module 3 seizure Flashcards
seizure patho
abnormal function of ion channels and neural networks
- rapid, synchronous, uncontrolled spread of electrical activity
anticonvulsant class warnings
inc. risk of suicidal thoughts
monitor for worsening depression/mood changes
withdrawal seizures
Na channel inhibitors: anticonvulsant Rx
phenytoin fosphenytoin carbamazepine oxcarbazepine eslicarbazepine lamotrigine lacosamide
phenytoin, fosphenytoin MOA
slows rate of channel recovery fro inactivated to close state
- channel use dependent
phenytoin, fosphenytoin AE
IV BB: severe hypoTN, cardiac arrhythmia steven johnson toxic epidermal necrolysis hepatotoxicity/abnormalities hirsutism gingival hyperplasia acne altered vit. D metabolism -> osteoporsis CNS depression N/V/C
phenytoin, fosphenytoin administration
fosphenytoin: progrug
protein bound: 90-95%
phenytoin, fosphenytoin precaution
hepatically metabolized
inducer of : 3A4, 2C9, 2C19
phenytoin, fosphenytoin monitoring
drug levels - total: 10-20 - free: 1-2 Albumin CrCl
phenytoin, fosphenytoin and zero order kinetics
constant amount of drug eliminated per unit of time
- independent of dose concentration
carbamazepine MOA
Na channel inhibitor
slows rate of channel recovery from inactivated to closed state
- channel use dependent
carbamazepine administration
protein bound: 75-90%
metabolized -> active metabolite
first order kinetics
first order kinetics
constant fraction of the concentration of drug is eliminated.
- dependent on dose concentration
carbamazepine AE
BB: dermatologic reactions - steven johnsons - toxic epidermal necrolysis hypersensitivity DRESS jaundice hyponatremia CNS depression N/V
carbamazepine precautions
hepatically metabolized
autoinducer
potent inducer of 3A4, 1A2, 2C9/19
carbamazepine monitoring
CBC
drug levels: 6-12
oxcarbazepine
NA channel inhibitor
similar structure to carbamazepine with less DI and AE
Eslicarbazepine
active metabolite of oxcarbazepine
lamotrigine MOA
Na channel inhibitor
slows rate of channel recovery from inactive to closed state
- channel use dependent
lamotrigine AE
BB: serious rash - Steven Johnson - toxic epidermal necrolysis - DRESS -- can be r/t rapid titration blood dyscrasias: - neutropenia - thrombocytopenia - aplastic anemia CNS depression N/V
lamotrigine administration
protein bound: 55%
lamotrigine precaution
hepatically metabolized
lamotrigine monitoring
CBC
Lacosamide MOA
Na channel inhibitor
enhances slow inactivation of voltage gated Na channels
lacosamide AE
cardiac rhythm and conduction abnml dizzy ataxia HA nausea
lacosamide precaution
hepatically metabolized
lacosamide administration
protein bound: <15%
schedule V drug
Ca channel inhibitors
Ethosuximide
gabapentin
pregabalin
K channel inhibitor
ezogabine
GABA
benzodiazepines clobazam barbiurates vigabatrin tiagabine
Glutamate (NMDA, AMPA)
felbate
rufinamide
perampanel
mixed action meds
valroic acid
levtiracetam
topiramate
zonisamide
