Antiepileptics Flashcards
1
Q
Anti-Epilepsy Drugs (AED’s) TRADITIONAL Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Phenytoin/Fosphenytoin Carbamazepine Valproic Acid/Valproate/Divalproex sodium Lorazepam/Diazepam Phenobarbital/Primidone
2
Q
Anti-Epilepsy Drugs (AED’s) New Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Lamotrigine Gabapentin Topiramate Pregabalin Oxcarbazepine Lacosamide Levetiracetam
3
Q
Higher risk for developing fetus Hepatic enzyme involvement (drug-drug!) More sedative, adverse effects? Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Lorazepam/Diazepam Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional Carbamazepine Phenobarbital/Primidone Phenytoin/Fosphenytoin Valproic Acid/Valproate/Divalproex sodium Lorazepam/Diazepam
4
Q
May have less risk for developing fetus Less drug-drug interactions Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
New Lamotrigine Gabapentin Levetiracetam Topiramate Pregabalin Oxcarbazepine
5
Q
Treat: All types of seizures Drug of choice in adults and older children Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
6
Q
Treats Status epilepticus Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
7
Q
NO LONGER used as a drug for cardiac dysrhythmias Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
8
Q
MECHANISM OF ACTION selective inhibition of sodium channels Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
9
Q
Treat: Seizures, Bipolar disorder, Trigeminal and glossopharyngeal neuralgias Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Tradition
Carbamazepine
10
Q
MECHANISM OF ACTION
Blockade of Na+, Stimulates the release of ADH
A
Tradition
Carbamazepine
11
Q
Treat:
Epilepsy – useful against all types of seizures, Bipolar disorder, & Migraine prevention
Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Valproic Acid
12
Q
MECHANISM OF ACTION
Blockade of Na+, Ca++ channels AND may potentiate effects of GABA
A
Traditional
Valproic Acid
13
Q
Treat:
Anxiety (Generalized Anxiety Disorder, GAD)
Insomnia
Seizure Disorders
Muscle Spasms
Alcohol Withdrawal
Peri-Operative (anesthesia, conscious sedation)
A
Traditional
Benzodiazepine
14
Q
MECHANISM OF ACTION
Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), does NOT directly mimic GABA
A
Traditional
Benzodiazepine
15
Q
Nursing Considerations Which Benzo commonly used for STATUS EPILEPTICUS Midazolam Lorazepam Temazepam Diazepam Chlordiazepoxide
A
Lorazepam and Diazepam
16
Q
Treat:
Seizures
Sedatives
off label for alcohol withdrawal
A
Traditional Barbiturates
phenobarbital +primidone
17
Q
MECHANISM OF ACTION
Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), and directly mimic GABA (prolongs duration of chloride channel opening)
A
Traditional Barbiturates
phenobarbital +primidone
18
Q
Which barbiturate is used for STATUS EPILEPTICUS?
Methohexital
Phenobarbital
Primidone
A
Phenobarbital
19
Q
Benzo and Barbiturates are Classified as Traditional, but not quite the same risk profile?
True or False
A
True
20
Q
Which has the Gingival Hyperplasia (20% patients, folic acid supplementation and good oral hygiene)
Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
21
Q
Traditional
Phenobarbital/Primidone
BOXED WARNING
Too rapid infusion can cause dysrhythmias/hypotension, No faster than ? mg/min
A
50
22
Q
Hirsutism, Skin Rash,
Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
23
Q
SJS/TEN◦
Preliminary Data- Severe Rash- HLA-B1502 allele10% higher risk for SJS/TEN
Lamotrigine Carbamazepine Phenobarbital/Primidone Gabapentin Phenytoin/Fosphenytoin Levetiracetam Valproic Acid/Valproate/Divalproex sodium Topiramate Pregabalin Lacosamide Lorazepam/Diazepam Oxcarbazepine
A
Traditional
Phenytoin/Fosphenytoin
Traditional Antiepileptics
Carbamazepine
24
Q
Traditional
Phenytoin/Fosphenytoin
Incresed or Decreased levels of Vit K/D,
A
Decreased
25
HLA-B*1502 allele
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
Phenytoin/Fosphenytoin
Traditional Antiepileptics
Carbamazepine
26
Traditional
Phenytoin/Fosphenytoin
Narrow Therapeutic Index
? - ?mcg/mL
10-20
27
Toxic symptoms/ montor : Nystagmus, Ataxia, diplopia, drowsiness, sedation
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional
Phenytoin/Fosphenytoin
Carbamazepine
C. Valproic Acid
28
ENZYME INDUCER- renders OC’s ineffective
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional
| Phenytoin/Fosphenytoin
29
Administration
| DILUTE IV AND GIVE AS A SLOW IV PUSH (no faster than 50 mg/min) to reduce BP and cardiovascular risks
Traditional
| Phenytoin/Fosphenytoin
30
Teratogenic!-Pregnancy Category D
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional
Phenytoin/Fosphenytoin
Carbamazepine
C. Valproic Acid
31
Bone marrow suppression that leads to hematological effects- Aplastic anemia and agranulocytosis
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
| Carbamazepine
32
Aplastic anemia and agranulocytosis
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
| Carbamazepine
33
Promotes ADH (water) - can cause fluid retention
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
| Carbamazepine
34
LIVER ENZYME INDUCE: : Oral Contraceptives, Warfarin
Traditional Antiepileptics
| Carbamazepine
35
Teratogenic- Pregnancy Category D
| Risk is 4 times greater than other AEDs
Traditional Antiepileptics
| Valproic Acid
36
BOXED WARNING: Hepatotoxicity
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
| Valproic Acid
37
BOXED WARNING: Pancreatitis
Traditional Antiepileptics
| Valproic Acid
38
BOXED WARNING: Fetal Harm
Traditional Antiepileptics
| Valproic Acid
39
BOXED WARNING: patient with mitochondrial disease increased risk for liver failure.
