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Phamacology Summer > Antiepileptic Drugs > Flashcards

Antiepileptic Drugs Flashcards

1
Q

Which is true about Antiepileptic Drugs

 START WITH A LOW DOSE AND WORK UP IF NEEDED
 ABRUPT DISCONTINUATION CAN CAUSE SEIZURES- COMPLIANCE!
None
All

A

All

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2
Q

USED TO TREAT
◦ All types of seizures

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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3
Q

Statusepilepticus

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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4
Q

NO LONGER used as a drug for cardiac dysrhythmias

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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5
Q

MECHANISM OF ACTION:
◦ selective inhibition of sodium channels

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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6
Q

Which ?
Hirsutism, Skin Rash*
Decreased levels of Vit K/D, Gingival Hyperplasia

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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7
Q

Preliminary Data- Severe Rash- HLA-B1502 allele

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

Carbamazepine

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8
Q

Pregnancy Category D

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium

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9
Q

Pregnancy Category D

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium

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10
Q

 Cleft lip/palates

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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11
Q

BOXED WARNING: Too rapid infusion can cause dysrhythmias/hypotension (based on its Mechanism)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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12
Q

 No faster than 50 mg/min

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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13
Q

Long term usage- Osteoporosis

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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14
Q

Narrow Therapeutic Index ◦ 10-20 mcg/mL

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

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15
Q

Phenytoin/ Fosphenytoin

Toxic symptoms: 
Nystagmus 
Ataxia 
diplopia 
drowsiness 
sedation
None
All
A

All

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16
Q

ENZYME INDUCER

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Phenytoin/ Fosphenytoin

Carbamazepine

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17
Q

 USED TO TREAT
◦ Trigeminal and glossopharyngeal neuralgias

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

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18
Q

MECHANISM OF ACTION:
 Blockade of Na+, possibly Ca++ and K+
channels
 Stimulates the release of ADH

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

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19
Q

Bone marrow suppression that leads to hematological effects- Aplastic anemia and agranulocytosis

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

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20
Q 
Carbamazepine  
ADVERSE EFFECTS
nystagmus,
blurred vision, 
diplopia
Ataxia, 
vertigo, 
unsteadiness
Headache
None
All
A

ALL

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21
Q

ADVERSE EFFECTS
Promotes ADH- can cause fluid retention

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

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22
Q

Not the best for heart failure!)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

23
Q

Periodic checks of CBC
Report fever/sore throat

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

24
Q

CNS effects
 Use caution when driving

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

25
Q

CNS effects
 The visual disturbances should decrease over time

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

26
Q

◦ Fluid Retention

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

27
Q

 Check BMP/CBC (Na, BUN)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

28
Q

Blood dyscrasia (pancytopenia)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Carbamazepine

29
Q

ADVERSE EFFECTS
◦ GI – nausea, vomiting (use enteric coating)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A 
Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
30
Q

Blockade of Na+, Ca++ channels AND may potentiate effects of GABA

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

31
Q

BOXED WARNING: Hepatotoxicity

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

32
Q

◦ BOXED WARNING: Pancreatitis

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

33
Q

◦ BOXED WARNING: Fetal Harm

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

34
Q

BOXED WARNING: patient with mitochondrial disease increased risk for liver failure

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

35
Q

Alpers- Huttenlocher syndrome

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

36
Q

Alpers- Huttenlocher syndrome

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

37
Q

Teratogenic- Pregnancy Category D
◦ Risk is 4 times greater than other AEDs

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

38
Q

Neural Tube Defects- 1 in 20 women

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

39
Q

Spina Bifida

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

40
Q

 Cleft Palate

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

41
Q

Hepatotoxicty + Pancreatitis: Monitor LFTs + amylase periodically, patient should also monitor for N/V, jaundice, abdominal pain

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

42
Q

Rarely Thrombocytopenia: Monitor platelets, educate patient to notify prescriber of bruising

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Valproic Acid/ Valproate/ Divalproex sodium

43
Q

BiPolar Disorder

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Lamotrigine

44
Q

Pregnancy Category C

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Lamotrigine

45
Q

 Cleft Lip/Palate

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Lamotrigine

46
Q

Lamotrigine

◦ Serious Skin Rashes (SJS/TEN)
◦ CNS concerns
◦ Pregnancy Category C
All
None
A

All

47
Q

Off label: weight loss

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Topiramate

48
Q

ADVERSE EFFECTS
◦ weightloss/anorexia

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Topiramate

49
Q

◦ CNS- somnolence, dizziness, diplopia

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Topiramate

50
Q

Post herpetic Neuralgia

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Gabapentin

51
Q

DiabeticNeuropathy

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Gabapentin

52
Q

Peripheral Edema

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Gabapentin

53
Q

◦ Serious Skin Rashes (SJS/TEN)

Phenytoin/ Fosphenytoin
Carbamazepine
Valproic Acid/ Valproate/ Divalproex sodium
Lorazepam/Diazepam
Phenobarbital/ Primidone
Lamotrigine
Gabapentin
Topiramate
A

Lamotrigine
Valproic Acid/ Valproate/ Divalproex sodium
Carbamazepine
Phenytoin/ Fosphenytoin

Phamacology Summer (48 decks)

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