Epilepsy Flashcards
Phenobarbital drug interactions
-broad spectrum inducer
-2C9(major), 2C19, 2E1 (minor)
Phenobarbital adverse effects
-rash
-cross reactivity with other aromatic anti seizure medications( CBZ and PHY)
-osteoporosis: accelerate metabolism of vitamin D
-sedating/cognitively impairing
Phenytoin PK
-non linear absorption
-older adults require lower dose
Fosphenytoin PK
-IM or IV
-otherwise same as phenytoin after cleavage
Phenytoin drug interactions
-broad spectrum inducer
Phenytoin adverse effects(gold star)
-concentration dependent effects: nystagmus, ataxia, incoordination, diplopia
-rash
-Stevens-Johnson syndrome
-Aplastic anemia
-Gingival hyperplasia
-decreased bone density
Carbamazepine drug interactions
-only effective in focal seizures
-start low and go slow
-BROAD spectrum inducer
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
Carbamazepine adverse effects
-diplopia(double vision)
-paresthesia(tingling)
-ataxia
-headache
-anticholinergic effects
-HYPONAYTREMIA(low sodium)
-RASH
-Osteoporosis
CBZ Rash
-genetic risk
-East Asian genetic HLA testing
Oxcarbazepine metabolism
-goes through reduction reaction by ketoreductases
-NO AUTOINDUCTION
-at high doses, 3A4 and UGT induced
—-2C19 inhibited
Oxcarbazepine adverse effects
-Hyponatremia
-rash prone but less than CBZ
Eslicarbazepine adverse effects
-dizziness
-headache
-hyponatremia
-rash
Valproate metabolism
-glucuronidation, beta oxidation-major routes
-CYP mediated oxidation-minor
-Inhibits 2C19, UGT, Epoxide hydrolase
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
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
Lamotrigine adverse effects (gold star)
-Rash: life threatening so start low and go slow
-cardiac conduction: insufficient evidence
-fatigue or sleepiness
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
