Epilepsy Dr. Thomasson IRAT

Question 1

What antiseizure drug (ASD) is considered to be the most teratogenic?

Answer 1

Valproic acid/divalproex

Question 2

What ASDs should be avoided in patients with a history of kidney stones?

Answer 2

Topiramate and Zonisamide
(bc they are associated with causing kidney stones)

Question 3

What necessitates the slow titration of lamotrigine?

Answer 3

increasing levels too quickly has a chance for skin reactions, ranging from mild rash to steven-johnsons syndrome or toxic epidermal necrolysis

Question 4

Which ASDs have no significant drug interactions?

Answer 4

-gabapentin (2nd gen)
-pregabalin (3rd gen)
-lamotrigine (2nd)
-levetiracetam (2nd)
-zonisamide (2nd)

Question 5

Which ASDs have the highest likelihood of inducing the metabolism of oral contraceptives?

Answer 5

First gens:
-carbamazepine (1st)
-Phenytoin (1st)
-Phenobarbital (1st)

-oxcarbazepine (Trileptal) (2nd gen)
-high dose topiramate (200 mg and up) (2nd)
-eslicarbazepine (3rd)

Question 6

What are the warnings associated with carbamazepine?

Answer 6

-increased risk of Stevens-Johnson Syndrome (SJS)
-toxic epidermal necrolysis (TEN) for patients with the HLA-B*1502 allele - Asians
-aplastic anemia (the body stops producing new blood cells in the bone marrow (stem cells)
-agranulocytosis (severe low levels of neutrophils, life-threatening)

Question 7

Why is levetiracetam (keppra) nicknamed the “divorce drug”?

Answer 7

It can have severe behavioral effects that include:
aggression, agitation, irritability, worsening depression, anxiety, hostility, anger, and others.

Question 8

What are nicknames you have heard for Topamax and what is the reason?

Answer 8

Dopamax and Stupimax
because of the adverse effects of cognitive changes, especially that of difficulty of word-finding (also w/ Zonisamide) and “brain fog.”

Question 9

What are the main side effects of pregabalin and gabapentin? (anticonvulsants)

Answer 9

weight gain, somnolence (drowsiness), dizziness, N/V

pregablin and gabapentin require renal dose adjustment

Question 10

What are the side effects of Depakote? (antiepileptic, used for seizure)

Answer 10

abdominal pain, constipation, diarrhea, anorexia, increased appetite, weight gain, N/V, blurred vision, ataxia, dizziness, headache, nystagmus, insomnia, somnolence, abnormal thinking, tremor, dose-dependent thrombocytopenia, development of polycystic ovarian syndrome (women)

Question 11

What ASD must be avoided with a sulfa allergy?

Answer 11

Zonisamide

Question 12

What is the role of felbamate in the treatment of seizures?

Answer 12

Felbamate (2nd gen) may be useful in refractory epilepsy

Question 13

What is the therapeutic range for carbamazepine?

Answer 13

4-12 mcg

Question 14

Therapeutic range for divalproex (depakote)?

Answer 14

50-100 mcg/mL

Question 15

What ASD’s require monitoring of sodium?

Answer 15

Carbamazepine and Oxcarbazepine because they can cause hyponatremia

Question 16

Why do we measure free levels of phenytoin?

Answer 16

it is heavily protein-bound and the only free drug has a therapeutic effect. low or high total concentrations may still be within therapeutic ranges in patients with abnormalities in protein levels, especially albumin

Question 17

Drugs for generalized tonic-clonic seizures in adults

Answer 17

-Carbamezapine (1st gen)
-valproic acid (1st gen)
-lacosamide (Vimpat) (3rd gen)
-lamotrigine (2nd gen)

Question 18

Drugs for absence seizures

Answer 18

1: ethosuximide (1st gen) (its only indication)

valproic acid (1st gen)

Question 19

Which drug may also help for mood disorder or migraine?

Answer 19

valproic acid (1st gen)

avoid zonisamide, topiramate, levetiracetam

Question 20

Which drug may also help with neuropathic pain?

Answer 20

pregabalin

Question 21

Which drug is helpful in comorbid bipolar disorder and trigeminal neuralgia?

Answer 21

carbamazepine

-> avoid in absence seizure