Anticonvulsants Medication Flashcards
Antiepileptic Drugs (AED)
Used for long term management of chronic epilepsy
Management of seizures not caused by epilepsy
Off label use: Used for other conditions such as anxiety, bipolar disorder, chronic pain
Phenytoin (Dilantin)
Works to stabilize the neurons from becoming too excited
Stops spread of seizure activity in the motor cortex
Works on stabilizing the movement of Na+ across the cell membrane
Highly protein bound drug (last longer in body, causing drug interaction)
Given PO, IM or IV
Very narrow therapeutic window
Poor absorption with tube feeds so stop feeds for 2 hours before and after
Can not be given IV with D5W. Infuse over 30-60 minutes
Can be very irritating to the veins
Drug interactions
PPI (Proton Pump Inhibitor)
Sulfa meds
Oral Anticoagulants
Valproic Acid
Oral Contraceptive
Phenytoin Side Effects
Drowsiness
Ataxia
Irritability
Headache
Changes in conduction system—arrhythmias especially if toxic
Can cause suicidal thoughts
Stevens Johnson Syndrome
Can also cause gingival hyperplasia (red gums)
Carbamazepine (Tegretol)
Similar to Phenytoin
Used for several different types of seizures
Drug of choice for complex partial seizures
Inhibits the spread of seizure activity
Also used for:
Trigeminal Neuralgia
Bipolar disorder
Will make absence and myoclonic seizures worse
Labs
CBC (esp. WBCs)
Drug Level (4-12 mcg/ml)
Increase suicidal thoughts
Rashes can be common
Stevens Johnson Syndrome
Carbamazepine (Tegretol) Drug interactions
Drug Interactions:
Oral Contraceptives
Bupropion
Lamotrigine
TCA (Tricyclic Antidepressants)-very similar
Valproic Acid
Antifungals
When lithium is used can cause toxic neuro effects
When given in feeding tube must flush well before and after (100ml) and dilute the med with NSS or D5W
Take with food
Dont stop taking abruptly
Oxycarbazepine (Trileptal)
Like Carbamazepine but not as toxic risk
Works a sodium channel blocker
Used as adjunctive therapy or mono therapy for partial seizures in children and adults
Make absence and myoclonic worse
Sodium Channel blocker
Decreases efficacy of Oral Contraceptives
Must reduce dose with renal disease
Valproic Acid/Valproate (Depakote)
Believed to affect GABA to cause membrane stabilization
Absence seizures
Myoclonic seizures
Tonic-clonic seizures
Partial Seizures
Neonatal Seizures
Used to control symptoms of acute mania in bipolar disorder
Narrow therapeutic range
Need to check levels (50-100mcg/ml)
Take with food
Must be diluted when giving IV with at least 50ml NSS or D5W
Give over an hour (no more than 20mg/min)
Avoid sudden withdrawal
Valproic Acid/Valproate (Depakote) Side Effects
Can cause liver toxicity, need to monitor LFTs
GI side effects
Sedation
Dizziness
Increased ammonia levels
Suicidal thoughts
Gabapentin (Neurontin)
GABA agonist but works by binding to a protein and becomes a unique receptor which causes increased GABA in the brain
Think of GABA likes brakes in the car to slow down brain activity
Partial seizures
Can be used in kids over age 3
Alternative uses:
Chronic neuropathic pain
Anxiety
Hot flashes/Night sweats
Headaches
Hiccups
Alcohol withdrawal
Make myoclonic seizures worse
Reduced dose in renal patients
Cautious use in those with addiction history
Not controlled substances …yet ?
Withdrawal slowly
Doses will be very high for pain control
Gabapentin Side Effects
Fatigue– given at night often
Mental cloudiness
Leukopenia
Edema
Weight Gain
Emotional lability
Tremors
GI side effects
Lamotrigine (Lamictal)
Different from other AED
Works on Sodium Channels which decrease release of specific neuro transmitters calming brain activity
Partial seizures
Children older than 2 for generalized seizures
It is also mood stabilizer
Should not be given with Valproic Acid –cause toxic levels
Avoid other AED will decrease levels of lamotrigine
Can effect the efficacy of Oral Contraceptives
Lamotrigine Side Effects
Dizziness
Diplopia
Ataxia
Headaches
GI side effects
Neutropenia (rare)
Black box warnings
Rashes
Stevens Johnson
Start at very low doses and titrate up slowly to avoid rash
Need to monitor drug levels but window not as narrow as others
Topiramate (Topamax)
Used for seizures, but can also be used for
Migraine Headaches
Mood stabilizer
Side Effects
Weight loss
Mental fogginess
Other anticonvulsants may decrease levels
Ethosuximide (Zarontin)
Absence seizures only
Take with food
Drug Interactions with
Phenytoin
Valproic acid
Monitor CBC, LFTs, and renal function
Common side effects: diarrhea, dizziness, headache, nausea and vomiting, rash
Zonisamide (Zonegran)
Is a sulfa medication (avoid in those with sulfa allergies)
Add on therapy
Can cause Stevens Johnson
Can decrease sweating so watch body temp
Must swallow capsule whole
