CNS Drugs Flashcards
Phenobarbital (oral):
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Anti-seizure barbiturate
-Seizures, anxiety and sedation (sleep)
alcohol withdrawal (if benzo therapy not enough)
-For seizures: 2mg/kg/day in divided doses
-around 60 minutes
-May cause dizziness, light-headedness, constipation, nausea, drowsiness or insomnia/excitability, and hypotension/bradycardia (rare). Do not mix with alcohol and no driving. May decrease effectiveness of birth control.
-Long-acting barbiturate that prevents seizures at high dosing which depresses the sensory cortex, decreases motor activity, and alters cerebellar function
Phenytoin:
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Anti-seizure Hydantoin
-focal and generalized onset seizures
-post-traumatic seizures and trigeminal neuralgia
-Loading dose (optional):1 g divided into 3 doses (eg, 400 mg, 300 mg, 300 mg) administered at 2-hour intervals; begin maintenance dose 24 hours after first loading dose.
Maintenance dose: Initial: 100 mg 3 to 4 times daily; adjust dose based on response and serum concentrations. After an effective maintenance dose is established, may consider converting stable patients to once-daily dosing.
-with loading dose it is rapid, if loading dose not used, full effects take 1-3 weeks
-may cause dizziness and drowsiness. tell Dr if seizures worsen. can rarely cause gum overgrowth which would be seen after a month of use. let Dr know if you have increased suicide ideation. can cause hypotension/bradycardia (rare)
-Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex
Primidone:
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Anti-seizure Barbiturate
-Seizures
-Tremor
-Seizure: Initial: 100 to 125 mg/day at bedtime tapered up. Maintenance: 750 to 1,500 mg/day in divided doses 3 to 4 times/day with maximum dosage of 2 g/day.
-0.5-9 hours
-May cause drowsiness and decrease appetite and coordination. Let Dr know if its causing involuntary eye movements. Can cause nausea/vomiting. do not mix with alcohol and no driving. let Dr know if you have increased suicide ideation.
-Decreases neuron excitability, raises seizure threshold similar to phenobarbital
Valproate/Valproic Acid/Divalproex
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Antimanic/antiseizure: Histone Deacetylase inhibitor
-Bipolar, focal and generalized seizures, migraine prophylaxis
-none relevant
-complex dosing
- around 4 hours
-HA, constipation, vomiting, upset stomach, decreased or increased appetite. can cause drowsiness, avoid alcohol and driving. may also cause insomnia and excitability. Can cause weight gain/loss
-increased availability of GABA to brain neurons or may enhance the action of GABA or mimic its action at postsynaptic receptor sites. Also blocks voltage-dependent sodium channels, which results in suppression of high-frequency repetitive neuronal firing
Vigabatrin
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Anti-seizure
-Refractory complex partial seizures
-None
-Oral: Initial: 500 mg twice daily; increase daily dose by 500 mg increments at weekly intervals based on response and tolerability. Recommended dose: 1.5 g twice daily
-1 hour without food, 2 hours with food
-sleepiness, HA, nausea, diarrhea, vomiting, upset stomach, increased/decreased appetite, weight gain/loss, or anxiety. Has a BB for permanent vision loss: can occur within months, years, weeks or sooner. regular vision exams recommended.
-Irreversibly inhibits gamma-aminobutyric acid transaminase (GABA-T), increasing the levels of the inhibitory compound gamma amino butyric acid (GABA) within the brain
Topiramate:
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-Anti-seizure
-migraine prevention and seizures
-alcohol use disorder if unresponsive to naltrexone, anti-psych weight gain, and tremors
-seizures: up to 200 mg/day in 1 to 2 divided doses
HA prevention: 25 mg once daily; increase dose in 25 to 50 mg increments at intervals ≥1 week based on response and tolerability, up to 100 mg/day in 1 to 2 divided doses
-variable from 4-12 hours
-Blocks neuronal voltage-dependent sodium channels, enhances GABA(A) activity, antagonizes AMPA/kainate glutamate receptors, and weakly inhibits carbonic anhydrase.
Oxcarbazepine
Drug class
FDA use
Off-label use
Dosing
Onset of action:
Counseling points
Mechanism
-antiseizure
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FDA use
Off-label use
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FDA use
Off-label use
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Off-label use
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