Epilepsy (2) Flashcards
80% of adult seizures are
focal
all antiepileptic drugs (AEDs) carry what black box warning?
suicidality
what 6 drugs are a concern for renal dz?
gabapentin topiramate zonisamide lacosamide levetriacetam pregabalin
what 2 drugs are a concern for hepatic dz?
valproate and felbamate
which drug is contraindicated in diabetes?
valproate (bc wt gain and insulin resistance)
chronic AED use is associated with….
osteoporosis
name the 3 drugs that work by inactivating sodium channels
phenytoin
carbamazepine
lamotrigine
6 drugs that enhance gaba mediated inhibition
BZDP barbiturates topiramate? gabapentin tiagabine vigabatrin
which 2 drugs decrease glutamatinergic excitation
PB and topiramate?
carbamazepine
blocks Na+ channels
for focal and generalized szs
highly protein bound
metabolism thru autoinduction
ADRs for carbmazepine (6)
veritgo nausea HA SIADH leukopenia stevens-johnson syndrome(HLA B 1502)
oxycarbazepine
blocks Na channels
focal and sec gen tonic-clonic sz
fewer sfx than phenytoin or carbamazepine
phenytoin
blocks na channels and affects 2nd messenger
focal and generalized sz and status epilepticus
highly protein bound
basic pH IV- phlebitis
Fosphenytoin
h2o soluble prodrug of phenytoin
less phlebitis, pruitis, and parestheisas than phenytoin
Phenytoin considerations/ADRs
antiarrythminc -dont stop abruptly folic acid depleted! gingival hyperplasia! hirsutism teratogen(cleft palate)
lamotrigine
blocks na and ca channels(diminishes glutamate activity)
adjunctive in focal and generalized sz as well as absence szs
lamotrigine kinetics and AES
100% oral absorption
55% protein bound
rash, confusion, NV, diplopia
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
