antiepileptic Flashcards
1
Q
goal of TX?
A
Maximize QOL by eliminating seizures while minimizing ADRs
2
Q
When to stop AEDs:
A
- seizure free for 2-4 years
- complete control within one year of onset
- withdraewl slowly over 6 mo
3
Q
how do carbamazepine, lamotrigine, phenytoin and valproic acid help with seizures?
A
they inhibitors it high frequency firing
4
Q
epilepsy - glutamate
A
Go!
5
Q
epilepsy - GABA
A
Stop!
6
Q
Sodium channel blockers:
A
phenytoin, carbamazepine , oxcarbazepine, valproate, felbamate, lamotrigine, topiramate, zonisamide, rufinamide, lacosamide
7
Q
GABA enhancers:
A
barbiturates, benzodiazepines, carbamazepine, valproate, felbamate, topiramate, tiagabine, vigabatrin
8
Q
glutamate modulators:
A
phenytoin, gabapentin, lamotrigine, topiramate, levetiracetam, felbamate
9
Q
calcium channel blockers:
A
-ethosuximide, valproate, zonisamide, lamotrigine, topiramate
10
Q
H-current modulators
A
gabapentin, lamotrigine
11
Q
blockers of unique binding sites
A
-gabapentin, levetiracetam, pregabalin, lacosamide
12
Q
Carbonic anhydrase inhibitors:
A
topiramate, zonisamide
13
Q
Carbamazepine first line:
A
focal seizures
14
Q
other carbamazepine uses:
A
- tonic-clonic seizures
- mixed seizures
- pain control in trigeminal neuralgia
15
Q
what types of seizure is carbamazepine not useful for?
A
- absence
- myoclonic
16
Q
carbamazepine contra:
A
- bone marrow depression (risk of agranulocytosis, aplastic anemia)
- use of MAOIs
- asian ancestry, increased risk of SJS
17
Q
how is carbamazepine metabolized?
A
3A4
18
Q
Carbamazepine ADRs:
A
-drowsiness, diplopia, HA, ataxia, dizziness, N/V/D, constipation, ab pain, decreased appetite, leukopenia, hyponatremia, rash
19
Q
carbamazepine serious ADRs:
A
- aplastic anemia
- hepatitis
- Pancreatitis
- SJS
- TEN
- preg D
20
Q
Oxcarbazepine uses:
A
partial siezures
21
Q
oxcarbazepine and carbamazepine reaction:
A
rash
22
Q
oxcarbamazepine metabolism:
A
3A4
23
Q
oxcarbazepine ADRs:
A
-sedation, dizziness, diplopia, HA, N, rash, liver, bone marrow, less common than carbamazepine
24
Q
oxcarbazepine ADRs:
A
- SJS, TEN
- hyponatremia
- Angioedema
- Anaphylaxis
25
Lamotrigine MOA:
blocks sodium channels
26
Lamotriginie Indic.
- adjunt tx in pts. >2
- focal seizures, tonic clonic, absence, Lennox-gastaut
- 2nd line mono therapy in >16 focal
- 2nd line bipolar
27
Lamotrigine warnings:
- SJS
- DRESS
- suicide
- aseptic meningitis
28
how does lamotrigine interact with valproate?
-valproate increases lamotrigine
29
how does lamotrigine interact with OCPs?
decreases progesterone component of OCPs
30
lamotrigine ADRs:
HA, insomnia, drowsiness, dizziness, diplopia, ataxia (all increased if taken with carbamazepine or oxcarbazepine, separate doses by 1-2 hrs)
-rash, N
31
lamotrigine serious ADRs:
SJS, TEN (increased in taking valproate or peds)
32
Valproic acid indic:
- focal
- Tonic-clonic
- mixed
- ansence
- migraine prophylaxis
- bipolar
- lennox-gastaut
33
Valproic acid contra:
-liver dz
-prego
-
34
Valproic acid ADRS:
- N,V
- fatigue, dizziness, tremor, hairloss, wt gain
- depression, irritability,
- hyperammonemia
- irregular periods
- bone loss
35
Valproic acid serious ADRs:
- Hepatotoxicity
- pancreatitis
- thrombocytopenia
36
Valproic acid box warning:
- hepatoxicity
- teratogenicity
- pancreatitis
37
levetiracetam Indic:
-adjunct tx
-focal in pts. 4+
=myoclonic in pts. 12+
-tonic-clonic pts. 6+
38
levetiracetam warnings:
- suicide
| - renal adjustment
39
levetiracetam ADRs:
-dizziness, somnolence, asthenia, irritability
40
levetiracetam serious ADRs:
-anxiety, agitation
41
Topiramate MOA
sodium channel blocker
42
topiramate Indic:
- 2+
- focal
- tonic clonic
- lennox-gastaut
- migraine prophylaxis
- wt loss
43
topiramate warnings:
- acute myopia and secondary angle closure glaucoma
- oligohidrosis and hyperthermia
- metabolic acidosis
- nephrolithiasis
- suicide
- cleft palate
- renal dosing
44
Topiramate serious ADRs:
- bullous skin ran
- hepatic failure
- maculopathy, glaucoma
- pancreatitis
- nephrolithiasis
- metabolic acidosis
- neuropsych: depression, psychosis, aggression, hallucinations, agitation
- osteoporosis
45
Topiramate ADR's:
somnolence
- ataxia
- speech disorders/psychomotor slowing
- vision change
- memory
- paresthesia
- wt loss
46
Topiramate basic drug interactions:
p450
| 3a4
47
what drugs decrease topiramate concentration?
