Antiseizure Agents (part 2)

Question 1

What are the therapeutic levels of Dilantin?

Answer 1

10-20 mcg/mL

Question 2

A patient has blurred/double vision, nausea/vomiting, slurred speech, clumsiness, ataxia, confusion, and fatigue. What condition is causing this?

Answer 2

Dilantin toxicity

10-20 mcg/mL

Toxic levels = >20 mcg/mL

IV push 50 mg/minute

Question 3

Drugs for Treating Generalized Seizures

Adverse effects include gum/gingival hyperplasia, hirsutism, gynecomastia, skin rash, and SJS.

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 3

Hydantoins (Dilantin) 10-20 mcg/mL

MOA:

1. Reduces motor cortex activity
2. Block Na⁺ channels and Ca²⁺ influx

Uses:

• Tonic-clonic seizures
• Treats all forms of epilepsy except absence

Adverse Effects:

• Gum / gingival hyperplasia
• Dermatological
  
  • SJS (skin sloughing)
  • Hirsutism
  • Skin rash
• Gynecomastia

Question 4

Drugs for Treating Generalized Seizures

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 4

Hydantoins (Dilantin) 10-20 mcg/mL

MOA:

1. Reduces motor cortex activity
2. Block Na⁺ channels and Ca²⁺ influx

Uses:

• Tonic-clonic seizures
• Treats all forms of epilepsy except absence

Adverse Effects:

• Gum / gingival hyperplasia
• Dermatological
  
  • SJS (skin sloughing)
  • Hirsutism
  • Skin rash
• Gynecomastia

Question 5

Drugs for Treating Generalized Seizures

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 5

Barbiturates

Uses:

• Tonic-clonic seizures
• Febrile seizures (neonatal)

Adverse Effects:

• Stevens-Johnson Syndrome
  
  • severe inflammatory disease: fever, bullae of skin, ulcers on skin, mucous membranes, nose, eyes, and genitalia
• Agranulocytosis
• Ataxia
• Drowsiness
• “Hangover effect”
• Exfoliative dermatitis
• High potential for dependence

Interactions:

• Avoid Gingko (herbals)

Question 6

Drugs for Treating Generalized Seizures

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 6

Benzodiazepines

Inject slowly - 1 minute / 5mg

MOA:

• Enhances GABA
• Foci in the cortex, thalamus, and limbic areas

Uses:

• Acute seizure treatment
• Status epilepticus

Adverse Effects:

• Hypotension
• Tachycardia
• Thrombophlebitis (increase in blood clots)

Question 7

Drugs for Treating Generalized Seizures

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 7

Succinimides​

Uses:

• Absence seizures *** (Zarontin)

Adverse Effects:

• Thrombocytopenia
• Agranulocytosis (infection)
• Black box warning (mood changes)
• Steven-Johnson syndrome

Question 8

Drugs for Treating Generalized Seizures

1. ) Hydantoins (Dilantin)
2. ) Barbiturates
3. ) Benzodiazepines
4. ) Succinimides
5. ) Valproic Acid / Depakote

Answer 8

Valproic Acid / Depakote​

Uses: Adjunctive therapy for multiple seizures

Adverse Effects:

• Weight gain (freshman 15)
• Pancreatitis
• Hepatotoxicity (serious, but rare complication)