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Neurology Boards > Epilepsy- AED's > Flashcards

Epilepsy- AED's Flashcards

1
Q

Carbamazepine:

  1. Mechanism
  2. Clearance (anything special?)
  3. Inducer or inhibitor
  4. Side effects
  5. Teratogen
A
  1. Na Channel Blocker
  2. Hepatic, to 10,11 epoxide, autoinduction
  3. Inducer (PHT, VPA, OCPs, coumadin)
  4. Side effects:
    - Aplastic anemia, thrombocytopenia
    - SJS/TEN (asians with HLA-B 1502)
    - Nystagmus, dizziness, blurry vision
    - Hyponatremia
  5. Teratogen: spina bifida
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2
Q

Ethosuxamide

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. T-type Ca channel blocker (thalamic)
  2. Hepatic
  3. Side effects:
    - drowsy, headache
    - n/v, tongue swell
    - anemia, leukopenia
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3
Q

Valproate

  1. Mechanism
  2. Clearance
  3. Inducer or inhibitor
  4. Side effects
  5. Teratogen
A
  1. Na Channel blocker
    Inhibits GABA-transaminase
    NMDA antagonist
    Histone deacetylase inhibitor
  2. Hepatic
  3. Inhibitor
  4. Side effects:
    - Tremors
    - Pancreatitis, hyperammonemia, hepatotoxicity
    - Thrombocytopenia
    - Weight gain, hair loss
    - PCOS
  5. Teratogen: spina bifida
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4
Q

Phenytoin

  1. Mechanism
  2. Clearance
  3. Inducer or inhibitor
  4. Side effects
  5. Teratogen
  6. Why is fosphenytoin IV better than phenytoin IV?
A
  1. Na Channel Blocker
  2. Hepatic, zero-order kinetics
  3. Inducer
  4. Side effects:
    - Ataxia, nystagmus, tremors
    - Gingival hyperplasia
    - Aplastic anemia, hemorrhage in newborn
    - SJS/TEN
  5. Teratogen: fetal hydantoin synd, cleft lip
  6. Can be given faster, lower risk of purple glove syndrome (more water soluble)
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5
Q

Phenobarbital

  1. Mechanism
  2. Clearance
  3. Inducer or inhibitor
  4. Side effects
A
  1. GABA-A agonist (increases chloride influx)
  2. Hepatic
  3. Inducer
  4. Side effects:
    - sedation, hyperactivity in some kids
    - Amelogenesis imperfecta (abnormal teeth enamel)
    - Megaloglastic anemia, Vit K coagulopathy
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6
Q

Gabapentin

  1. Mechanism
  2. Clearance
  3. Side effects
  4. Which has higher bioavailability- gabapentin or pregabalin
A
  1. Increases Gaba activity
    Modulates GAD enzyme
    Ca channel
  2. Renal
  3. Side effects:
    - DRESS
    - Angioedema
    - Sedation
    - Hyperactivity in kids
  4. Pregabalin
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7
Q

Lamotrigine

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. VG Na Channel blocker
  2. Hepatic
  3. Side effects:
    - SJS/TEN
    - DRESS
    - Tics and insomnia
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8
Q

Topiramate

  1. Mechanism
  2. Clearance
  3. Side effects
  4. Teratogen
A
  1. VG Na channel blocker
    Increase GABA-A receptor activity
    Decrease AMPA Rc
    Carbonic anhydrase inhibitor
  2. Renal
  3. Side effects:
    - Cognition problems
    - Kidney stones
    - Open angle glaucoma
    - Paresthesias, weight loss
    - Hyperthermia in kids exercising
  4. Cleft lip and palate
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9
Q

Levetiracetam

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. SV2A receptor binding
  2. Renal
  3. Side effects:
    - Aggression
    - Hallucinations in kids
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10
Q

Brivacetam mechanism- what is different from levetiracetam?