valproic acid, phenytoin, crabamazepine, lamotrigine
48
topiramates effect on OCP?
decreases OCP efficacy
49
topiramate on CNS depressants?
adds to their effect
50
Ethosuximide MOA:
-calcium channel blocker
51
ethosuximide Indic:
absence sz
52
ethosuximide ADR:
N/V/D, ad pain, dec appetite, drowsiness, dizziness, HA, agitation, pink-brown urine
53
ethosuximide serious ADR:
-blood dycrasias, liver, kidney, SLE, rash, SJS, neuropsych
54
Phenytoin MOA:
slows recovery of Na channels
55
phenytoin uses:
tonic-clonic
| focal
56
phenytoin lowers the levels of what other drugs:
AEDs
Acetaminophen, amiodarone, digoxin, disopyramide, doxycycline, estrogens, furosemide, folic acid, itraconazole, levodopa, methadone, metronidazole, OCPs, paroxetine, prednisone, quetiapine, rifampin, theophylline, vitamin D, warfarin (may also increase levels)
57
drugs that lower the levels of phenytoin:
carbamazepine, phenobarb, valproate, vigabatrin, EtOH (chronic), antacids with calcium, ciprofloxacin, folic acid, MTX, rifampin, sucralfate, vinblastine
58
drugs that increase the levels of phenytoin:
carbamazepine, diazepam, ethosuximide, oxcarbazepine, topiramate, valproate, EtOH, amiodarone, aspirin, diltiazem, fluconazole, estrogens, fluoxetine, isoniazid, metronidazole, omeprazole, ranitidine, sertraline, sulfonamides, trazodone, warfarin
59
Phenytoin ADRs:
- sedation
- impaired cognition
- slurred speech
- nystagnus
- dec coordination
- confusion
- dizziness
- HA
60
Phenytoin serious ADRs:
- osteomalacia
- lymphadenopathy
- dermatitis
61
fosphenytoin facts:
- phenytoin prodrug
| - IV only
62
fosphenytoin uses:
status epilepticus
63
Zonisamide Indic:
- not mono
| - adjunct for focal
64
zonisamide contra:
sulfonamide allergy
65
zonisamide warnings:
SJS
- blood dycrasias
- oligohidrosis
- suicidal ideation
- metabolic acidosis
- terstogenicity
- kidney stones
66
zonisamide ADRs:
Somnolence, fatigue, anorexia, weight loss, dizziness, confusion, abnormal thinking, ataxia, agitation/irritability, difficulty with memory and/or concentration
67
zonisamide serious ADRs:
Nephrolithiasis, leukopenia, oligohidrosis, rash, depression, metabolic acidosis
68
lacosamide MOA:
sodium channel blocker
69
lacosamide Indic:
-adjunct tx focal
70
lacosamide warnings:
- suicide
- dizziness and ataxia
- prolonged PR
- afib
- syncope
- DRESS
71
lacosamide ADRs:
diplopia
HA
Dizziness
N
72
Perampanel MOA:
glutamate receptor antagonist
73
perampanel Indic:
- focal
| - tonic clonic
74
perampanel metabolism
p450/3A4
75
perampanel ADR
anxiety, confusion, imbalance, diplopia, N, wt gain, aggression, paranoia
-potential for addiction
76
Perampanel effect on OCP
reduces OCP effect
77
perampanel effect with EtOH
-additive
78
how is perampane effected by carbamazepine, oxcarbazepine, phenytoin, rifampin?
it is decreased
79
how does perampanel effect carbamazepine, lamotriginie, valproic acid, and clobazam?
decreases their levels
80
how does perampanel effect oxcarbazepine?
increases its level
81
barbiturates:
phenobarbital and primidone
82
phenobarbital Indic:
Short term sedative
Generalized and focal seizures
Lennox-Gastaut syndrome
First-line alternative for status epilepticus
83
phenobarbital warnings:
```
Addictive
-CIV
Hyperalgesia
Pregnancy
Peds
EtOH
Respiratory depression
```
84
phenobarbital interaction with anticoagulants:
decreases anticoagulant activity
| induces hepatic microsomal
85
phenobarbital interaction with corticosteroids:
enhance the metabolism of exogenous corticosteroids
| probably through the induction of hepatic microsomal enzymes.
