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pharm summer 1 > antiepileptic > Flashcards

antiepileptic Flashcards

1
Q

goal of TX?

A

Maximize QOL by eliminating seizures while minimizing ADRs

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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
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3
Q

how do carbamazepine, lamotrigine, phenytoin and valproic acid help with seizures?

A

they inhibitors it high frequency firing

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4
Q

epilepsy - glutamate

A

Go!

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5
Q

epilepsy - GABA

A

Stop!

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6
Q

Sodium channel blockers:

A

phenytoin, carbamazepine , oxcarbazepine, valproate, felbamate, lamotrigine, topiramate, zonisamide, rufinamide, lacosamide

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7
Q

GABA enhancers:

A

barbiturates, benzodiazepines, carbamazepine, valproate, felbamate, topiramate, tiagabine, vigabatrin

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8
Q

glutamate modulators:

A

phenytoin, gabapentin, lamotrigine, topiramate, levetiracetam, felbamate

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9
Q

calcium channel blockers:

A

-ethosuximide, valproate, zonisamide, lamotrigine, topiramate

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10
Q

H-current modulators

A

gabapentin, lamotrigine

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11
Q

blockers of unique binding sites

A

-gabapentin, levetiracetam, pregabalin, lacosamide

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12
Q

Carbonic anhydrase inhibitors:

A

topiramate, zonisamide

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13
Q

Carbamazepine first line:

A

focal seizures

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14
Q

other carbamazepine uses:

A
  • tonic-clonic seizures
  • mixed seizures
  • pain control in trigeminal neuralgia
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15
Q

what types of seizure is carbamazepine not useful for?

A
  • absence

- myoclonic

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16
Q

carbamazepine contra:

A
  • bone marrow depression (risk of agranulocytosis, aplastic anemia)
  • use of MAOIs
  • asian ancestry, increased risk of SJS
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17
Q

how is carbamazepine metabolized?

A

3A4

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18
Q

Carbamazepine ADRs:

A

-drowsiness, diplopia, HA, ataxia, dizziness, N/V/D, constipation, ab pain, decreased appetite, leukopenia, hyponatremia, rash

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19
Q

carbamazepine serious ADRs:

A
  • aplastic anemia
  • hepatitis
  • Pancreatitis
  • SJS
  • TEN
  • preg D
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20
Q

Oxcarbazepine uses:

A

partial siezures

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21
Q

oxcarbazepine and carbamazepine reaction:

A

rash

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22
Q

oxcarbamazepine metabolism:

A

3A4

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23
Q

oxcarbazepine ADRs:

A

-sedation, dizziness, diplopia, HA, N, rash, liver, bone marrow, less common than carbamazepine

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24
Q

oxcarbazepine ADRs:

A
  • SJS, TEN
  • hyponatremia
  • Angioedema
  • Anaphylaxis
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25
Q

Lamotrigine MOA:

A

blocks sodium channels

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26
Q

Lamotriginie Indic.

A
  • adjunt tx in pts. >2
  • focal seizures, tonic clonic, absence, Lennox-gastaut
  • 2nd line mono therapy in >16 focal
  • 2nd line bipolar
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27
Q

Lamotrigine warnings:

A
  • SJS
  • DRESS
  • suicide
  • aseptic meningitis
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28
Q

how does lamotrigine interact with valproate?

A

-valproate increases lamotrigine

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29
Q

how does lamotrigine interact with OCPs?

A

decreases progesterone component of OCPs

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30
Q

lamotrigine ADRs:

A

HA, insomnia, drowsiness, dizziness, diplopia, ataxia (all increased if taken with carbamazepine or oxcarbazepine, separate doses by 1-2 hrs)
-rash, N

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31
Q

lamotrigine serious ADRs:

A

SJS, TEN (increased in taking valproate or peds)

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32
Q

Valproic acid indic:

A
  • focal
  • Tonic-clonic
  • mixed
  • ansence
  • migraine prophylaxis
  • bipolar
  • lennox-gastaut
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33
Q

Valproic acid contra:

A

-liver dz
-prego
-

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34
Q

Valproic acid ADRS:

A
  • N,V
  • fatigue, dizziness, tremor, hairloss, wt gain
  • depression, irritability,
  • hyperammonemia
  • irregular periods
  • bone loss
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35
Q

Valproic acid serious ADRs:

A
  • Hepatotoxicity
  • pancreatitis
  • thrombocytopenia
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36
Q

Valproic acid box warning:

A
  • hepatoxicity
  • teratogenicity
  • pancreatitis
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37
Q

levetiracetam Indic:

A

-adjunct tx
-focal in pts. 4+
=myoclonic in pts. 12+
-tonic-clonic pts. 6+

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38
Q

levetiracetam warnings:

A
  • suicide

- renal adjustment

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39
Q

levetiracetam ADRs:

