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Clin Phar II Lec > Antiepileptic Drugs > Flashcards

Antiepileptic Drugs Flashcards

Treatment; Slides 55 onwards

1
Q

Cause fewer cognitive impairments (2)

A

Gabapentin and Lamotrigine

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2
Q

May cause substantial cognitive impairments esp. when given at high or rapid doses

A

Topiramate

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3
Q

Most widely used AEDs (4)

A

Carbamazepine, Phenobarbital, Phenytoin, Valproic Acid

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4
Q

Superior to valproic acid for efficacy in the treatment of
partial seizures

A

Carbamazepine

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5
Q

Newer generation agents (3)

A

Lamotrigine, Oxcarbazepine, Topiramate

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6
Q

Received FDA approval for use as monotherapy in patients
with partial seizures (3)

A

Lamotrigine, Oxcarbazepine, Topiramate

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7
Q

Lamotrigine, Oxcarbazepine, Topiramate are FDA approved as _____________

A

monotherapy in patients
with partial seizures

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8
Q

traditional treatment for Tonic-Clonic Seizures

A

Phenytoin

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9
Q

increasingly used due
to lower incidences of side effects and with equal efficacy compared to phenytoin in treating Tonic-Clonic Seizures (2)

A

Carbamazepine and Valproic acid

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10
Q

Generally considered the drug of first choice for atonic seizures and for juvenile myoclonic epilepsy
(JME)

A

Valproic acid

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11
Q

FDA-approved as adjunctive treatment of myoclonic seizures in patients with JME

A

Levetiracetam

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11
Q

Alternative agents (3)

A

Lamotrigine, Topiramate, Zonisamide

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12
Q

Levetiracetam is FDA-approved as _________

A

adjunctive treatment of myoclonic seizures in patients with JME

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13
Q

viewed as a tool with which to optimize therapy for an individual patient not as a therapeutic endpoint in itself

A

Serum concentrations of the older AEDs

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14
Q

Serum concentration is a target that should be correlated with ______

A

clinical response

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15
Q

First-line therapy for patients with newly diagnosed partial seizures and for patients with primary generalized convulsive seizures

A

Carbamazepine

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16
Q

Associated with a 1% risk of spina bifida when ingested during
the first trimester of pregnancy

A

Carbamazepine

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17
Q

congenital disability condition which affects the spine as a type of neural tube defect; can happen anywhere along the spine if the neural tube does not close entirely in the membranes of the spinal cord

A

spina bifida

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18
Q

Most Common Adverse Effects include neurosensory side effects (diplopia, blurred vision, nystagmus, ataxia, unsteadiness, dizziness and headache); seen in 35%
to 50% of px

A

Carbamazepine

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19
Q

Most Common Adverse Effects include Hematologic side effect (leukopenia - 10% incidence)

A

Carbamazepine

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20
Q

double vision

A

diplopia

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21
Q

rapid or uncontrollable eye movement

A

nystagmus

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22
Q

loss of muscle control or coordination

A

ataxia

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23
Q

Drug Interactions of Carbamazepine are _________

A

very significant

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24
Q

Drugs that inhibit CYP3A4 potentially may increase this AED’s serum concentrations

A

Carbamazepine

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25
Q

Second-line agent for patients with partial seizures who have failed initial treatment

A

Gabapentin

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26
Q

Shown to be useful for chronic pain and other non-epileptic conditions

A

Gabapentin

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27
Q

we can also find benefits in this AED for px with less severe seizure disorders in the elderly

A

Gabapentin

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28
Q

Minimal CNS adverse effects and few drug interactions due
to broad therapeutic index

A

Gabapentin

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29
Q

CNS adverse effects include ataxia, somnolence, dizziness and fatigue

A

Gabapentin

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30
Q

T/F
Drug Interactions are not likely to occur in Gabapentin since this drug does not induce or inhibit liver enzymes

