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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
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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
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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
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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
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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

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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

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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

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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

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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

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10
Q

MECHANISM OF ACTION

Blockade of Na+, Stimulates the release of ADH

A

Tradition

Carbamazepine

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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

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12
Q

MECHANISM OF ACTION

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

A

Traditional

Valproic Acid

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13
Q

Treat:
Anxiety (Generalized Anxiety Disorder, GAD)
Insomnia
Seizure Disorders
Muscle Spasms
Alcohol Withdrawal
Peri-Operative (anesthesia, conscious sedation)

A

Traditional

Benzodiazepine

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14
Q

MECHANISM OF ACTION

Potentiate/amplifies the actions of GABA (gamma-amino-butyric acid), does NOT directly mimic GABA

A

Traditional

Benzodiazepine

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15
Q 
Nursing Considerations
Which Benzo commonly used for STATUS EPILEPTICUS
Midazolam
Lorazepam 
Temazepam
Diazepam
Chlordiazepoxide
A

Lorazepam and Diazepam

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16
Q

Treat:
Seizures
Sedatives
off label for alcohol withdrawal

A

Traditional Barbiturates

phenobarbital +primidone

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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

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18
Q

Which barbiturate is used for STATUS EPILEPTICUS?
Methohexital
Phenobarbital
Primidone

A

Phenobarbital

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19
Q

Benzo and Barbiturates are Classified as Traditional, but not quite the same risk profile?
True or False

A

True

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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

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21
Q

Traditional
Phenobarbital/Primidone
BOXED WARNING
Too rapid infusion can cause dysrhythmias/hypotension, No faster than ? mg/min

A

50

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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

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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

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24
Q

Traditional
Phenytoin/Fosphenytoin
Incresed or Decreased levels of Vit K/D,

A

Decreased

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25
Q

HLA-B*1502 allele

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

Traditional Antiepileptics
Phenytoin/Fosphenytoin

Traditional Antiepileptics
Carbamazepine

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26
Q

Traditional
Phenytoin/Fosphenytoin
Narrow Therapeutic Index
? - ?mcg/mL

A

10-20

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27
Q

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
A

Traditional
Phenytoin/Fosphenytoin

Carbamazepine

C. Valproic Acid

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28
Q

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
A

Traditional

Phenytoin/Fosphenytoin

29
Q

Administration

DILUTE IV AND GIVE AS A SLOW IV PUSH (no faster than 50 mg/min) to reduce BP and cardiovascular risks

A

Traditional

Phenytoin/Fosphenytoin

30
Q

Teratogenic!-Pregnancy Category D

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

Traditional
Phenytoin/Fosphenytoin

Carbamazepine

C. Valproic Acid

31
Q

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
A

Traditional Antiepileptics

Carbamazepine

32
Q

Aplastic anemia and agranulocytosis

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

Traditional Antiepileptics

Carbamazepine

33
Q

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
A

Traditional Antiepileptics

Carbamazepine

34
Q

LIVER ENZYME INDUCE: : Oral Contraceptives, Warfarin

A

Traditional Antiepileptics

Carbamazepine

35
Q

Teratogenic- Pregnancy Category D

Risk is 4 times greater than other AEDs

A

Traditional Antiepileptics

Valproic Acid

36
Q

BOXED WARNING: Hepatotoxicity

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

Traditional Antiepileptics

Valproic Acid

37
Q

BOXED WARNING: Pancreatitis

A

Traditional Antiepileptics

Valproic Acid

38
Q

BOXED WARNING: Fetal Harm

A

Traditional Antiepileptics

Valproic Acid

39
Q

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
A

Traditional Antiepileptics

Valproic Acid

40
Q

Avoid Drugs like Phenytoin that cause SJS/TEN- Allopurinol, Carbamazepine, Lamotrigine, Phenobarbital

