Epilepsy Flashcards by Aika Bush

Phenobarbital drug interactions

-broad spectrum inducer
-2C9(major), 2C19, 2E1 (minor)

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Phenobarbital adverse effects

-rash
-cross reactivity with other aromatic anti seizure medications( CBZ and PHY)
-osteoporosis: accelerate metabolism of vitamin D
-sedating/cognitively impairing

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Phenytoin PK

-non linear absorption
-older adults require lower dose

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Fosphenytoin PK

-IM or IV
-otherwise same as phenytoin after cleavage

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Phenytoin drug interactions

-broad spectrum inducer

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Phenytoin adverse effects(gold star)

-concentration dependent effects: nystagmus, ataxia, incoordination, diplopia
-rash
-Stevens-Johnson syndrome
-Aplastic anemia
-Gingival hyperplasia
-decreased bone density

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Carbamazepine drug interactions

-only effective in focal seizures
-start low and go slow
-BROAD spectrum inducer

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Carbamazepine metabolism (gold star)

-Metabolized by CYP3A4 to an active metabolite (stable epoxide)
-CBZ-epoxide is metabolized by epoxide hydrolase to CBZ dihyrodiol
-AUTOINDUCTION
*active metabolite may be responsible for many CNS adverse effects

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Carbamazepine adverse effects

-diplopia(double vision)
-paresthesia(tingling)
-ataxia
-headache
-anticholinergic effects
-HYPONAYTREMIA(low sodium)
-RASH
-Osteoporosis

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CBZ Rash

-genetic risk
-East Asian genetic HLA testing

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Oxcarbazepine metabolism

-goes through reduction reaction by ketoreductases
-NO AUTOINDUCTION
-at high doses, 3A4 and UGT induced
—-2C19 inhibited

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Oxcarbazepine adverse effects

-Hyponatremia
-rash prone but less than CBZ

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Eslicarbazepine adverse effects

-dizziness
-headache
-hyponatremia
-rash

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Valproate metabolism

-glucuronidation, beta oxidation-major routes
-CYP mediated oxidation-minor
-Inhibits 2C19, UGT, Epoxide hydrolase

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Valproate adverse effects (gold star)

-tremor
-inhibition of platelet aggregation
-alopecia
-weight gain(low fat diet)
-liver toxicity: kids younger than 2
-Teratogenicity: avoid at all costs

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Lamotrigrine metabolism

-almost entirely metabolized via glucuronidation
-if on another inducer, will need to increase the dose (CBZ, PB, PRM, PHT)
-if on an inhibitor, reduce dose: VPA

*Lamotrigrine can be induced by birth control

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Lamotrigine adverse effects (gold star)

-Rash: life threatening so start low and go slow
-cardiac conduction: insufficient evidence
-fatigue or sleepiness

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Levetiracetam drug interactions

-not very many drug interactions

Keppra adverse effects

-Sedation is prominent
-behavioral effects
-titrate dose
-no weight gain

Brivaracetam PK

-inhibit CYP2C19 (modest)
-inhibit epoxide hydrolase

Lacosamide adverse effects

-dizziness
-headache
-diplopia

Topiramate (Topamax) drug interactions

-inhibition of 2C19
-induction of 3A4 (modest)

Topiramate adverse effects (gold star)

-abnormal thinking(word finding difficulties)
-parenthesis
-kidney stones
-narrow angle glaucoma
-ologohydrosis(decreased sweating)

Gabapentin adverse effects

-drowsiness
-weight gain
-edema

Gabapentin and pregabalin drug interactions

-none -they are not inducers or inhibitors

pregabalin adverse effects

-sames as gabapentin but worse because dosing is not saturable

Cenobamate

-inhibit 2C19 -moderate 3A4 inducer

Cenobamate adverse effects

-MUST start low and go slow -could die otherwise -hypersensitivity

Phenytoin brand name

Dilantin

Valproic acid brand name

Depakote, Depakene

Lamotrigrine brand name

lamictal

Briviracetam brand name

Breviact

Eslicabazepine brand name

Apitom

Lacosamide brand name

Vimpat

Perampanel brand name

Fycompa

Clobazam brand name

Onfi

Pregabalin brand name

Lyrica

Gabapentin brand name

neurotin

Oxcarbamazepine

Trileptal

Cenbamate

XCOPRI

Cannabidiol

Epidiolex

Perampanel adverse effects

-dizziness -drowsiness -Severe aggression -titrate dose

Zonisamide

-cross sensitivity reactions