Antiepileptic

Question 1

Goals of Treatment

Answer 1

• Reduce seizures to a level that allows the patient to live as normal a life as possible
• Balance the desire for complete seizure control with acceptable side effects

Question 3

Phenytoin

Answer 3

Other Indications: diabetic neuropathy, rarely cardiac arthymias

Monitoring: Therapeutic levels 10-20mcgs/ml
» BECAUSE HAS NARROW THERAPEUTIC INDICES

Adverse Effects:
> Gingival Hyperplasia and Hirsutism common
- folic acid (0.5mg/day) may prevent gum overgrowth
- risk can be min. by good oral hygiene, including dental flossing and gum massage
> Nystagmus, ataxia, sedation (dose-limiting)
> Symptoms of toxicity include nystagmus, diplopia, ataxia

Drugs Interactions:

• Reduces efficacy of birth control
• Bottom Line: MANY DRUG INTERACTIONS so administer with food

Question 4

Carbamezepine

Answer 4

Other Indications: bipolar disorder, neuropathic pain, hiccups, restless leg syndrome

Monitoring: therapeutic level 5-12mcg/ml
» ER IS PREFERRED BC ADHERENCE AND MINIMIZES PEAK/TROUGH FLUCTUATIONS
» CBC AND LFTS

Adverse Effects: n/v, sedation, dilopia common with initial (titrate slowly to decrease), nystagmus, ataxia, RASH, PHOTOSENSITIVITY

> > INDUCES OWN METABOLISM: SO LEVELS MAY DECREASE OVER FIRST MONTH OF USE

Drug Interactions

Question 5

Valproic Acid

Answer 5

NEEDS LAB MONITORING
» TREMORS CAN OCCUR IF LEVELS ARE HIGH BUT STILL WITHIN THERAPEUTIC LEVEL (>80)

ADVERSE EFFECTS: HAIR LOSS, HEPATOXIC
SIDES OF HEPATOXICITY????

TAKE WITH FOOD

DOES NOT INTERACT WITH BIRTH CONTROL

Question 6

Topiramate

Answer 6

KIDNEY STONES AND GLAUCOMA

Question 7

Antiepileptic Drugs: Drug Interactions (general info)

Answer 7

• Almost all antiepileptic drugs have multiple drug interactions including:
  » interactions with other antiepileptic
  » reduces the effectiveness of BC
  » those that have few interactions: ethosuximide, gabapentin, pregabalin, levetiracetam

Question 8

Which Antiepileptic Require Drug Monitoring?

Answer 8

Phenytoin
Carbamazepine
eslicarbasepine
ethosuximide
oxcarbazepine
topiramate
valproic acid
zonisamide

Question 9

Extra Random Info on Antiepileptic Drugs

Answer 9

Almost all are heptatotoxic and need liver/renal dosing

Question 10

Reducing SIde Effects on Antiepileptic Drugs

Answer 10

TITRATE

Question 11

Antiepileptic Drugs that are controlled substances

Answer 11

pregabalin, lacosamide

Question 12

What do most also treat?

Answer 12

Bipolar, borderline personality disorder, neuropathic pain