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PHM701 - SEIZURES > SEIZURE MEDICATIONS > Flashcards

SEIZURE MEDICATIONS Flashcards

1
Q

Levetiracetam/Keppra uses

A

Go-to, used in all seizure types

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2
Q

Keppra dosing

A

500mg BID, titrate q2w until at max recommended dose of 1.5g BID

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3
Q

Keppra side effects

A

Well tolerated, some weight gain

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4
Q

Keppra monitoring

A

Dose adjust based on GFR- watch renal function

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5
Q

Keppra enhances what drugs?

A

CNS depressants

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6
Q

Oxcarbazepine uses

A

Adjunctive therapy in partial seizure treatment in children 6+

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7
Q

Initial oxcarbazepine dosing

A

5mg/kg/day, weekly increments of 5mg/kg/day

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8
Q

Target oxcarbazepine dosing

A

30-50mg/kg/day

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9
Q

Dosing frequency of oxcarbazepine

A

BID

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10
Q

Oxcarbazepine side effects

A

Most common in children: somnolence, HA, dizziness, N/V, rash is potentially fatal but reversible

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11
Q

Oxcarbazepine monitoring

A

Sodium, hepatic function
Get baseline electrolytes and hepatic enzymes

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12
Q

Oxcarbazepine and drug interactions

A

Lower potential for drug interactions because of low protein binding, hepatic enzyme induction, MHD eliminated by the kidneys

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13
Q

Lamotrigine uses

A

Partial onset seizures

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14
Q

Initial lamotrigine dose

A

0.5mg/kg/day divided BID x2 weeks, then 1mg/kg/day x2 weeks, then increase 1mg/kg/day q2w until response

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15
Q

Maintenance lamotrigine dose

A

5-15mg/kg/day div BID

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16
Q

MDD of lamotrigine

A

400mg/day

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17
Q

When does the dose of lamotrigine need to be decreased?

A

Patients taking VPA

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18
Q

Lamotrigine side effect

A

SJS! More likely to occur with fast titration

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19
Q

Other info about lamotrigine

A

Broad spectrum of activity, low teratogenic potential, nonsedative

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20
Q

Gabapentin uses

A

Partial seizures, also useful in comorbid neuropathic pain/mood stabilization in BPD

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21
Q

Initial gabapentin dosing

A

30mg/kg/day

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22
Q

Max gabapentin dosing

A

1800mg/day

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23
Q

Dosing frequency of gabapentin

A

TID

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24
Q

Gabapentin side effects

A

Somnolence, dizziness, ataxia, weight gain with higher doses

Lower incidence of neurotoxic side effects

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25
Q

That one weird fact about gabapentin

A

Doses 2-3x higher often necessary to achieve max benefits

With a higher dose, lower % is absorbed

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26
Q

Gabapentin interactions with other drugs

A

No PK interactions, pure renal elimination and no binding to serum proteins

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27
Q

Phenytoin use

A

Generalized seizures

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28
Q

Phenytoin dosing

A

200-400mg

29
Q

Concentration-dependent phenytoin side effects

A

nystagmus, double-vision, blurred vision, incoordination, drowsiness, dizziness, HA

30
Q

Idiosyncratic phenytoin side effects

A

aplastic anemia, granulocytopenia, hepatotoxicity, rash, SJS, Lupus-like reaction

31
Q

Chronic phenytoin side effects

A

gingival hyperplasia, acne, hirsutism, peripheral neuropathy, chronic cerebellar damage, megaloblastic anemia, osteoporosis, fetal vitamin K depletion

32
Q

Phenytoin monitoring

A

Baseline CBC and liver enzymes, bone density screen for osteoporosis, normal TDM stuff

33
Q

Phenytoin PK/PD: protein binding

A

Highly protein bound

34
Q

Phenytoin PK/PD: hepatic metabolism

A

Capacity-limited

35
Q

Phenytoin Tmax

A

4-12h

36
Q

Phenytoin PK/PD: toxicity

A

Has both concentration independent and dependent toxicity

37
Q

Fosphenytoin is used when?

