Epilepsy (2) Flashcards by ajriffic .

80% of adult seizures are

focal

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all antiepileptic drugs (AEDs) carry what black box warning?

suicidality

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what 6 drugs are a concern for renal dz?

gabapentin
topiramate
zonisamide
lacosamide
levetriacetam
pregabalin

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what 2 drugs are a concern for hepatic dz?

valproate and felbamate

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which drug is contraindicated in diabetes?

valproate (bc wt gain and insulin resistance)

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chronic AED use is associated with….

osteoporosis

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name the 3 drugs that work by inactivating sodium channels

phenytoin
carbamazepine
lamotrigine

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6 drugs that enhance gaba mediated inhibition

BZDP
barbiturates
topiramate?
gabapentin
tiagabine
vigabatrin

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which 2 drugs decrease glutamatinergic excitation

PB and topiramate?

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carbamazepine

blocks Na+ channels
for focal and generalized szs
highly protein bound
metabolism thru autoinduction

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ADRs for carbmazepine (6)

veritgo 
nausea
HA
SIADH
leukopenia
stevens-johnson syndrome(HLA B 1502)

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oxycarbazepine

blocks Na channels
focal and sec gen tonic-clonic sz
fewer sfx than phenytoin or carbamazepine

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phenytoin

blocks na channels and affects 2nd messenger
focal and generalized sz and status epilepticus
highly protein bound
basic pH IV- phlebitis

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Fosphenytoin

h2o soluble prodrug of phenytoin

less phlebitis, pruitis, and parestheisas than phenytoin

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Phenytoin considerations/ADRs

antiarrythminc -dont stop abruptly
folic acid depleted!
gingival hyperplasia!
hirsutism
teratogen(cleft palate)

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lamotrigine

blocks na and ca channels(diminishes glutamate activity)

adjunctive in focal and generalized sz as well as absence szs

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lamotrigine kinetics and AES

100% oral absorption
55% protein bound

rash, confusion, NV, diplopia

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zonisamide

sulfonamide derivative
blocks NA and ca channels, enhances GABA
adjunct for foacl and generalized sz
good oral absorption

zonisamide sfx

sedation, nausea, cognitive impairment, rash, oligohydrosis, kidney stones

lacosamide

monotherapy or adjuct for focal onset sz
100% absorbed oral and renal excretion with p450 met
ADR: dizzy nausea

ethosuximide

inhib Ca channels
DOC for absence szs
absorbed orally p40 met
sfx: nausea, lethargy ha, anxiety

phenobarbital

improves GABA
for gen and focal szs
P450 met and induce
sfx: sedation*, irritability, ataxia, slow thinking

tiagabine

inhib GABA reuptake
adjunct for focal sz
quickly absorbed, inc clearance in Peds
sfx:dizziness, fatigue, nervousness, diff concentrating

vigabatrin

irreversible inhib of gaba transaminase(inc gaba)
for infant sz, refractory focal szs
limited use dt BLACK BOX WARNING: permanent vision loss

Perampanel

non-compt AMPA receptor antagonist for adjunct tx of focal onset sz in those over 12 warnings of serious alt of mood and agression

topiramate

blocks Na, enhances GABA, antag NMDA hep met ADR:wt loss, impaired cognition, HA, paresthesias, metabolic acidosis TERATOGENIC

Felbamate

augments gaba, competes for NMDA | for refractory lennox-gastuat syndrome

valproic acid and sodium vlproate

ca current block and na block and enhance GABA | for gen and focal szs

valproic acid sfx

n, v, hair loss, abdom pain, sedation, acute hepatic failure, pancreatitis, thrombocytopenia

gabapentin

binds ca channels adjuct for refract sz and newly diagnosed focal monotherapy nonprotein bound adjust does for CKD

levetiracetam

moa unk for focal and gen sz favorable pk profile completely absorbed and minimal protein bound

pregabalin

related to gabapentin modulates glutamate, noreadrenaline, and sub p adjuct for partial onset sz adjust dose for CKD sfx:dizziness, somnolence, dry mouth, periph edema

medication can be d/c if pt is sz free for _____ years. med must be tapered gradually

2-5 years

status epilepticus is a sz lasting more than...

5 minutes

Initial therapy for status epilepticus (SE) s/b a ____________ drug. 3 examples

benzodiazepine lorazepam!(wait 1 min for response then repeat) diazepam midazolam

_________ is the prefered secondline nonbenzo tx. ______ and ______ are alternatives.

Fosphenytoin phenytoin valproic acid

benzos are good for...

termination of SE, admin 1-3 doses q1 minute | not indicated if sz has stopped

Lorazepam

DOC for pt with IV access in SE -may cause vein irritation, DILUTE DOA: 12-24 hrs

Diazepam

2nd choice to termnate sz bc lipophilic and dist out of brain quickly as well as short DOA (15min-2hrs) however, if no IV acess this can be admin rectally

Midazolam

3rd choice to terminate sz can be given IM or given by continuous infusion for refractory szs

___________ are the 2nd line after 2-3 doeses of benzos

hydantoins

levetriacetam and lacosamide

useful for focla or nonconvulsive szs

Phenobarbital

prefered to phenytoin in Peds 3rd line agent if sz presists after 2-3 doses of benzo and loading dose of hydantoin more CNS and resp dep than hydantoins propylene glycol can cuase toxicity with repeated admin

____________ and ________ are used for maintenance therapy

hydantoins and phenobarbital