Ch 3a - Epilepsy Drugs Flashcards
SE of ACTH
- hyperglycemia
- HTN
immune suppression
MOA and SE of Carbamazepine (carbatrol, tegretol)
Sodium channel blocker
- hyponatremia
- agranulocytosis
- liver inducer
- autoinduction
MOA and SE of ethosuxamide
Ca channel blocker
GI side effects
MOA and SE of felbamate
Na channel antag, NMDA channel ag, GABA ag
liver failure
aplastic anemia
insomnia
SE of gabapentin
inhibits L type Ca channels
peripheral edema
MOA and SE of Lamotrigine
Na channel blocker
SJS
MOA and SE of oxcarbazapine
Na channel blocker
hyponatremia
MOA and SE of phenobarbital
Inc frequency of GABA Cl channel opening
hyperactivity
cognitive disturbance
Dupuytrens Contractures
MOA and SE of Phenytoin/Dilantin
Na channel blocker
gum hyperplasia
hypertrichosis
nonlinear kinetics
SLE-like syndrome
cerebellar atrophy
coarsening of facial features
arryhthmias if IV form given too fast
MOA and SE of tigabine
blocks GABA uptake
absence status
MOA and SE of topamax
NA Channel blocker, enhances chloride currents through GABA receptor
- weight loss
- kidney stones
- oligohydrosis
- glaucoma
- metabolic acidosis
- word finding difficulties
MOA and SE of valproate
Na channel blocker, Ca channel blocker
hepatotoxicity
weight gain
PCOS
alopecia
pancreatitis
tremor
hyperammonemia
MOA and SE of vigabatrin
Inhibits GABA-transaminase, which breaks down GABA
Vigorous, Irreversible, GABA TRansaminase, INhibitor
visual field deficits
MOA and SE of zonisamide
Na and Ca channel blocker
weight loss
kidney stones
oligohydrosis
MOA of keppra
binds to SV2A (synaptic vesicle protein), “may” block N type Ca channels and inhibit K channel
MOA of pregabalin (lyrica)
modulates P/Q type voltage gated Ca channels
oxcarbazepine vs carbamazepine
OXC is rapidly metabolized into MHD, an active metabolite
CBZ creates an epoxide during its metabolism, which is thought to be responsible for the SEs (liver, blood)
OXC > CBZ
AEDs that can worsen myoclonic seizures
Carbamazepine
Phenytoin
Gabapentin
Lamotrigine**
Tiagabine
Vigabatrin
**Although LTG can worsten myoclonus, it has been used successfully in JME
AEDs with mood stabilizer SEs
CBZ
LTG
OXC
VPA
CLOVe cigarettes help calm you down
AEDs with weight loss SEs
Felbamate
topiramate
zonisamide
AEDs with weight gain SEs
- gabapentin
- pregabalin
- VPA
AEDs that also help with migraines
- topamax
- Gabapentin
- VPA
AEDs that help with tremor
- primindone
- topamax
Topamax and Primindone for Tremor Prevention.
Which AEDs are eliminated entirely by the kidneys?
Gabapentin
Vigabatrin
Keppra
Nephron-tin, Vigabtrin for Voiding, and Keppra by the kidneys
Which AEDs are common inducers?
CBZ
Phenobarb
phenytoin
Which AEDs are inducers but usually dont induce?
OXC
Topiramate
LTG
zonisamide
Which AEDs usually inhibit other AEDs
VPA
felbamate
(must take caution when using this with multiple AEDs)
Which AEDs are free of interactions
- gabapentin
- keppra
- pregabalin
- vigabatrin
All the Na channel AEDs
CBZ
LTG
Phenytoin
Topamax
VPA
Zonisamide
AEDs that block T type voltage gated Ca channels
Ethosuxamide
VPA
zonisamide
Low protein binding AEDs
Gabapentin
Levitiracetam
Vigabatrin
Ethosuxamide
slippery GLoVE makes it hard to bind protein
High protein binding AEDs
VPA
Tiagabine
Phenytoin
CBZ
Very Tight Protein Connection
Surgery can be used to treat seizures
jk
Vagus nerve stimulation can also be used to treat refractory seizures
just know
Procedure commonly used palliatively for those suffering from generalized szs?
corpus callosotomy
Post op patients s/p corpus callosotomy can have?
L limb apraxia
Hemispherectomy can be used to treat seizures in
Sturge Weber Syndrome
Hemimegalencephaly
Antinatal MCA/ICA strokes
Rasmussen Encephalitis
Diffuse cortical dysplasia
Hemispherectomy leaves SHARDs of brain tissue everywhere!
Rasmussen Encephalitis presents with
Epilepsia Partialis Continua (EPC)
This is a focal motor status epilepticus that leads to progressive hemiparesis and progressive atrophy is seen on MRI
What receptor is assoc with Rasmussen Encephalitis
Glu R3
Common supplement to help tx for neonatal seizures
B6 pyridoxine
Ketogenic can also successfully tx seizures
just know
In what patients is keto diet contraindicated?
Pyruvate carboxylase def
Acute intermittent porphyria
Myoclonic epilepsy with ragged red fibers
MELAS (mitochondrial epilepsy with Lactic acidosis and stroke like episodes)
Cytochrome oxidase def
carnitine def
Free fatty acid oxidation defects
PYRuvian COMA
Special considerations for women with epilepsy?
AEDs that induce can lower OCP levels and cause pregnancy
In pregnancy, the goal is to maintain seizure freedom, monotherapy is preferred. Even if its not a safe preg drug
just know
Infants born to women taking AED inducing drugs are at higher risk for
hemorrhagic disease of the newborn.
These mothers should take Vit K daily until birth and then infants get Vit K IM at birth normally
New adjunct recommendation therapy for AEDs
Some concern for bone health, can ask patients to take Ca supplements if on AEDs long term
