Epilepsy Dr. Thomasson IRAT Flashcards
What antiseizure drug (ASD) is considered to be the most teratogenic?
Valproic acid/divalproex
What ASDs should be avoided in patients with a history of kidney stones?
Topiramate and Zonisamide
(bc they are associated with causing kidney stones)
What necessitates the slow titration of lamotrigine?
increasing levels too quickly has a chance for skin reactions, ranging from mild rash to steven-johnsons syndrome or toxic epidermal necrolysis
Which ASDs have no significant drug interactions?
-gabapentin (2nd gen)
-pregabalin (3rd gen)
-lamotrigine (2nd)
-levetiracetam (2nd)
-zonisamide (2nd)
Which ASDs have the highest likelihood of inducing the metabolism of oral contraceptives?
First gens:
-carbamazepine (1st)
-Phenytoin (1st)
-Phenobarbital (1st)
-oxcarbazepine (Trileptal) (2nd gen)
-high dose topiramate (200 mg and up) (2nd)
-eslicarbazepine (3rd)
What are the warnings associated with carbamazepine?
-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)
Why is levetiracetam (keppra) nicknamed the “divorce drug”?
It can have severe behavioral effects that include:
aggression, agitation, irritability, worsening depression, anxiety, hostility, anger, and others.
What are nicknames you have heard for Topamax and what is the reason?
Dopamax and Stupimax
because of the adverse effects of cognitive changes, especially that of difficulty of word-finding (also w/ Zonisamide) and “brain fog.”
What are the main side effects of pregabalin and gabapentin? (anticonvulsants)
weight gain, somnolence (drowsiness), dizziness, N/V
pregablin and gabapentin require renal dose adjustment
What are the side effects of Depakote? (antiepileptic, used for seizure)
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)
What ASD must be avoided with a sulfa allergy?
Zonisamide
What is the role of felbamate in the treatment of seizures?
Felbamate (2nd gen) may be useful in refractory epilepsy
What is the therapeutic range for carbamazepine?
4-12 mcg
Therapeutic range for divalproex (depakote)?
50-100 mcg/mL
What ASD’s require monitoring of sodium?
Carbamazepine and Oxcarbazepine because they can cause hyponatremia
Why do we measure free levels of phenytoin?
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
Drugs for generalized tonic-clonic seizures in adults
-Carbamezapine (1st gen)
-valproic acid (1st gen)
-lacosamide (Vimpat) (3rd gen)
-lamotrigine (2nd gen)
Drugs for absence seizures
1: ethosuximide (1st gen) (its only indication)
valproic acid (1st gen)
Which drug may also help for mood disorder or migraine?
valproic acid (1st gen)
avoid zonisamide, topiramate, levetiracetam
Which drug may also help with neuropathic pain?
pregabalin
Which drug is helpful in comorbid bipolar disorder and trigeminal neuralgia?
carbamazepine
-> avoid in absence seizure