A

T

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31
Q

Gabapentin therapeutic index makes it a (safer/less safer) option

A

safer

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32
Q

Useful as both monotherapy and adjunctive treatment in patients with partial seizures

A

Lamotrigine

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33
Q

Useful alternative for primary generalized seizure types

A

Lamotrigine

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34
Q

Adjunctive therapy for primary GTC seizures

A

Lamotrigine

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35
Q

as monotherapy, it has comparable efficacy with more traditional AEDs such as carbamazepine and phenytoin

A

Lamotrigine

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36
Q

Most frequently reported A/E: diplopia, drowsiness, ataxia,
headaches

A

Lamotrigine

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37
Q

A/E are more common when given in combination with other AEDs

A

Lamotrigine

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38
Q

observed more in carbamazepine + lamotrigine

A

diplopia

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39
Q

manifested more in lamotrigine + valproic acid

A

tremors

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40
Q

diplopia is common in the combination of ____________

A

carbamazepine + lamotrigine

41
Q

tremors is common in the combination of ____________

A

lamotrigine + valproic acid

42
Q

Drug has Low potential for pharmacokinetic drug interactions
and Do not induce or inhibit liver enzymes

A

Lamotrigine

43
Q

Indicated for patients with partial seizures who have failed initial therapy

A

Levetiracetam

44
Q

Approved for adjunctive treatment of myoclonic seizures in patients with JME

A

Levetiracetam

45
Q

Adjunctive treatment of primarily generalized seizures in
patients with idiopathic generalized epilepsy

A

Levetiracetam

46
Q

Adverse Effects of this AED Appears to be modest

A

Levetiracetam

47
Q

Most common CNS effects (sedation, fatigue, and
coordination difficulties)

A

Levetiracetam

48
Q

drug Does not induce or inhibit liver enzymes and does not appear to interact with other AEDs, warfarin, digoxin, or oral contraceptive drugs

A

Levetiracetam

49
Q

T/F
Oxcarbazepine is indicated for use as monotherapy

A

T

50
Q

Adjunctive therapy in the treatment of partial seizures in adults
and children as young as four years of age

A

Oxcarbazepine

51
Q

Potential first-line drug for patients with primary generalized
convulsive seizures

A

Oxcarbazepine

52
Q

May also be effective in patients not demonstrating a response
to carbamazepine

A

Oxcarbazepine

53
Q

fewer S/E than phenytoin, carbamazepine, and valproic acid

A

Oxcarbazepine

54
Q

Most frequently reported S/E: dizziness, nausea, headache,
diarrhea, vomiting, URTI, constipation, dyspepsia, ataxia, and nervousness

A

Oxcarbazepine

55
Q

Decreases the bioavailability and pharmacologic activity of ethinyl estradiol and levonorgestrel

A

Oxcarbazepine

56
Q

ethinyl estradiol and levonorgestrel drug class

A

oral contraceptives

57
Q

Drug of choice for neonatal seizures

A

Phenobarbital

58
Q

Reserved for patients who have failed therapy with other AEDs

A

Phenobarbital

59
Q

May be useful given IV in refractory status epilepticus

A

Phenobarbital

60
Q

life-threatening condition when seizures persist despite administration of both 1st line and 2nd line medications

A

status epilepticus

61
Q

advantage: available in Multiple dosage forms available

A

Phenobarbital

62
Q

T/F
phenytoin is available in oral solid, oral liquid, IM, IV

A

F - phenobarbital

63
Q

Most inexpensive AED

A

Phenobarbital

64
Q

primary factors limiting the use of
phenobarbital

A

CNS side effects

65
Q

Adverse Effects: Hyperactivity in children

A

Phenobarbital

66
Q

May also cause porphyria and rashes as serious as SJS

A

Phenobarbital

67
Q

Potent enzyme inducer (increases elimination of any drug
metabolized by CYP450)

