Epilepsy drugs Flashcards
What are 1st line drugs for focal/partial seizures?
Phenytoin CBZ/OxCBZ VPA Keppra Lamictal Zonisamide
What are the 1st line drugs for absence?
Ethosuximide
VPA
What are the 1st line drugs for myoclonic, atonic, atypical absence?
VPA
Keppra
What are the 1st line drugs for tonic-clonic?
VPA Keppra Lamictal OxCBZ Topamax
What is the MOA of pheny?
Stabilizes neuronal membranes by decreasing sodium influx/increasing sodium efflux through voltage-gated dependent sodium channel blockade
What enzymes metabolize phenytoin?
2C9, 2C19
Is phenytoin protein bound?
Highly 90%
What is the therapeutic range of phenytoin?
10-20 Total
1-2 free
What is the initial dose of phenytoin?
5mg/kg/d divided 1-3x/d
What drugs cause an increased risk of SJS and TEN if HLA-B*1502 positive?
Phenytoin
CBZ
What are the systemic SE of phenytoin?
Gingival hyperplasia Hirsutism Vit D deficiency Folic acid deficiency Impaired cognition Osteomalacia
What are the neurologic SE of phenytoin?
Confusion Slurred speech Diplopia Ataxia Neuropathy Lethargy Nystagmus
What are the rare SE of phenytoin?
Rash
LDA
What is the DOC for neonatal seizures?
Phenobarbital
What is the MOA of phenobarb?
Elevate seizure threshold by decreasing postsynaptic excitation, possibly by stimulating postsynaptic GABA receptors
What is the therapeutic range of phenobarbital?
10-40
What is the dosing for phenobarb?
1-3 mg/kg/d
What are the systemic SE of phenobarb?
Nausea
Rash
What are the neurologic SE of phenobarb?
Altered sleep cycles Sedation, lethargy Behavioral changes, confusion Hyperactivity Ataxia Tolerance Dependence Depression Decreased libido
What is the MOA of ethosuximide?
Inhibits T-Type ca channels
What is the brand name of ethosuximide?
Zarontin
What is the therapeutic range of ethosuximide?
40-100
What is the dosing for zarontin?
500-1000mg BID (max 1500)
What are the AE for zarontin?
N/V, hiccups
Sleep disturbance, drowsiness, HA
Blood dyscrasias
What are the second generation AEDs?
CBZ (tegretol, carbatol)
VPA (depacon, depakene, stavor)
What are the 3rd gen AEDs?
Felbamate (Felbatol) Gaba (neurontin) Pregaba (Lyrica) Lamotrigine (Lamictal) Levetiracetam (Keppra) OxCBZ (Trileptal) Tiagabine (Gabitril) Topiramate (Topamax) Zonisamide (Zonegran) Lacosamide (Vimpat) Vigabatrin (Sabril) Clobazam (Frisium, Onfi) Perampanel (Fycompa) Eslicarbazepine (Aptiom) Brivaracetam (Briviact)
What AEDs may cause OC failure?
OxCBZ
Pheny
Phenobarb
CBZ
Why are seizures increased in pregnancy?
Estrogen has seizure activating effect
Progesterone has a seizure protective effect
Menstruation and ovulation may lower seizure threshold
What happens to AEDs during pregnancy?
Increased clearance of many AEDs
Altered protein binding of some AEDs
What do phenobarb and pheny cause in pregnancy?
Congenital heart malformation and orofacial clefts
What do VPA and CBZ cause in pregnancy?
Spina bifida and hypospadias
VPA associated with impaired cognitive development in children exposed in utero to VPA
What do we supplement in women on AEDs of child bearing potential?
Folic acid
What is the safest AED?
Lamictal
When can we WD AED therapy?
2-4 years seizure free
Single type of partial seizure or single type of primary generalized tonic-clonic seizures
EEG normalized w/tx
How should AED WD be done?
Over 3-6 months
What are non pharm therapies for seizures?
Ketogenic diet
Surgery
VNS
What is a ketogenic diet?
High fat, low carbs/protein
No sugar
Vit and mineral supp
Fluids controlled
What is VNS?
Vagal nerve stimulation
Implanted medical device
>12 yo
