Medications Flashcards
Good AEDs for bilateral convulsive seizures?
Carbamazepine and Phenytoin
Carbamazepine
FOCAL seizures, ok for GTCs. Needs slow titration.
When should you NOT use carbamazepine?
Absence or myoclonic seizures - may trigger SE in these pts.
Major side effects of carbamazepine?
Weight gain. Dose related: dizziness, diplopia, nausea, sedation, mild leukopenia, hyponatremia. Elderly: bradyarrhythmias. SJS!! Esp in Asians. HLAB1502. Pancreatitis, lupus-like syndrome, agranulocytosis, hepatic failure.
Titration schedule for Tegretol (carbamazepine)
Start at 100 - 200 mg qhs (or 100 mg BID). Can inc in 3-7 day intervals. Check CBC in 1 week.
Oxcarbazepine advantages?
FOCAL EPILEPSY.
Faster titration than Tegretol, minor interactions, no known hepatic or hematologic adverse effect. Approved for initial monotherapy for focal seizures.
Disadvantages of oxcarb?
Dose related effects similar to CBZ. Can lower OCP levels. Weight gain. INEFFECTIVE for myoclonic or absence seizures.
Major side effects of oxcarbazepine?
Dizziness, diplopia, HYPONATREMIA (more so than CBZ), somnolence, ataxia, GI upset. Idiosyncratic: rash.
Chronic side effects of oxcarbazepine?
Osteopenia/osteoporosis, elevated cholesterol and serum vascular risk markers.
Titration schedule for oxcarbazepine?
Adults- 150 to 300 mg BID, inc by 300 to 600 mg every 1-2 weeks to target dose of 1200-2400 mg/d.
NOTE: can convert CBZ to OXC rapidly over 1 day to 2 weeks at ratio of 300 mg OXC to 200 mg CBZ
Eslicarbazepine (Aptiom) advantages?
Milder enzyme induction compared to CBZ and OXC. Once daily dosing. Lower risk of rash & hyponatremia.
Approved for conversion to monotherapy in refractory epilepsy.
Eslicarbazepine (Aptiom) disadvantages?
Weak P450 inducer. Ineffective for absence or myoclonic.
Eslicarbazepine major side effects?
Dose-related: dizziness, diplopia, somnolence, ataxia, GI upset.
Eslicarbazepine dose titration?
Start at 400 mg qd, inc by 400 mg weekly. Goal 800-1200 for monotherapy; up to 1600 w/ polytherapy.
