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BCPS > Antiepileptics > Flashcards

Antiepileptics Flashcards

1
Q

What is the mechanism of action of Carbamazepine?

A

Fast Na channel blocker

Carbamazepine is also known for its enzyme induction and autoinduction properties.

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2
Q

What are the major adverse drug reactions (ADRs) associated with Carbamazepine?

A

-Delayed rash
-SIADH
-Blood dyscrasias
-Decreased bone density
-Toxicity: slurred speech, N/V, diplopia, tremor, drowsiness

HLA-B*1502 genotype is associated with increased risk of SJS.

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3
Q

What is the therapeutic level of Carbamazepine?

A

4-12 mcg/ml

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4
Q

What is the mechanism of action of Fosphenytoin?

A

Fast Na channel blocker

Fosphenytoin is a prodrug for phenytoin.

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5
Q

What is the maximum administration rate for Fosphenytoin?

A

150 mg PE per minute

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6
Q

What are the common ADRs of Gabapentin?

A

Sedation, respiratory depression increase with other CNS depressants

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7
Q

What is the mechanism of action of Lacosamide?

A

Slow Na channel blocker

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8
Q

What is a significant cardiovascular concern associated with Lacosamide?

A

PR prolongation or 1st degree AV block

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9
Q

What is the mechanism of action of Lamotrigine?

A

Decrease glutamate and aspartate release; delays repetitive firing of neurons; block fast Na channels

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10
Q

What are the major black box warnings (BBW) for Lamotrigine?

A

Rash/SJS/DRESS

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11
Q

What is the mechanism of action of Levetiracetam?

A

Prevent hypersynchronization of epileptiform burst firing & propagation of seizure activity through binding at SV2A receptor

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12
Q

What are the common ADRs of Levetiracetam?

A

-Depression
-Behavior changes
-Agitation
-Coordination difficulties
-Drowsiness

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13
Q

What is the mechanism of action of Oxcarbazepine?

A

Fast Na channel blocker

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14
Q

What is a notable side effect of Oxcarbazepine compared to Carbamazepine?

A

Hyponatremia > CBZ
Rash < CBZ (cross reactivity)
Blood dyscrasias < CBZ

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15
Q

What is the mechanism of action of Phenobarbital?

A

Increase GABA-mediated chloride influx

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16
Q

What is the therapeutic level of Phenobarbital?

A

15-40 mcg/ml

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17
Q

What are the common ADRs of Phenytoin?

A

-Dose related: nystagmus, ataxia, drowsiness, cognitive impairment
-Non-dose related: gingival hyperplasia, hirsutism, acne, rash (DRESS), hepatotoxic
-Decrease bone density

18
Q

What is the maximum administration rate for Phenytoin?

A

50 mg/min due to arrhythmia, hypotension

19
Q

What is the mechanism of action of Pregabalin?

A

Inhibit subunit of voltage-dependent Ca channel

20
Q

What are the common ADRs of Pregabalin?

A

-Somnolence
-Behavioral problems
-Dizziness
-Weight gain
-Ataxia
-Angioedema

21
Q

What is the mechanism of action of Topiramate?

A

Fast Na channel blocker; enhance GABA; antagonize AMPA; carbonic anhydrase inhibitor

22
Q

What are the common ADRs of Topiramate?

A

-Drowsiness
-Paresthesias
-Weight loss
-Nephrolithiasis
-Psychomotor slowing
-Glaucoma
-Metabolic acidosis
-Word-finding difficulties
-Oligohidrosis

23
Q

What is the mechanism of action of Valproic acid?

A

Blocks T-type Ca current, block Na channel, increase GABA

24
Q

What are the major black box warnings (BBW) for Valproic acid?

A

-Hepatotoxicity
-Teratogenic
-Pancreatitis

25
Q

What is the therapeutic level of Valproic acid?

A

40-100 or 150 mcg/ml

26
Q

What is the mechanism of action of Zonisamide?

A

No effect on CYP

27
Q

What are the common ADRs of Zonisamide?

A

-Weight loss
-Rash
-Oligohidrosis
-Somnolence
-Agitation
-Hallucinations
-Metabolic acidosis
-Nephrolithiasis

28
Q

What is the mechanism of action of Brivaracetam?

A

Unknown - high affinity for synaptic vesicle protein 2A

29
Q

What are the common ADRs of Cannabidiol?

A

-Hepatotoxicity
-Sedation
-Diarrhea

30
Q

What is the mechanism of action of Cenobamate?

A

Inhibit voltage gated Na channels, modulate GABA receptor

31
Q

What is a significant ADR associated with Cenobamate?

A

DRESS (titrate slowly)

32
Q

What is the mechanism of action of Clobazam?

A

Long acting benzo

33
Q

What are the common ADRs of Ethosuximide?

A

-Anorexia
-N/V
-Leukopenia
-Agranulocytosis
-Pancytopenia

34
Q

What is the mechanism of action of Felbamate?

A

Blocks glycine site on NMDA receptor

35
Q

What is the major concern when using Felbamate?

A

Hepatotoxicity, aplastic anemia (must sign consent)

36
Q

What is a major concern associated with Fenfluramine?

A

Serotonin syndrome with other serotonergic meds

37
Q

What is the mechanism of action of Ganaxolone?

A

Positive modulation of GABA receptor

38
Q

What are the common ADRs of Perampanel?

A

-Somnolence
-Sedation
-Dizziness
-Fatigue

39
Q

What is the mechanism of action of Rufinamide?

A

Fast Na channel blocker

40
Q

What is a significant ADR of Rufinamide?

A

HA, dizziness, fatigue, nausea, somnolence (slow dose titration), rash (children)

41
Q

What is the mechanism of action of Tiagabine?

A

Block GABA uptake in presynaptic neuron

42
Q

What is the major concern associated with Vigabatrin?

A

BBW: Vision loss

BCPS (34 decks)

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