Seizure Meds Flashcards
Phenytoin -uses
all forms of seizures except absence
Phenytoin - things to know
most widely used, a drug of 1st choice
narrow TI
Teratogenic
Phenytoin - AE
- mild CNS effects, nystagmus
- gingival hyperplasia (folic acid can help)
- SJS, DRESS, TEN (with genetic defect - mostly Asians)
- If given IV push, hypotension and dysrhythmias
Phenytoin - drug interactions
- CYP, esp. birth control, warfarin, and glucocorticoids
- drugs that increase levels - diazepam, cimetidone, alcohol (acutely), and valproic acid
- drugs that decrease levels - carbamazepine, phenobarb, alcohol (chronically)
- enteral tube feeds
carbamazepine - uses
- tonic-clonic and partial
carbamazepine - things to know
- half life decrease as therapy progresses
- teratogenic
- check CBC at baseline, DO NOT give in pts with hemolytic abnormalities
carbamazepine - AE
- neuro - visual disturbance, ataxia, vertigo, HA
- leukopenia, thrombocytopenia (rare)
- fatal aplastic anemia (very rare)
- SJS, TEN, DRESS (see in 2-4 weeks)
- hyponatremia
- hepatic and renal failure
carbamazepine - interactions
- inactivates birth control and warfarin
- grapefruit juice
Valproic Acid - uses
1st line for all partial and generalized
Valproic Acid - AE
- minimal cognitive impairment or sedation
- N/V/indigestion (take with food)
- hepatotoxicity - BBW
- pancreatitis - BBW
- teratogenic
Valproic Acid- Interactions
- increases levels of phenobarb
- topiramate -> hyperammonemia -> encephalopathy
- carbapenem abx
Ethosuzimide (Zarontin) - uses
1st choice for absence seizures
Ethosuzimide (Zarontin)- AE
- initially drowsiness, dizziness, lethargy
- N/V - take with food
- RARE: lupus, leukopenia, aplastic anemia, SJS
Phenobarbital - uses
partial and tonic clonic
Phenobarbital - AE
- drowsiness (decreased over time)
- cognitive deficits in kids
- depression
- agitation and confusion in older adults
- acute intermittent porphyria
- resp depression
- disrupt metab of vit D and K (patient should eat food high in those and calcium)
Phenobarbital - interactions
- CYP - birth control and warfarin
- valproic acid
Primidone (mysoline) - uses
- tonic clonic, partial, not absence
Primidone (mysoline) - AE
- initially, sedation
- confusion in older adults
- paradoxical effects in kids
- acute intermittent porphyria
- RARE: psychosis, leukopenia, thrombocytopenia, lupus
Primidone (mysoline) - Interactions
birth control, warfarin
Oxcarbazepine (Trileptal) - uses
partial seizures - mono >4, adjunct >2
Oxcarbazepine (Trileptal) - AE
- CNS effects (improve over time)
- hyponatremia
- SJs, TEN
- hemolytic effects (rare)
- multi organ hypersensitivity
- decreased bone density
Oxcarbazepine (Trileptal) - interactions
- phenytoin
- perampanel, phenobarab, valproic acid
- eslicarbazepine
- birth control
- Na depleting drugs
Lamotrigine (Lamicatal) - uses
adjunct for partial, lennox gasteau, and tonic clonic
mono for partial >16yo
Lamotrigine (Lamicatal) - AE
- dizziness, diplopia, blurred vision, N/V, HA
- SJS, TEN, DResS (valproic acid increases that risk)
- hypersensitivity
- aseptic meningitis (very rare)
- suicidal thoughts
Lamotrigine (Lamicatal) - interactions
- affected by drugs that induce or inhibit hepatic metabolism
- birth control
Gabapentin (Neurontin) - uses
adjunct for partial
Gabapentin (Neurontin) - AE
- well tolerated
- somnolence, dizziness, ataxia, fatigue, nastigmus, and peripheral edema (decreases over time)
Gabapentin (Neurontin) - Interactions
none
Pregabalin (Lyrica) - uses
adjunct for partial
Pregabalin (Lyrica) - AE
dizziness and somnolence (doesn't go away) blurred vision (goes away) - weight gain - cognitive issues, HA, edema - hypersensitivity (angioedema) - potential for abuse (withdraw slowly) - reproductive risks for men and women
Pregabalin (Lyrica) - Interactions
opioids, benzos
Levetiracetam (Keppra) - uses
adjunct for myoclonic (>12), partial (>4), tonic clonic (>6)
Levetiracetam (Keppra) - AE
possible renal failure
drowsiness, weakness,suicide
Levetiracetam (Keppra) - interactions
none
Topiramate (Topomax) - uses
adjunct >2 partial, tonic clonic, and LG
mono >10 tonic clonic
Topiramate (Topomax) - AE
wt loss, dizziness, solomnence ataxia, congnitive issues
metabolic acidosis 9at risk: keto, renal dz, resp disorders, and diarrhea
hypohydriasis, closed angle glaucoma, suicide
Topiramate (Topomax) - interactions
phenytoic, carbamazepine, valproic acid
Tiagabine (Gabitril) - uses
adjunct for partial >12
Tiagabine (Gabitril) - ae
dizziness, somnolence, nervousness
Tiagabine (Gabitril) - Imnteractions
decreased by phenytoin, phenobarb, and carbamen
zonisamide (Zonegran) - uses
adjunct for partial in adults
zonisamide (Zonegran) - AE
drowsiness, dizziness, anorexia, HA, N metabolic acidosis cognitive effects - suicide SJS, TEN - kidney stones - rarely hypohidrosis
zonisamide (Zonegran) - Interactions
CYP3A4, grapefruit juice
Felbamate (Felbatol) - uses
adjunct or mono in adults with partial
adjunct in kids with LG
Felbamate (Felbatol) - AE
aplastic anemia, liver damage, GI disturbance
Felbamate (Felbatol) - Interactions
phytoin, valproic acid, carbamen