86
phenobarbital interaction with griseofulvin:
Interferes with absorption of orally administered griseofulvin, thus decreasing its blood level.
87
phenobarbital interaction with doxy:
Shortens half-life of doxycycline for as long as 2 weeks after barbiturate therapy is discontinued.
probably through the induction of hepatic microsomal enzymes that metabolize the antibiotic
88
phenobarbital interaction with.Phenytoin, Sodium Valproate, Valproic Acid
Variable effects on phenytoin. Monitor levels frequently
| Sodium valproate and valproic acid increase the phenobarbital serum levels
89
phenobarbital interaction with.CNS Depressants
other CNS depressants, including other sedatives or hypnotics, antihistamines, tranquilizers, or alcohol, may produce additive depressant effects
90
phenobarbital interaction with MAOIs
MAOIs prolong the effects of barbiturates
91
phenobarbital interaction with Estradiol, Estrone, Progesterone, and other Steroidal Hormones
may decrease the effect of estradiol by increasing its metabolism
reports of patients treated with antiepileptic drugs (e.g., phenobarbital) who become pregnant while taking oral contraceptives.
An alternate contraceptive method recommended for women taking phenobarbital.
92
Phenobarbital ADRs:
CNS depressant: decreased cognition, somnolence, fatigue, respiratory depression, bradycardia
Depression, hyperactivity, impaired attention, dizziness,
decreased libido, erectile dysfunction
Nausea, folate deficiency
Anemia
Rash, fever
Bone loss, hypocalcemia
93
Primidone
-metabolized to phenobarbital
94
primidone Indic
-clonic tonic
psychomotor sz
focal
95
primidone ADRs:
ataxia, vertigo, N/V, diplopia
96
Benzodiazepines:
- clonazepam
- diazepam
- lorazepam
- midazolam
- clobazam
97
Clonazepam uses:
- lennox-gastaut
| - absence sz
98
Diazepam first line use:
status
99
lorazepam 1st line:
status
100
midazolam 1st line use:
status
101
clobazam uses
-adjunct Lennox gastaut
102
Gabapentin Indic
focal
| -bipolar
103
gabapentin warning:
- pancreatic cancer
| - DRESS
104
Gabapentin ADRs:
- sedation
- somnolence
- dizziness
- wt gain
105
Pregabalin Indic
-adjunct focal
106
Pregabalin ADRs:
angioedema, peripheral edema, wt gain, somnolence, dizziness, CV
lower dose=lower side effects
107
tiagabine Indic
adjunct tx pts 12 + focal
| -anxiety, bruxism, migraine, neuropathic pain
108
tiagabine warnings
-new onset sz
109
tiagabine ADRs:
-dizzy, Asthenia, nervousness, tremor, slow thinking, depression, aphasia, ab pain
110
vigabatrin Indic
-refactory focal sz
111
vigabatrin ADRs:
*vision loss*
112
Ezogabine MOA
opens potassium channels
113
ezogabine ADRS:
-dizzy, somnolence, confusion, hallucinations, blue skin, retinal pigment changes, long qt, urinary retention
CV
114
ezogabine DIs;
EtOH, digoxin
115
Felbamate MOA:
blocks sodium channel
116
Felbamate is last line due to what?
aplastic anemia risk
117
felbamate warning
hepatic failure
118
felbamate Indic
- refractory partial sz
| - lennox-gastaut syndrome
119
Elicarbazepine tx
-partial
120
eslicarbazepine ADRs:
vertigo, vision changes, N/V, fatigue, dizziness, fatigue, HA, ataxia, balance disorder
121
eslicarbazepine serious ADRs:
SJS, TEN, DRESS, anaphylaxis, hyponatremia, elevated LFTs, thyroid function
122
eslicarbazepine DIs
```
3a4
OCPs
warfin
statin
prego cat c
```
123
Brivaracetam Indic:
partial onset
| -oral or injectable
124
brivacetam ADrs:
somnolence, sedation, dizzy, fatigue, N/V
125
tremor=
valproic acid
126
AED toxicity:
unsteadiness, incoordination, dizziness
