Anticonvulsants

Question 1

carbamazepine (Tegretol) and oxcarbamazepine (Trileptal)

Answer 1

• for partial seizures and neuropathic pain
• Na+ channel blocker
• more effective than Lithium for mixed states, dysphoric manic states, and rapid cycling

dose related SE: GI, ataxia, clonus, tremor, risk of neurotoxicity when combined, fatal in overdose
idiosyncratic SE: transient leukopenia, transient pruritic rash, STEVENS JOHNSON SYNDROME or TOXIC EPIDERMAL NECROLYSIS, LIVER effects (cholestasis)

*oxcarbamazepine not metabolized to epoxide and can be tolerated at higher doses (so preferred)

Question 2

valproic acid (Depakote)

Answer 2

• for seizures,
• mania (unlike carbamazepine)
• not good antidepressant
• inhibit Na currents and other effects (not fully understood)
• possible teratogen

dose dependent SE: sedation, nausea, vomiting, diarrhea
idiosyncratic: weight gain, elevated LFT, bone marrow suppression, FATAL HEPATOTOXICITY, hemorrhagic pancreatitis, agranulocytosis

Question 3

lamotrigine (Lamictal)

Answer 3

• maintenance for bipolar
• partial and generalized seizures associated with Lennox-Gastaut syndrome
• not good for acute
• Na channel blocker, potentiates potassium channel opening
• metabolized by liver

SE: rash especially on valproic acid, benign except STEVENS JOHNSON SYNDROME

Question 4

ECT

Answer 4

treat MDD, pregnant women MDD, psycotic sx, catatonia

SE: amnesia for 6 mo

Question 5

Ethosuximide (Zarontin)

Answer 5

• for generalized, not partial seizures
• inhibits t-type Ca channels

attenuates absence seizures

-eliminated by liver

Question 6

Phenytoin

Answer 6

simple partial, complex partial, primary and secondary generalized tonic clonic seizures
-not used as often anymore

• oral absorption slow and somewhat variable
• Dilantin is controlled release formulation (once a day)
• Fosphentoin is water soluble for IV (used if benzos fail at treating status epilipticus)

-metabolized by cytP450 in liver

SE: (cerebellar signs) ataxia, nystagmus, lethargy, rashes, STEVENS JOHNSON SYNDROME, hepatitis, lymphadenopathy, gingival hyperplasia, coarsening of facial features, hirsutism, accelerates metabolism of Vit D which can cause osteoporosis

• women need calcium supplement
• teratogenic

Question 7

levetiracetam

Answer 7

• partial seizures, primary and secondary generalized seizures
• binds presynaptic vesicular protein, SV2
• elimination not cytP450 dependent

SE: anxiety, behavioral problems in children

*becoming more frequently used

Question 8

topiramate

Answer 8

-blocks Glur 5 subunit containing AMPA receptors (Glu)

SE: somnolence, dizziness anxiety, memory problems, ataxia, weight loss, kidney stones, anhydrosis, glaucoma

• broad spectrum: partial and generalized seizures associated with Lennox-Gastaut Syndrome
• migraine prophylaxis

Question 9

lorazepam

Answer 9

• this IV or diazepam used to treat status epilepticus

- benzodiazepine (enhance GABA induced Cl currents)

Question 10

partial seizure drugs

Answer 10

oxcarbamazepine
lamotrigine
leveteractetam
topiramate

Question 11

primary generalized seizure drugs

Answer 11

lamotrigine
valproate
leveteracetam
zonisamide
topiramate

Question 12

status epilepticus drugs

Answer 12

lorazepam
diazepam
fosphenytoin