seizure drugs

Question 1

phentoin

Answer 1

hydantoins
tonic clonic, focal, epilepsy 1st line
PO or IV (emergent - vein irritant, long 1/2 life, 1/day)
SE: cognitive changes, confusion, abnormal movements, lethargy, gingival hyperplasia, hirsutism, osteoporosis, hypertrophy of SQ facial tissue
therapeutic monitoring: 10-20 mic/ml, highly p bound (malnourished, low p - toxicity), interact!, CYP450 inducer

Question 2

valproic acid

Answer 2

generalized seizure, partial seizures, bipolar
PO or IV - highly p bound (interactions!), delayed release, sprinkles
contraindicated for liver disease, urea cycle disorder
SE: hepatotoxicity, pancreatitis

Question 3

topiramate

Answer 3

adjunct for partial and secondary generalized, tonic clonic
only PO
SE: general CNS depression, GI upset, visual changes, closed angle glaucoma
interact with contraceptive meds

Question 4

levetiracetam

Answer 4

adjunct for partial and without generalization
well tolerated
PO and IV