical

A

OC interaction: decrease effectiveness of OC’s and decrease lamotrigine conc.

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4
Q

Levetiracetam (Keppra) Dosing

A

Renal dosing adjustment needed

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5
Q

Levetiracetam (Keppra) Adverse Effects

A

Behavioral abnormalities, psychosis, suicidal thoughts/behaviors, unusual mood changes or worsening of depression - most commonly in younger patients

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6
Q

Valproate (Depakote, Depakene, Depacon) Dosing

A

Monitor serum concentrations: 50-125 mcg/ml

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7
Q

Valproate (Depakote, Depakene, Depacon) Adverse Effects

A

Hyperammonemia, thrombocytopenia, N/V, weight gain, alopecia, PCOS

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8
Q

Valproate (Depakote, Depakene, Depacon) Monitoring/Clinical

A

Pregnancy D

Monitor: CBC with platelets, LFTs, serum conc.

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9
Q

Zonisamide (Zonegran) Adverse Effects

A

CI’d in sulfa hypersensitivity, metabolic acidosis, renal calculi

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10
Q

Zonisamide (Zonegran) Monitoring/Clinical

A

Metabolized via glucuronidation (UDP-GT)

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11
Q

Clobazam (Onfi) C-IV Adverse Effects

A

Withdrawal symptoms

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12
Q

Clobazam (Onfi) C-IV Monitoring/Clinical

A

3A4 substrate (major), inducer (weak), may decrease efficacy of oral contraceptives

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13
Q

Clonazepam (Klonopin) C-IV Adverse Effects

A

Anterograde amnesia, paradoxical reactions, withdrawal symptoms

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14
Q

Clonazepam (Klonopin) C-IV Monitoring/Clinical

A

3A4 substrate (major), Pregnancy D

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15
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Dosing

A

Monitor serum concentrations: 4-12 mcg/ml

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16
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Adverse Effects

A

Boxed warning: Stevens-Johnson Syndrome (Asians who are HLA-B1502 +), DRESS (Northern European HLA-A3101 +), aplastic anemia, hyponatremia

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17
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Monitoring/Clinical

A

Pregnancy D, 3A4 substrate (major), strong inducers of 1A3, 2B6, 2C8, 2C9, 2C19, 3A4
Monitoring: CBC with platelets, electrolytes, may autoinduce own metabolism for several weeks after initiation and dose increases

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18
Q

Eslicarbazepine Acetate (Aptiom) Adverse Effects

A

Stevens-Johnson Syndrome, hyponatremia, same HLA-B/HLA-A as carbamazepine

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19
Q

Eslicarbazepine Acetate (Aptiom) Monitoring/Clinical

A

Rapidly metabolized to active metabolite eslicarbazepine, active metabolite of oxcarbazepine, 2C19 inhibitor (moderate)
Monitoring: electrolytes

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20
Q

Ezobagine (Potiga) C-V Dosing

A

Renal dosing: CrCl less than 50ml/min: 600mg

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21
Q

Ezobagine (Potiga) C-V Adverse Effects

A

Boxed warning: retinal abnormalities, may progress to vision loss
Warnings: urinary retention, grey-blue/brown skin discoloration (sign of toxicity), QTc prolongation, memory impairment, hallucinations

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22
Q

Ezobagine (Potiga) C-V Monitoring/Clinical

A

Baseline ophthalmic exam, repeat every 6 months

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23
Q

Felbamate (Felbatol) Adverse Effects

A

Boxed warning: aplastic anemia, hepatic failure

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24
Q

Felbamate (Felbatol) Monitoring/Clinical

A

MUST monitor LFT’s at baseline and frequently after, D/C if evidence of bone marrow suppression

25
Q

Gabapentin (Nuerontin, Gralise, Fanatrex) Dosing

A

Renal dosing: CrCl 30-60 ml/min: 600-1800 mg/day

Not recommended CrCl less than 30 ml/min

26
Q

Gabapentin (Nuerontin, Gralise, Fanatrex) Adverse Effects

A

Somnolence, peripheral edema

27
Q

Gabapentin (Nuerontin, Gralise, Fanatrex) Monitoring/Clinical

A

Renal clearance: 100%

Monitor renal function at baseline and routinely

28
Q

Lacosamide (Vimpat) Adverse Effects

A

Use with caution in patients with cardiac conduction abnormalities, prolongs PR interval, dermatological reactions, visual disturbances, idiosyncratic reactions: hepatic impairment, 1st degree AV block

29
Q

Lacosamide (Vimpat) Monitoring/Clinical

A

2C19 substrate and inhibitor (major)

30
Q

Oxcarbazepine (Trileptal, Oxtellar) Dosing

A

Oxcarbazepine is 1.5 times the dose of carbamazepine if converting

31
Q

Oxcarbazepine (Trileptal, Oxtellar) Adverse Effects

A

Same HLA-B/HLA-A as carbamazepine, hyponatremia

32
Q

Oxcarbazepine (Trileptal, Oxtellar) Monitoring/Clinical

A

3A4/5 substrate/inducer (major/strong), 2C19 inhibitor (moderate)
Monitoring: electrolytes

