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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
CNS effects  The visual disturbances should decrease over time ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Carbamazepine
26
◦ Fluid Retention ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Carbamazepine
27
 Check BMP/CBC (Na, BUN) ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Carbamazepine
28
Blood dyscrasia (pancytopenia) ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Carbamazepine
29
ADVERSE EFFECTS ◦ GI – nausea, vomiting (use enteric coating) ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
30
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 ```
Valproic Acid/ Valproate/ Divalproex sodium
31
BOXED WARNING: Hepatotoxicity ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
32
◦ BOXED WARNING: Pancreatitis ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
33
◦ BOXED WARNING: Fetal Harm ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
34
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 ```
Valproic Acid/ Valproate/ Divalproex sodium
35
Alpers- Huttenlocher syndrome ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
36
Alpers- Huttenlocher syndrome ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
37
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 ```
Valproic Acid/ Valproate/ Divalproex sodium
38
Neural Tube Defects- 1 in 20 women ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
39
Spina Bifida ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
40
 Cleft Palate ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Valproic Acid/ Valproate/ Divalproex sodium
41
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 ```
Valproic Acid/ Valproate/ Divalproex sodium
42
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 ```
Valproic Acid/ Valproate/ Divalproex sodium
43
BiPolar Disorder ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Lamotrigine
44
Pregnancy Category C ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Lamotrigine
45
 Cleft Lip/Palate ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Lamotrigine
46
Lamotrigine ``` ◦ Serious Skin Rashes (SJS/TEN) ◦ CNS concerns ◦ Pregnancy Category C All None ```
All
47
Off label: weight loss ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Topiramate
48
ADVERSE EFFECTS ◦ weightloss/anorexia ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Topiramate
49
◦ CNS- somnolence, dizziness, diplopia ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Topiramate
50
Post herpetic Neuralgia ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Gabapentin
51
DiabeticNeuropathy ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Gabapentin
52
Peripheral Edema ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Gabapentin
53
◦ Serious Skin Rashes (SJS/TEN) ``` Phenytoin/ Fosphenytoin Carbamazepine Valproic Acid/ Valproate/ Divalproex sodium Lorazepam/Diazepam Phenobarbital/ Primidone Lamotrigine Gabapentin Topiramate ```
Lamotrigine Valproic Acid/ Valproate/ Divalproex sodium Carbamazepine Phenytoin/ Fosphenytoin

Phamacology Summer (48 decks)

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