mitochondrial DNA polymerase gamma (POLG) gene (Alpers-Huttenlocher syndrome)
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
| Valproic Acid
40
Avoid Drugs like Phenytoin that cause SJS/TEN- Allopurinol, Carbamazepine, Lamotrigine, Phenobarbital
Traditional
Phenytoin/Fosphenytoin
Carbamazepine
41
Cleft lip/palates
Traditional
| Phenytoin/Fosphenytoin
42
Long term usage- Osteoporosis
Traditional
| Phenytoin/Fosphenytoin
43
Spina Bifida, & Cleft Palate
Traditional Antiepileptics
| Valproic Acid
44
HPR- High pregnancy Risk
| H- Hepatotoxicity, R- Rash skin, P- Pregnancy risk/ Pancreatitis/ Platelets
Traditional Antiepileptics
| Valproic Acid
45
```
Traditional Antiepileptics
Valproic Acid
HPR-
H-
R-
P-
```
High pregnancy Risk
Hepatotoxicity
Rash skin
Pregnancy risk/ Pancreatitis/ Platelets
46
NC
Hepatotoxicty + Pancreatitis: Monitor LFTs + amylase periodically, patient should also monitor for N/V, jaundice, abdominal pain
Traditional Antiepileptics
| Valproic Acid
47
NC
| Rarely Thrombocytopenia: Monitor platelets, educate patient to notify prescriber of bruising
Traditional Antiepileptics
| Valproic Acid
48
Administration
Give with Food
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
Traditional Antiepileptics
Valproic Acid
Carbamazepine
49
```
Mnemonic
CBS
C- Check labs! (CBC/BMP),
B- Blood dyscrasia (pancytopenia),
S- Skin Rash
```
Traditional Antiepileptics
| Carbamazepine
50
```
Traditional Antiepileptics
Carbamazepine
CBS
C-
B-
S-
```
Check labs! (CBC/BMP),
Blood dyscrasia (pancytopenia),
Skin Rash
51
Nursing Considerations
Due to bone marrow suppression
Periodic checks of CBC---- Report fever/sore throat
Traditional Antiepileptics
| Carbamazepine
52
```
Fluid Retention
Check BMP (Blood Metabolic Panel) (Na, BUN)
```
Traditional Antiepileptics
| Carbamazepine
53
CNS effects
Use caution when driving,
The visual disturbances should decrease over time
Traditional Antiepileptics
| Carbamazepine
54
Due to SJS/TEN HLA-B*1502
| Protect skin from sun exposure
Traditional Antiepileptics
Carbamazepine
Traditional
Phenytoin/Fosphenytoin
55
Gingival Hyperplasia
| Periodic dental visits, Brush teeth with soft bristle toothbrush, floss, massage gums
Traditional
| Phenytoin/Fosphenytoin
56
Teratogenic- Do not use in pregnancy
| renders OC’s ineffective
Traditional
| Phenytoin/Fosphenytoin
57
CNS Sedation- Do not drive or operate heavy machinery if experiencing CNS depression
Traditional
| Phenytoin/Fosphenytoin
58
ENZYME INDUCER- renders OC’s ineffective
Traditional
| Phenytoin/Fosphenytoin
59
Administration- Slow IV (50 mg/min
Traditional
| Phenytoin/Fosphenytoin
60
LIVER ENZYME INDUCE: : Oral Contraceptives, Warfarin
Traditional
| Phenytoin/Fosphenytoin
61
```
Which drugs causes SJS/TEN reactions
Allopurinol
Carbamazepine
Lamotrigine
Phenobarbital
```
Alll
62
Treat:
Epilepsy
BiPolar Disorder
New Antiepileptics
| Lamotrigine
63
ADVERSE EFFECTS
Serious Skin Rashes (SJS/TEN)
Pregnancy Category C--Cleft Lip/Palate
New Antiepileptics
| Lamotrigine
64
Pregnancy Category C--Cleft Lip/Palate
New Antiepileptics
| Lamotrigine
65
Treat:
Epilepsy, Migraines/Cluster Headaches, Off label: weight loss
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
New Antipileptics
| Topiramate
66
ADVERSE EFFECTS
Weight loss/anorexia
Some patients report 10 kg + Patients may experience reduced sweating/ increased body temperature (be careful with exercise!)
New Antiepileptics
| Topiramate
67
CNS- somnolence, dizziness, diplopia
New Antipileptics
| Topiramate
68
Treat:
Post herpetic Neuralgia
Diabetic Neuropathy
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
New Antiepileptics
| Gabapentin
69
ADVERSE EFFECTS
Peripheral Edema
```
Lamotrigine
Carbamazepine
Phenobarbital/Primidone
Gabapentin
Phenytoin/Fosphenytoin
Levetiracetam
Valproic Acid/Valproate/Divalproex sodium
Topiramate
Pregabalin
Lacosamide
Lorazepam/Diazepam
Oxcarbazepine
```
New Antiepileptics
| Gabapentin
