Seizure, Alzheimer's, and Insomnia Medications Flashcards
Levetiracetam (Keppra)
2nd line for Generalized Tonic-Clonic
Watch kidney function
2 days to steady state
SE: Somnolence, ataxia, HA, behavioral changes
Pregnancy: C
Carbamazepine (Tegretol)
1st line for Generalized tonic-clonic and focal
Sodium Channel Blocker
4-12 mg/L Therapeutic dose
SE: Toxic epidermal necrolysis, SJS, Bone marrow suppression, Liver toxicity
Pregnancy: D
Phenytoin (Dilantin)
1st line for focal and generalized tonic-clonic
Alters Na and Ca membrane potential to block high-frequency repetitive firing
IV - CV risk w/ rapid infusion, put on cardiac monitor
SE: Gingival hypertrophy, hirsutism, coarsened facial features, megaloblastic anemia
High Doses: Inhibit MAO, Serotonin, and NE release, promote dopamine uptake
Pregnancy: D
Gabapentin (Neurontin)
2nd line focal and generalized tonic-clonic
Reduces presynaptic GABA use
SE: somnolence, dizziness, ataxia, HA, tremor
Pregnancy: C
Valproic Acid (Depakote)
1st line focal and primary generalized
Increases GABA levels
SE: BBW for liver dysfunction (
Pregnancy D
20-100 mg/L Therapeutic
Lamotrigine (Lamictal)
1st line focal and absence
Effective in kids w/ newly diagnosed absence seizures
Na Channel blocker, increases AA release to stabilize membrane
SE: BBW SJS, dizziness, HA, N, rash
Pregnancy C
Topiramate (Topamax)
1st line Focal
Blocks NA channels, enhances GABA
SE: kidney stone (keep hydrated), cognitive swallowing, narrow angle glaucoma
Pregnancy C
Phenobarbital
2nd line for focal and generalized tonic clonic
Enhances GABA, Interferes w/ transmission from thalamus to cortex
SE: restless eye/tongue/jaw, sleep apnea, Suicide
Pregnancy D
Ethosuximide (Zarontin)
1st line Absence
Depresses motor cortex
Therapeutic 40-100 mg/L
SE: SLE, Bone marrow suppression, hiccups
Pregnancy C
Zonisamide (Zonegram)
Adjunctive only for focal w/o consciousness impairment
Na and Ca channel blocker
Metabolized in liver, urine/stool secretion
SE: Sleepiness, dizziness, rash, fever
Pregnancy C
Not recommended w/ decreases CrCl
Oxcarbazepine (Trileptal)
1st line focal
Sodium channel blocker - stabilizes membrane to prevent rapid fire and impulse propagation
Titrate up; metabolized liver, excreted urine
SE: Hyponatremia, angioedema, severe rash
Pregnancy C
Felbamate (Felbatol)
2nd line focal and generalized tonic-clonic
Inhibit GABA and benzodiazepine receptor binding
SE: hepatic failure, aplastic anemia, suicide
Need pt to sign consent form due to lethality
Pregnancy C
Tiagabine (Gabitril)
2nd line focal
Increases GABA activity in CNS
SE: dizzy, nervous, confused, weak
Pregnancy C
Cholinesterase Inhibitors
MOA: curb acetylcholine breakdown
May slow AD progression for limited (6-12 mo) time
- Donepezil (Aricept): Only tx for all stages of AD, well tolerated
- Rivastigmine: mild/moderate AD
- Galantamine: mild/moderate AD - CI w/ severe renal/hepatic impairment
SE: D/V/N, fatigue, insomnia, appetite, weight loss
NMDA Receptor Agonists
Memantine (Nameda)
Moderate/severe AD
Regulates glutamate activity
SE: Dizziness, confusion, hallucinations
