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HSHD 2 Block 2 > Antiseizure Drugs > Flashcards

Antiseizure Drugs Flashcards

1
Q

Goals of therapy

A

Eliminate seizures

Avoid side effects

Achieve best possible psychosocial function

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2
Q

Principles of AED therapy

A

Verify a diagnosis of epilepsy

Acute symptomatic seizures (e.g. hyponatremic seizure or seizure related to drug intoxication) is not epilepsy and does not require initiation of an AED.

Many other things can mimic an epileptic seizure, such as psychogenic non-epileptic seizures and syncope.

Select an AED based on seizure-type, other medications and co-morbidities, and potential adverse effects.

Manage adverse effects

Attempt to get seizure-freedom with monotherapy.

Monitory therapy with serum drug levels, if available.

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3
Q

Drugs for Focal-onset seizures:

A

ALL AEDs except ethosuxamide (based on FDA approval)

There is no clear front-runner to choose from based on efficacy alone. You must make a selection based on other things, like drug interractions and side effects.

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4
Q

Drugs for absence seizures

A

Ethosuxamide (works for nothing else)

Valproic acid

Zonisamide

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5
Q

Drugs for Primary generalized seizures

A

Valproic acid

Lamotrigine

Topiramate

Zonisamide

Levetiracetam

Perampanel

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6
Q

Drugs for myoclonus

A

Valproic acid

Levetiracetame

Zonisamide

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7
Q

Criteria for surgery

A

Some patients with epilepsy need to have surgery to reduce seizure frequency. One criteria commonly used to recommend epilepsy surgery is the use of at least two AEDs over at least two years, which fail to achieve seizure freedom.

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8
Q

Efficacy of first AED

A

The first drug you choose has about a 60% chance of seizure freedom. Each drug you choose after that has diminishing returns unless use is limited by side effects (in which case you get a do-over).

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9
Q

What are complex partial seizures and drugs of choice

A

Complex Partial Seizures

Focal onset seizures with altered awareness

ALL AEDs are useful except for ethosuxamide

“classic” drugs of choice:

carbamazepine

phenytoin

valproic acid

oxcarbazepine

lamotrigine

lacosamide

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10
Q

Side effects of Pheytoin

A

Gum hypertrophy

Facial coarsening and hirsutism

Osteopenia

Teratogenesis

Ataxia with cerebellar atrophy

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11
Q

Side effects of Valproic acid

A

Weight gain

Tremor

Alopecia

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12
Q

Side effects of topiramate

A

Nausea and weight loss

Nephrolithiasis

Glaucoma exacerbation

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13
Q

Side effects of Levetiracetam

A

Irritability and mood disorder exacerbation

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14
Q

Drugs that interact with Broad spectrum CYP inducers

A

Carbamazepine

Phenytoin

Phenobarbital

Primidone

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15
Q

Drugs that interact with CYP3A inducers

A

Oxcarbazepine

Topiramate

Felbamate

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16
Q

Drugs that interact with CYP450 inhibitors

A

Valproic acid

17
Q

Drugs that have NO effects on the CYP system

A

Levetirecetam

Gabapentin

Lamotrigine

Tiagabine

Zonisamide

18
Q

Drugs that carry a risk of stevens johnson syndrome

A

Carbamazepine

Oxcarbazepine

Valproic acid

Phenytoin

Phenobarbital

Ethosuxamide

Lamotrigine

Zonisamide

19
Q

Drugs with hepatotoxicity

A

Carbamazepine

Oxcarbazepine

Valproic acid

Phenytoin

Phenobarbital

Felbamate

20
Q

Drugs that cause Leukopenia/aplastic anemia

A

Carbamazepine

Oxcarbazepine

Valproic acid

Phenobarbital

Ethosuxamide

Zonisamide

Felbamate

21
Q

How does Voltage-gated sodium channel modulation work

A

The most important known AED mechanism of action is modulation of sustained repetitive firing, usually through modulation of voltage-gated sodium channel function.

22
Q

Benzodiazapenes MOA

A

GABA receptor modulation

The second most important AED mechanism of action is enhancement of GABAA receptor function and therefore, enhancement of synaptic inhibition.

23
Q

AED used for tremor

A

Primidone

24
Q

AED used for pain

A

gabapentin, pregabalin

25
Q

AED used for migraine

A

topiramate, valproic acid

26
Q

AED used for mood disorder

A

lamotirigine, valproic acid, topiramate

27
Q

Phenytoin MOA and indication

A

Mechanism of action: Sodium channel modulator

Indication: FDA approved for focal onset seizures

28
Q

Phenytoin pharmokinetics

A

Liver metabolism, which is nonlinear

Phenytoin switches from first-order to zero-order kinetics in the middle of its therapeutic dose range.

Interracts with mutliple drugs (broad spectrum CYP inducer)

Twice daily dosing, half-life of ~22 hours (good if you miss a dose)

29
Q

Carbamazepine MOA, indications, pharmacokinetics, adverse effects

A

Mechanism of action: Sodium channel modulator

Indication: FDA approved for patrial onset seizures

Phamacokinetics:

Liver metabolism

Broad spectrum CYP inducer

TID dosing, half life 8-22 hours

Adverse effects:

Hyponatremia

Hepatitis

Aplastic anemia

Ataxia

30
Q

Gabapentin indication and pharmacokinetics

A

Indication: FDA approved for focal onset seizures

Pharmacokinetics: very favorable

No active metabolites or protein binding

93% excreted unchanged in urine

Does not induce hepatic enzymes

Low interraction with other AEDs

TID or QID dosing, half life 5-7 hours

31
Q

Lamotrigine indication, pharmacokinetics, side effects

A

Indication: FDA approved for focal onset seizures but commonly used also in generalized seizures

Pharmacokinetics:

Metabolized in the liver but not CYP450

daily or BID dosing, half life 12-60 hours

High rate of rash, including Stevens Johnson syndrome

32
Q

Levetiracetam MOA, indication, pharmacokinetics, side effects

A

Mechanism of action: not entirely clear

Indication: FDA approved for focal onset seizures but also frequently used in generalized seizures

Pharmacokinetics:

2/3 excreted unchanged and 1/3 metabolized in the liver

BID dosing, half-life 6-8 hours

Adverse effects: irritability and aggressiveness

33
Q

Fetal malformations associated with each drug

A

—Structural teratogenesis with 1st trimester exposure and cognitive teratogenesis is with exposure throughout pregnancy

—Valproate- Associated with spina bifida, hypospadias, lower verbal IQ and autism, may be dose dependent

—Phenobarbital is associated with cardiac malformations

—Topiramate- Associated with facial clefts

—Carbamazepine- Spina bifida

—Phenytoin- hypospadias and cardiac defects

—Levetiracetam- Only 2 major malformations occurred (inguinal hernia and reflux requiring surgery)

—Folic acid decreases the risk of neural tube defects, lower verbal IQ and the risk of spontaneous miscarriage (1-4 mg)

HSHD 2 Block 2 (8 decks)

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