A

Traditional
Phenytoin/Fosphenytoin

Carbamazepine

41
Q

Cleft lip/palates

A

Traditional

Phenytoin/Fosphenytoin

42
Q

Long term usage- Osteoporosis

A

Traditional

Phenytoin/Fosphenytoin

43
Q

Spina Bifida, & Cleft Palate

A

Traditional Antiepileptics

Valproic Acid

44
Q

HPR- High pregnancy Risk

H- Hepatotoxicity, R- Rash skin, P- Pregnancy risk/ Pancreatitis/ Platelets

A

Traditional Antiepileptics

Valproic Acid

45
Q 
Traditional Antiepileptics
Valproic Acid
HPR- 
H- 
R- 
P-
A

High pregnancy Risk
Hepatotoxicity
Rash skin
Pregnancy risk/ Pancreatitis/ Platelets

46
Q

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

A

Traditional Antiepileptics

Valproic Acid

47
Q

NC

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

A

Traditional Antiepileptics

Valproic Acid

48
Q

Administration
Give with Food

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

Traditional Antiepileptics
Valproic Acid

Carbamazepine

49
Q 
Mnemonic 
CBS
C- Check labs! (CBC/BMP), 
B- Blood dyscrasia (pancytopenia), 
S- Skin Rash
A

Traditional Antiepileptics

Carbamazepine

50
Q 
Traditional Antiepileptics
Carbamazepine
CBS
C-
B-
S-
A

Check labs! (CBC/BMP),
Blood dyscrasia (pancytopenia),
Skin Rash

51
Q

Nursing Considerations
Due to bone marrow suppression
Periodic checks of CBC—- Report fever/sore throat

A

Traditional Antiepileptics

Carbamazepine

52
Q 
Fluid Retention
Check BMP (Blood Metabolic Panel)  (Na, BUN)
A

Traditional Antiepileptics

Carbamazepine

53
Q

CNS effects
Use caution when driving,
The visual disturbances should decrease over time

A

Traditional Antiepileptics

Carbamazepine

54
Q

Due to SJS/TEN HLA-B*1502

Protect skin from sun exposure

A

Traditional Antiepileptics
Carbamazepine

Traditional
Phenytoin/Fosphenytoin

55
Q

Gingival Hyperplasia

Periodic dental visits, Brush teeth with soft bristle toothbrush, floss, massage gums

A

Traditional

Phenytoin/Fosphenytoin

56
Q

Teratogenic- Do not use in pregnancy

renders OC’s ineffective

A

Traditional

Phenytoin/Fosphenytoin

57
Q

CNS Sedation- Do not drive or operate heavy machinery if experiencing CNS depression

A

Traditional

Phenytoin/Fosphenytoin

58
Q

ENZYME INDUCER- renders OC’s ineffective

A

Traditional

Phenytoin/Fosphenytoin

59
Q

Administration- Slow IV (50 mg/min

A

Traditional

Phenytoin/Fosphenytoin

60
Q

LIVER ENZYME INDUCE: : Oral Contraceptives, Warfarin

A

Traditional

Phenytoin/Fosphenytoin

61
Q 
Which drugs causes SJS/TEN reactions 
Allopurinol 
Carbamazepine
 Lamotrigine
 Phenobarbital
62
Q

Treat:
Epilepsy
BiPolar Disorder

A

New Antiepileptics

Lamotrigine

63
Q

ADVERSE EFFECTS
Serious Skin Rashes (SJS/TEN)
Pregnancy Category C–Cleft Lip/Palate

A

New Antiepileptics

Lamotrigine

64
Q

Pregnancy Category C–Cleft Lip/Palate

A

New Antiepileptics

Lamotrigine

65
Q

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
A

New Antipileptics

Topiramate

66
Q

ADVERSE EFFECTS
Weight loss/anorexia
Some patients report 10 kg + Patients may experience reduced sweating/ increased body temperature (be careful with exercise!)

A

New Antiepileptics

Topiramate

67
Q

CNS- somnolence, dizziness, diplopia

A

New Antipileptics

Topiramate

68
Q

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
A

New Antiepileptics

Gabapentin

69
Q

ADVERSE EFFECTS
Peripheral Edema

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

New Antiepileptics

Gabapentin

Phamacology (13 decks)

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