A

-dizziness, somnolence, asthenia, irritability

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40
Q

levetiracetam serious ADRs:

A

-anxiety, agitation

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41
Q

Topiramate MOA

A

sodium channel blocker

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42
Q

topiramate Indic:

A
  • 2+
  • focal
  • tonic clonic
  • lennox-gastaut
  • migraine prophylaxis
  • wt loss
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43
Q

topiramate warnings:

A
  • acute myopia and secondary angle closure glaucoma
  • oligohidrosis and hyperthermia
  • metabolic acidosis
  • nephrolithiasis
  • suicide
  • cleft palate
  • renal dosing
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44
Q

Topiramate serious ADRs:

A
  • bullous skin ran
  • hepatic failure
  • maculopathy, glaucoma
  • pancreatitis
  • nephrolithiasis
  • metabolic acidosis
  • neuropsych: depression, psychosis, aggression, hallucinations, agitation
  • osteoporosis
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45
Q

Topiramate ADR’s:

A

somnolence

  • ataxia
  • speech disorders/psychomotor slowing
  • vision change
  • memory
  • paresthesia
  • wt loss
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46
Q

Topiramate basic drug interactions:

A

p450

3a4

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47
Q

what drugs decrease topiramate concentration?

A

valproic acid, phenytoin, crabamazepine, lamotrigine

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48
Q

topiramates effect on OCP?

A

decreases OCP efficacy

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49
Q

topiramate on CNS depressants?

A

adds to their effect

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50
Q

Ethosuximide MOA:

A

-calcium channel blocker

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51
Q

ethosuximide Indic:

A

absence sz

52
Q

ethosuximide ADR:

A

N/V/D, ad pain, dec appetite, drowsiness, dizziness, HA, agitation, pink-brown urine

53
Q

ethosuximide serious ADR:

A

-blood dycrasias, liver, kidney, SLE, rash, SJS, neuropsych

54
Q

Phenytoin MOA:

A

slows recovery of Na channels

55
Q

phenytoin uses:

A

tonic-clonic

focal

56
Q

phenytoin lowers the levels of what other drugs:

A

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
Q

drugs that lower the levels of phenytoin:

A

carbamazepine, phenobarb, valproate, vigabatrin, EtOH (chronic), antacids with calcium, ciprofloxacin, folic acid, MTX, rifampin, sucralfate, vinblastine

58
Q

drugs that increase the levels of phenytoin:

A

carbamazepine, diazepam, ethosuximide, oxcarbazepine, topiramate, valproate, EtOH, amiodarone, aspirin, diltiazem, fluconazole, estrogens, fluoxetine, isoniazid, metronidazole, omeprazole, ranitidine, sertraline, sulfonamides, trazodone, warfarin

59
Q

Phenytoin ADRs:

A
  • sedation
  • impaired cognition
  • slurred speech
  • nystagnus
  • dec coordination
  • confusion
  • dizziness
  • HA
60
Q

Phenytoin serious ADRs:

A
  • osteomalacia
  • lymphadenopathy
  • dermatitis
61
Q

fosphenytoin facts:

A
  • phenytoin prodrug

- IV only

62
Q

fosphenytoin uses:

A

status epilepticus

63
Q

Zonisamide Indic:

A
  • not mono

- adjunct for focal

64
Q

zonisamide contra:

A

sulfonamide allergy

65
Q

zonisamide warnings:

A

SJS

  • blood dycrasias
  • oligohidrosis
  • suicidal ideation
  • metabolic acidosis
  • terstogenicity
  • kidney stones
66
Q

zonisamide ADRs:

A

Somnolence, fatigue, anorexia, weight loss, dizziness, confusion, abnormal thinking, ataxia, agitation/irritability, difficulty with memory and/or concentration

67
Q

zonisamide serious ADRs:

A

Nephrolithiasis, leukopenia, oligohidrosis, rash, depression, metabolic acidosis

68
Q

lacosamide MOA:

A

sodium channel blocker

69
Q

lacosamide Indic:

A

-adjunct tx focal

70
Q

lacosamide warnings:

A
  • suicide
  • dizziness and ataxia
  • prolonged PR
  • afib
  • syncope
  • DRESS
71
Q

lacosamide ADRs:

A

diplopia
HA
Dizziness
N

72
Q

Perampanel MOA:

A

glutamate receptor antagonist

73
Q

perampanel Indic:

A
  • focal

- tonic clonic

74
Q

perampanel metabolism

A

p450/3A4

75
Q

perampanel ADR

A

anxiety, confusion, imbalance, diplopia, N, wt gain, aggression, paranoia
-potential for addiction

76
Q

Perampanel effect on OCP

A

reduces OCP effect

77
Q

perampanel effect with EtOH

A

-additive

78
Q

how is perampane effected by carbamazepine, oxcarbazepine, phenytoin, rifampin?