A

IV, usually given in status epilepticus after IV benzo administration

38
Q

Valproate initial dosing

A

15mg/kg/day initially in 2-3 divided doses, increasing in 5-10mg/kg/day increments at weekly intervals to a max of 60mg/kg/day

39
Q

Valproate maintenance dosing

A

15-40mg/kg/day in 3 divided doses

40
Q

When to reduce starting dose of valproate

A

Elderly patients

41
Q

Valproate side effects

A

N/V/D, abdominal cramps, transient elevations in LFTs

Occasionally: drowsiness, ataxia, tremor, behavioral disturbances, transient hair loss, asymptomatic hyperammonemia, weight gain

42
Q

Drowsiness and ataxia are more likely in patients taking valproate with what?

A

Other AEDs

43
Q

Valproate monitoring

A

Baseline LFTs, platelets, repeat LFTs frequently (esp. in first 6 months of treatment)

Monitor coagulation tests prior to surgery

44
Q

Valproate CI

A

Hepatic disease/dysfunction

45
Q

Target valproate levels

A

50-120mg/L

46
Q

Drugs that can lower valproate levels

A

Carbamazepine, lamotrigine, phenytoin, rifampin

47
Q

Drugs that can increase valproate levels

A

ASA, chlorpromazine, cimetidine, felbamate

48
Q

Drugs levels that can increase by valproate

A

Lamotrigine, phenobarbital

49
Q

Valproate can do what to other AEDs at protein binding sites?

A

Displace them

50
Q

Carbamazepine uses

A

Partial and secondary generalized seizures

51
Q

Adult dosing for carbamazepine

A

600-2,000mg/day

52
Q

Kids dosing for carbamazepine

A

10-40mg/kg/day

53
Q

Carbamazepine dosing frequency

A

TID or QID, but BID for SR formulation

54
Q

Carbamazepine side effects that can be minimized by slow titration

A

dizziness, drowsiness, HA, diplopia, N/V

55
Q

Carbamazepine side effects: hyponatremia and water intoxication…what’s it caused by?

A

Carbamazepine monotherapy, elevated serum levels, age >25, vomiting, diarrhea

56
Q

Carbamazepine monitoring

A

Baseline CBC and platelet counts

Serum levels once weekly in first month of therapy

57
Q

Target carbamazepine serum levels

A

4-12mg/L

58
Q

Carbamazepine and MAOIs

A

D/C MAOI at least 14 days before starting carbamazepine

59
Q

Carbamazepine can do what to CYP3A4 drugs?

A

Stimulate their metabolism

60
Q

Drugs that can inhibit carbamazepine metabolism

A

Cimetidine, clarithromycin, danazol, erythromycin, fluoxetine

61
Q

How long does it take for carbamazepine and valproate to reach Css?

A

2-4 days

That may not last for long with carbamazepine because it goes through autoinduction

62
Q

Topiramate uses

A

Focal (partial) onset seizures, primary generalizes tonic-clonic seizures

63
Q

Topiramate initial dosing

A

50mg/day, increase in 50mg dose increments until max dose of 200mg/day in 1-2 divided doses. Could go up to 400mg/day depending on formulation

64
Q

Topiramate elderly dosing

A

25mg/day, titrated up 25mg weekly until effective dose reached

65
Q

Topiramate kids dosing

A

initial- 1-3mg/kg/day at night x1 week, increase at 1-2 week intervals. Maintenance: 5-9mg/kg/day, max is 400mg/day

66
Q

Topiramate side effects

A

Dizziness, drowsiness, fatigue, metabolic acidosis, kidney stones, secondary acute angle closure glaucoma, hypohidrosis, hyperthermia, suicidal ideation, anorexia/weight loss, finger/toe numbness

67
Q

Topiramate monitoring

A

Electrolytes, SCr, acute acidosis, ammonia levels, IOP, screen for eating disorder

68
Q

Topiramate has synergistic effects with what other AED and why?

A

Lamotrigine, because they have different MoAs!

PHM701 - SEIZURES (2 decks)

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