ASMs mechanism Flashcards
Phenytoin SE
osteopenia, hepatotoxicity, gum hypertrophy, rash
SE CBZ
hyponatremia, leukopenia, hepatotoxicity, rash, SJS/TEN
SE Phenobarbital/Primidone (Mysoline®)
joint contractures, sedation, depression, DRESS
VPA
increased appetite, wt gain, hair loss, hepatotoxicity, thrombocytopenia, polycystic ovary, worsen ADHD
Ethosuximide
rash, nausea/decreased appetite, agranulocytosis (rare)
Lacosamide (Vimpat)-
PR prolongation
Levetiracetam (Keppra)-
Irritability, depression, mood
Clonazepam (Klonopin)/Clorazepate (Tranxene)-
Dizziness, sedation, respiratory depression, drooling
Lamotrigine (Lamictal)-
diplopia, tremor, insomnia, rash, SJS
Oxcarbazepine (Trileptal)
diplopia, rash, hyponatremia
Pregabalin (Lyrica)/Gabapentin (Neurontin)-
weight gain, dizziness
Topiramate (Topamax®)/Zonisamide (Zonegran®)
urolithiasis, tingling, weight loss, word finding, acidosis, oligohidrosis, glaucoma
Perampanel (Fycompa)-
weight gain, irritability (especially in teenagers)
Ezogabine/retigabine (Potiga)-
pigmentary retinopathy leading to visual loss in 1/3, blue discoloration, urinary retention
Brivaracetam (Briviact)-
irritability, suicidality
Vigabatrin (Sabril®)
peripheral visual loss, MRI white matter changes
Rufinamide (Banzel®)-
QT interval shortening, nausea, decreased appetite
Felbamate (Felbatol®)-
bone marrow suppression and liver toxicity
black box warning aplastic anemia, sometimes fatal. Discontinue if any evidence of bone marrow depression occurs.
Cytochrome P450 system inducers
Carbamazepine
phenytoin
phenobarbital, primidone
felbamate
Cytochrome P450 system inhibitors
VPA
Felbamate
Cytochrome P450 system inducers
Carbamazepine
phenytoin
phenobarbital, primidone
felbamate
Influenced by p450 inducers/inhibitors
Ethosuximide oxcarbazepine Lamotrigine* zonisamide (Zonegran®), topiramate Rufinamide
ETOZ LR
Uridine glucuronyl transferase (UGT) MEChanism
Lamotrigine (Lamictal®), oxcarbazepine (Trileptal®), valproate (Depakote®)
Epoxide hydrolase
metabolism
Carbamazepine
Protein bindings
VPA/Phenytoin