33
Q

Perampanel (Fycompa) C-III Adverse Effects

A

Boxed warning: dose-related serious and/or life threatening neuropsychiatric events, use with caution in patients with pre-existing behavioral problems or psychosis, gait disturbances, somnolence

34
Q

Perampanel (Fycompa) C-III Monitoring/Clinical

A

3A4/5 substrate (major)

35
Q

Phenobarbital C-IV Dosing

A

Monitor serum concentrations 15-40 mcg/ml

36
Q

Phenobarbital C-IV Adverse Effects

A

Somnolence, confusion, cognitive impairment, impaired calcium metabolism

37
Q

Phenobarbital C-IV Monitoring/Clinical

A

Pregnancy D, 2C9 substrate (major), 1A2, 2C, 3A, and UGT inducer (strong)

38
Q

Phenytoin (Dilantin) Dosing

Fosphenytoin (Cerebyx) Dosing

A

Monitor serum concentrations 10-20 mpg/ml (phenytoin), conversion from fosphenytoin to phenytoin occurs 0.5-1 hour post-dose

39
Q

Phenytoin (Dilantin) Adverse Effects

Fosphenytoin (Cerebyx) Adverse Effects

A

Fospheytoin IV: hypotension, arrhythmias
Phenytoin IV: arrhythmias, hypotension, purple glove syndrome
CI’d with sinus bradycardia or 2nd/3rd degree heart block
Decreased BMD, dermatological reactions, nystagmus, ataxia, double vision, hepatotoxicity, hirsutism, gingival hyperplasia, cardiac arrhythmias, Stevens-Johnson Syndrome, alteration of Vit D metabolism, osteoporosis

40
Q

Phenytoin (Dilantin) Monitoring/Clinical

Fosphenytoin (Cerebyx) Monitoring/Clinical

A

Pregnancy D, 2C9/2C19 substrate (major), 1A2, 2C19, 3A4, and UGT inducer (strong), serum conc (obtain albumin with same blood draw)

41
Q

Pregabalin (Lyrica) C-V Dosing

A

Renal dosing adjustment needed

42
Q

Pregabalin (Lyrica) C-V Adverse Effects

A

Angioedema, peripheral edema, PR interval prolongation

43
Q

Pregabalin (Lyrica) C-V Monitoring/Clinical

A

Renal clearance 100%

44
Q

Primidone (Mysoline) Adverse Effects

A

Metabolized to phenobarbital, same side effects as phenobarbital

45
Q

Primidone (Mysoline) Monitoring/Clinical

A

Pregnancy D

46
Q

Rufinamide (Banzel) Dosing

A

Indicated for Lennox-Gastaut Refractory Seizures

47
Q

Rufinamide (Banzel) Adverse Effects

A

CI’d if familial short QT syndrome

DRESS, Stevens-Johnson Syndrome

48
Q

Tiagabine (Gabitril) Dosing

A

Special dosing for concomitant enzyme inducing drugs and concomitant valproate therapy
Monitor serum concentrations 0.02-0.2 mcg/ml

49
Q

Tiagabine (Gabitril) Adverse Effects

A

Use with caution off-label for patient without seizure disorder and with hectic disease - may trigger seizures, cognitive impairment

50
Q

Tiagabine (Gabitril) Monitoring/Clinical

A

3A4 substrate (major)

51
Q

Topiramate (Topamax) Dosing

A

50% reduced dose with CrCl less than 70 ml/min

52
Q

Topiramate (Topamax) Adverse Effects

A

Use with caution in patients with nephrolithiasis, renal impairment, hepatic disease
CNS depression, metabolic acidosis, oligohydrosis/hyperthermia, acute myopia, secondary angle-closure glaucoma, nephrolithiasis, visual field defects, cognitive impairment, hyperchloremic non-anion gap metabolic acidosis

53
Q

Topiramate (Topamax) Monitoring/Clinical

A

Pregnancy D, 2C19 inhibitor (moderate), 3A4 substrate/inducer (moderate-strong, dose dependent)
Monitoring: basic metabolic profile, urinalysis every 3-6 months

54
Q

Vigabatrin (Sabril) Dosing

A

Indicated for Refractory Seizures, dosing needs renally adjusted

55
Q

Vigabatrin (Sabril) Adverse Effects

A

CI’d in patients with other risk factors for irreversible vision loss
Boxed warning for vision loss
Peripheral neuropathy, depression, weight gain, insomnia, permanent loss of peripheral vision

56
Q

Vigabatrin (Sabril) Monitoring/Clinical

A

SCr, vision assessment at baseline and every 3-6 months

57
Q

Ethosuximide (Zarontin) Dosing

A

Indicated for Absence Seizures

58
Q

Ethosuximide (Zarontin) Adverse Effects

A

Avoid in renal/hepatic dysfunction, SLE, Stevens-Johnson Syndrome, leukopenia, eosinophilia, psychiatric and sleep disturbances, aggression, hiccups

Therapeutics (7 decks)

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