A
  1. More affinity to SV2A receptor
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11
Q

Oxcarbamazepine

  1. Mechanism
  2. Clearance
  3. Inhibitor or Inducer
  4. Side effects
  5. Teratogen
A
  1. Na Channel blocker
  2. Hepatic (doesn’t metabolize into epoxide, so less side effects than CBZ)
  3. Mild inducer- decreases OCPs
  4. Side effects:
    - Nystagmus, dizzy, blurry vision
    - Hyponatremia (more than CBZ)
    - Aplastic anemia
    - SJS/TEN
  5. Spina bifida
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12
Q

Zonisamide

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. VG Na Channel Blocker
    T-Type Ca channel blocker
    Carbonic anhydrase inhibitor
  2. Renal and Hepatic
  3. Side effects:
    - Sedation, dizzy, ataxia, concentration
    - Kidney stones
    - Acidosis
    - Sulfa allergy, SJS, DRESS
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13
Q

Lacosamide

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. Prolongs inactivation of Na Ch
    Inhibits CRMP-2- inhib neuronal growth
  2. Renal
  3. Side effects:
    - Ataxia, dizzy
    - PR prolong
    - DRESS
    - DM patients: syncope, afib
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14
Q

Clobazam

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. Binds GABA receptor
  2. Hepatic
  3. Side effects
    - sedation
    - SJS/TEN
    - Gelastic seizures
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15
Q

Perampanel

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. AMPA antagonist
  2. Hepatic
  3. Side effects:
    - Aggression, homicidal ideations
    - Dizzy, vertigo
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16
Q

Tiagabine

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. GABA reuptake inhib
  2. Hepatic
  3. Side effects:
    - Seizures with overdose
    - Cognitive symptoms with increased spike/wave in some
17
Q

Vigabatrin

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. Irreversible inhib of GABA transaminase
  2. Renal
  3. Side effects:
    - Vision loss (concentric)
    - Neuopathy
    - Neurotoxicity- T2/DWI changes in BG in kids
18
Q

Felbamate

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. NMDA antagonist
    VG Na channel blocker
  2. Hepatic
  3. Side effects:
    - Hepatotoxicity
    - Aplastic anemia
19
Q

Rufinamide

  1. Mechanism
  2. Clearance
  3. Side effects
A
  1. Prolongs inactivation of VG Na channel
  2. Hepatic
  3. Side effects:
    - Ataxia, dizzy
    - Shortens QTc
20
Q

List 5 AED’s that decrease OCP levels.

A
  1. Phenytoin
  2. Carbamazepine
  3. Oxcarbamazepine
  4. Phenobarb
  5. TPM > 200mg daily
21
Q

List 5 AEDs that worsen myoclonic seizures.

A
  1. Lamotrigine
  2. Gabapentin
  3. Carbamazepine
  4. Vigabatrin
  5. Phenytoin
22
Q

List 4 AEDs to treat myoclonic epilepsies.

A
  1. Clonazepam
  2. VPA
  3. Topiramate
  4. Zonisamide
23
Q

List 4 AEDs to treat absence seizures.

A
  1. Ethosuximide
  2. VPA
  3. Lamotrigine
  4. Levetiracetam
24
Q

List 4 AEDs to avoid for absence epilepsy.

A
  1. Phenytoin
  2. Carbamazepine
  3. Vigabatrin
  4. Tigabine
25
Q

What is the treatment for Infantile spasms?

A

ACTH or vigabatrin

26
Q
  1. What AED should be avoided in Lennox-Gastaut syndrome?

2. What AEDs should be used for that syndrome?

A
  1. Carbamazepine (increase drop attacks)

2. TPM, VPA, clobazam

27
Q

List the 6 AEDs that can be use for generalized epilepsy.

A
  1. VPA
  2. Lamotrigine
  3. Ethosuximide
  4. Topiramate
  5. Levetiracetam
  6. Zonisamide

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