Epilepsy Drugs Flashcards
What are the dosing options for valporate
twice daily
or
one daily
what is the contraindication for valporate
pregnancy
severe liver impairment
what patients group do we reccomend to take vitamin d for people who are taking valporate
immobilised
inadequate sun exposure
inadequate dietary calcium
what is the period in which we should be most careful of live dysfunction for valporate
first 6 months
In what type of therapy is liver dysfunction highest with sodium valporate
combination therapy
when should we discontinue valporate
hepatic dysfunction symptoms
pancreatitis
prolonged prothrombin time
what are the main side effects of valporate
gi disturbance
drowsy
thrombocytopenia
weight gain (obesity)
what are the notable side effects of valporate
gynecomastia
rhabdomyolysis
male infertility
teratogenic
How long should valporate be given over iv
3-5 mins
in a patient under 55 what needs to be done before valporate can be given
2 independent specialists agree
what drugs does valporate increase the concentrations of
phenobarbital
primidone
nimodipine
what drug does valporate decrease the concentration of but increase free form version of it
phenytoin
what anticoagulant does valporate increase the effect of
warfarin
what drug does valporate increase the risk of toxicity of
lamotrigine
what does the levetiracetam loading schedule depend on
type of seizure
when should the doses of levetiracetam be increased minimum
minimum every two weeks
what is the max dose of levetiracetam
1.5g BD
what should levetiracetam be used with caution in
QT prolongation
what are the common side effects of levetiraccetem
mood disturbance
(aggression)
depression
Insomnia
Increased risk of infection
what are the notable side effects for levetiracetam
severe cutaneous adverse reactions
nuetropenia
AKI
Hyponatraemia
Hepatic disorders
what are the cautions for levetiracetam
hepatic impairment (reduce by 50% if less than 60mls/min)
renal impairment
what is the max dose of levetiracetam for a patient with 50-80mls/min
2g daily
what is the max dose of levetiracetam for a patient with 30-50mls/min
1.5g daily
what is the max dose of levetiracetam for a patient with <30mls/min
1g daily
what does levetiracetam decrease the clearance of
methotrexate so we need to monitor both
what other medications can lead to increase sedation with levetiracetam
alcohol
opioids
benzodiazepines
what is the loading dose regimen for lamotrigine
25mg OD for 14 days
50mg OD for 14 days
100mg OD for 7 days
what is the maintenance dose for lamotrigine
200mg
can be given in divided dose
what are the cautions for lamotrigine
parkinsons as can excacerbate symptoms
myoclonic seizures
what condition is lamotrigine associated with amonst many other anti epileptic meds
hypersensitivity syndrome
when it comes to using contraception with lamotrigine what is preffered and why should we not use COC, contraceptic patch and vaginal ring
the three reduce the levels of lamotrigine
so instead
use cont contraception without pill free break
what are the side effect of lamotrigine
Aggression
Drowsy
GI
Insomnia
Tremor (hence why cant give in parkinsons)
what are the notable side effects of lamotrigine
oedema
hallucination
disseminated intravascular coagulation
hepatic disorders
what does lamotrigine increase the concentration of
valporate
what is the loading schedule of topirimate
25mg at night for 7 days
increasing by 25-50mg every 7 to 14 days
what are the cautions of topirimate
acute porphyria’s
metabolic acidosis
nephrolithiasis
When using contraception with topiramate what should be used
highly effective forms
or
progesterone only pill + condoms
what contraceptives cannot be given with topirimate
combined pill
desogestral
what are the side effects of topirimate
usual suspects +
alopecia
anaemia
cognitive impairment
what are the noteable side effects of topiramate
eye inflammation
hepatic failure
neutropenia
what medication can it increase the exposure of but have its concentration reduced by
phenytoin
what enzyme does topirimate inhibit
CYP2C19
because topirimate inhibits a
CYP2C19 what medications cant be used with it
proton pump inhibitors
clopidogrel
citalopram
what drug is there cross sensitivity with phenobarbital
carbemazepine
what should phenobarbital be avoided in
renal impairment
hepatic impairment
what medications cannot be taken when a patient has acute porphyrias
phenobarbital
topirimate
what are the cautions of phenobarbital
elderly
children
history of alchohol or drug abuse
respiratory depression
what are the side effects of phenobarbital
sedation!!!
what enzyme does phenobarbital induce
CYP3A4
what is phenytoin indicated in
tonic clonic seizures
status epilepticus
how is phenytoin dosed
by weight
OR
150-300mg
what are the dose increases for phenytoin based on
plasma levels
before we can treat status epilecticus with phenytoin what must first be given
slow iv loading dose
what is the maintenance dose for status epilecticus of phenytoin
100mg 6-8 hours
what are the cautions of phenytoin
pregnancy
older age
infection
low albumin
enteral feeding
HF
respiratory depression