A

it is decreased

79
Q

how does perampanel effect carbamazepine, lamotriginie, valproic acid, and clobazam?

A

decreases their levels

80
Q

how does perampanel effect oxcarbazepine?

A

increases its level

81
Q

barbiturates:

A

phenobarbital and primidone

82
Q

phenobarbital Indic:

A

Short term sedative
Generalized and focal seizures
Lennox-Gastaut syndrome
First-line alternative for status epilepticus

83
Q

phenobarbital warnings:

A 
Addictive
-CIV
Hyperalgesia
Pregnancy
Peds
EtOH
Respiratory depression
84
Q

phenobarbital interaction with anticoagulants:

A

decreases anticoagulant activity

induces hepatic microsomal

85
Q

phenobarbital interaction with corticosteroids:

A

enhance the metabolism of exogenous corticosteroids

probably through the induction of hepatic microsomal enzymes.

86
Q

phenobarbital interaction with griseofulvin:

A

Interferes with absorption of orally administered griseofulvin, thus decreasing its blood level.

87
Q

phenobarbital interaction with doxy:

A

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
Q

phenobarbital interaction with.Phenytoin, Sodium Valproate, Valproic Acid

A

Variable effects on phenytoin. Monitor levels frequently

Sodium valproate and valproic acid increase the phenobarbital serum levels

89
Q

phenobarbital interaction with.CNS Depressants

A

other CNS depressants, including other sedatives or hypnotics, antihistamines, tranquilizers, or alcohol, may produce additive depressant effects

90
Q

phenobarbital interaction with MAOIs

A

MAOIs prolong the effects of barbiturates

91
Q

phenobarbital interaction with Estradiol, Estrone, Progesterone, and other Steroidal Hormones

A

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
Q

Phenobarbital ADRs:

A

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
Q

Primidone

A

-metabolized to phenobarbital

94
Q

primidone Indic

A

-clonic tonic
psychomotor sz
focal

95
Q

primidone ADRs:

A

ataxia, vertigo, N/V, diplopia

96
Q

Benzodiazepines:

A
  • clonazepam
  • diazepam
  • lorazepam
  • midazolam
  • clobazam
97
Q

Clonazepam uses:

A
  • lennox-gastaut

- absence sz

98
Q

Diazepam first line use:

A

status

99
Q

lorazepam 1st line:

A

status

100
Q

midazolam 1st line use:

A

status

101
Q

clobazam uses

A

-adjunct Lennox gastaut

102
Q

Gabapentin Indic

A

focal

-bipolar

103
Q

gabapentin warning:

A
  • pancreatic cancer

- DRESS

104
Q

Gabapentin ADRs:

A
  • sedation
  • somnolence
  • dizziness
  • wt gain
105
Q

Pregabalin Indic

A

-adjunct focal

106
Q

Pregabalin ADRs:

A

angioedema, peripheral edema, wt gain, somnolence, dizziness, CV
lower dose=lower side effects

107
Q

tiagabine Indic

A

adjunct tx pts 12 + focal

-anxiety, bruxism, migraine, neuropathic pain

108
Q

tiagabine warnings

A

-new onset sz

109
Q

tiagabine ADRs:

A

-dizzy, Asthenia, nervousness, tremor, slow thinking, depression, aphasia, ab pain

110
Q

vigabatrin Indic

A

-refactory focal sz

111
Q

vigabatrin ADRs:

A

vision loss

112
Q

Ezogabine MOA

A

opens potassium channels

113
Q

ezogabine ADRS:

A

-dizzy, somnolence, confusion, hallucinations, blue skin, retinal pigment changes, long qt, urinary retention
CV

114
Q

ezogabine DIs;

A

EtOH, digoxin

115
Q

Felbamate MOA:

A

blocks sodium channel

116
Q

Felbamate is last line due to what?

A

aplastic anemia risk

117
Q

felbamate warning

A

hepatic failure

118
Q

felbamate Indic

A
  • refractory partial sz

- lennox-gastaut syndrome

119
Q

Elicarbazepine tx

A

-partial

120
Q

eslicarbazepine ADRs:

A

vertigo, vision changes, N/V, fatigue, dizziness, fatigue, HA, ataxia, balance disorder

121
Q

eslicarbazepine serious ADRs:

A

SJS, TEN, DRESS, anaphylaxis, hyponatremia, elevated LFTs, thyroid function

122
Q

eslicarbazepine DIs

A 
3a4
OCPs
warfin
statin
prego cat c
123
Q

Brivaracetam Indic:

A

partial onset

-oral or injectable

124
Q

brivacetam ADrs:

A

somnolence, sedation, dizzy, fatigue, N/V

125
Q

tremor=

A

valproic acid

126
Q

AED toxicity:

A

unsteadiness, incoordination, dizziness

pharm summer 1 (4 decks)

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