DROGA LIST Flashcards
Lamotrigine (Lamictal)
Moa: Nat+ inactivation
Indicated: focal partial seizure more so adjunct therapy, to of Lennox G seizures, Bipolar trigeminal neuralgia .
Dosing: Titrate up 4 weeks to reduce risk of lamictal rash can be fatal.
Lamictal Rash risk increase with use of VPA.
Stop Lamictal.
Metabolizes UGT, and induces UGT.
CNS ADE: dizziness, diplopia, HA
Phenobarbital
MOA: GABA A- CL- open
Indications: sedation, epilepsy- focal and generalize.
Class 4 Scheduled drug
CI: Preg Cat D, Resp Dz, Liver Dz
Monitor: over sedation, osteoporosis CBC, PB.
1st line in neonate seizures.
Ethosuximide
MOA:CA+ Blocks
MC: Tx fro absent seizures in children
ADE: GI upset, CNS depression
Generally well tolerated
Primidone
Primidone parent drug- children = phenytoin and PB
Formulation: Oral use
Indication: antiseizure mostly used for essential tremor
Takes 20 days for PB to build up check levels of Pb and primidone
Order: CBC at baseline then 6 mo
Watch toxicity in elderly
Phenytoin
Therapeutic range 300-400mg MOA: Blocks NA+ channel inhibits repetitive AP Oral Phenytoin= prevent seizures IV= for active clinic tonic seizures IV given with antifreeze Loading dose 1 gram in 20 min Anything over 40-50 mg per 1 min increases risk for vascular and derm rxn IV= purple glove sx
Fosphenytoin
IV formulation more soluble with phosphate group
No need for antifreeze
Faster infusion of 7 min per 1 gram but parent drug so still takes 42 min to work
Major MOA CA2+
Gabapentin, Ethoxsumide
Major MOA: NA+
Phenytoin, carbamazepine, lamotrigine
Major MOA GABA:
Phenobarbital
Gabapentin (neurontin)
Indications: adjunct to seizures, post hepatic neuralgia
MOA: Blocks CA+ reentry
ADE: Sedation, dizziness
Check Kidney function
Dose: slow titrate up work up to 300 mg TID.
Pregabalin (Lyrica)
Schedule 5 drug
Indication: partial epilepsy, dm neuropathy, fibromyalgia pain, post herpatic pain
More potent and better absorbed than gabapentin
ADE: dizziness, euphoria, blurred vision
Take regularly check kidney function
Drugs that give rashes that are not nice
Lamotrigine
Carbamazepine
Oxcarbamazepine
Phenytoin
Enzyme inducers plus hormonal birth control ?
Lessens efficacy of BC and can cause pregnancy abnormalities
Enzyme inducing drugs
Phenytoin hepatic enzyme inducer and saturable metabolism
Carbamazepine enzyme inducer and own metabolism inducer
Phenobarbital enzyme inducer and long 1/2 life
Valproic acid enzyme
Enzyme inhibitor UGT and aspirin kicks this drug off
Valproic acid displacement
Valproic acid can be displaced by aspirin risk for toxicity increases.Total vpa goes up in linear fashion but active goes up exponentially.
Carbamazepine
MOA:NA+ channel blocker
Self CYP 34A inducer- 6wks fixed dose may need to increase dose.
Toxic metabolite: epoxide
Black box warning: aplastic anemia, agranulocytosis
ADE: Hyponatremia, severe derm rash, psychosis.
CI: SSRI, SMRI, TCA, SNR, BC, Cardiovascular drugs, Preg D
Test: HLA-B ALLE
Oxcarbazepine
Relative to carbamazepine: 1.5 less of the dose needed to be effective
Same ADE, but less severe.
Indication: only for focal epilepsy.
ADE: MORE HYPONATREMIA
Eslicarbazepine
Similar to carbamazepine and oxcarbazepine
Advantage: daily dosing can be split and crushed, approved as mono therapy
Disadvantage: only FDA for seizure $$$$
Clonazepam
Indication: maintenance seizure Formulation:Oral regular daily therapy long 1/2 life Few drugs interactions Therapeutic range Less tolerance
Lorazepam
Indication: Maintenece seizure
Formulation = long term oral use for maintenance seizures
IV Formulation: for status epilepticus
1ST line ED seizure
Clobazepam
Indication: refractory seizure less tolerance with this drug
Diazepam
Formulations: IV, rectal gel and
Midazolam
Off label use for rescue drug in seizure
IM- NASAL formulation