A

Phenobarbital

68
Q

First-line AED for primary generalized convulsive and partial seizures

A

Phenytoin

69
Q

CNS depressant effects (lethargy, fatigue, incoordination,
blurred vision, higher cortical dysfunction, and drowsiness)

A

Phenytoin

70
Q

adverse effects on CNS are usually transient, can be minimized by slow dosage titration

A

Phenytoin

71
Q

T/F
if newer AEDs are available, phenytoin would be a lower priority

A

T

72
Q

T/F
Phenytoin is Associated with minimal drug interaction

A

F - numerous drug interaction

73
Q

drug interactions Involve altered absorption, metabolism, protein binding; May enhance or reduce its effects

A

Phenytoin

74
Q

Dosing Must be in mg PE

A

Phenytoin

75
Q

dosing unit of phenytoin

A

mg phenytoin
equivalents or PE

76
Q

75 mg fosphenytoin is equal to ____ mg phenytoin sodium

A

50

77
Q

Second-line agent for patients with partial seizures who have failed initial treatment

A

Pregabalin

78
Q

Useful for chronic neuropathic pain and generalized anxiety disorder

A

Pregabalin

79
Q

Most frequently reported A/E: dizziness, ataxia, blurred vision,
and weight gain

A

Pregabalin

80
Q

Drug Interactions are Unlikely to happen, predominantly excreted unchanged in the urine and undergoes negligible metabolism

A

Pregabalin

81
Q

First-line AED for partial seizures as an adjunct and/or monotherapy

A

Topiramate

82
Q

Approved for the treatment of tonic-clonic seizures in primary generalized epilepsy

A

Topiramate

83
Q

T/F
most A/Es occur irregardless of how topiramate is administered; whether in high doses or rapid titration

A

F

84
Q

Slow dosage titration and increments (increments must be assessed in 1 to 2 weeks)

A

Topiramate

85
Q

Main: ataxia, impaired concentration, memory difficulties, attentional deficits, fatigue, paresthesia, somnolence, and “thinking abnormally” which rarely has included psychosis

A

Topiramate

86
Q

Cognitive dysfunctions in concomitant therapy with topiramate, valproic acid, or phenobarbital

A

Topiramate

87
Q

Cognitive dysfunctions from
Topiramate arise in concomitant therapy with _________, __________, or ________

A

topiramate, valproic acid, phenobarbital

88
Q

First-line therapy for primary generalized seizures including myoclonic, atonic, and absence seizures

A

Valproic Acid or Divalproex Sodium

89
Q

Used as both monotherapy and adjunctive therapy for partial seizures

A

Valproic Acid or Divalproex Sodium

90
Q

Useful in patients with mixed seizure disorders

A

Valproic Acid or Divalproex Sodium

91
Q

Most frequently reported: Gastrointestinal symptoms w/ 20%
incidence (nausea, vomiting, anorexia and weight gain)

A

Valproic Acid or Divalproex Sodium

92
Q

T/F
GI complains in valproic acid can be completely alleviated

A

F

93
Q

how to Minimize GI complaints from Valproic Acid or Divalproex Sodium?

A

enteric-coated formulation or by
giving the drug with food

94
Q

A/E: Alopecia and hair changes (temporary)

A

Valproic Acid or Divalproex Sodium

95
Q

Most serious side effect of Valproic Acid or Divalproex Sodium

A

hepatotoxicity

96
Q

Highly protein-bound, can be displaced by other drugs

A

Valproic Acid or Divalproex Sodium

97
Q

Approved for the adjunctive treatment of partial seizures

A

Zonisamide

98
Q

Most common: somnolence, dizziness, anorexia, headache, nausea, agitation, word-finding difficulties, irritability; usually dose, dependent

A

Zonisamide

99
Q

T/F
Zonisamide does not induce or inhibit liver enzymes

A

T

100
Q

Should be avoided in patients
allergic to sulfa drugs

A

Zonisamide

Clin Phar II Lec (3 decks)

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