Seizure Pharm Flashcards
ADRS of ALL AED(5)
Increased risk of suicidality
SJS/TEN
Bone loss
Alcohol use is CI
Contraception - teratogenic and decreased effectiveness of oral contraceptives
general AED Drug-Drug interactions (5)
GI medications (antacids)
Anti-infectives (e-mycin, clarithromycin, fluconazole, antivirals)
Oral contraceptives
Warfarin
Psychiatric meds
when are Drug Levels Ordered?
After starting new drug
Following dose adjustment or addition of another drug
Recurrent seizures despite medication (poorly controlled)
Carbamazepine brand + indications
Tegretol
Indications: first line, trigeminal neuralgia
Carbamazepine ADRs
dizziness, diplopia/blurry vision, nausea, ataxia,
Rare: LFT increase (5-10%), aplastic anemia, agranulocytosis, thrombocytopenia, SJS
drugs induced by Carbamazepine
OCs
TCAs
warfarin
increase these doses
inducers of Carbamazepine metabolism
other AEDs
St Johns wort
grapefruit juice
increase CBZ dose
inhibitors of CBZ metabolism
macrocodes
CCBs
Tagament
decrease CBZ dose
Oxcarbazepine
brand name + why not used
Trileptal
May promote some types of seizures so not used
Phenytoin
contraindication + brand
Dilantin
CI: pregnancy
why is Dilantin CI in pregnancy?
Phenytoin
cleft palate, cleft lip, congenital heart disease, slowed growth rate, mental deficiency
Phenytoin ADRs (6)
osteoporosis
coarsening of facial features/gingival hyperplasia
increased body hair
CNS
loss of libidio, hormone dysfunction
vitamin K and folate deficiency
drugs induced by Phenytoin
furosemide
other AED
increase these drug dose
drugs inhibited by Phenytoin
warfarin, steroids
decrease dose
inducers of Phenytoin
other AEDs
amiodarone
increased PHT dose
inhibitors of Phenytoin
sulfonamides
tangamet
decrease PHT dose
Fosphenytoin
brand + indications
Cerebyx
IV, status epilepticus tx, short term tx with oral meds
Cerebyx ADrs
Fosphenytoin
cardiac depression and HoTN, rate of infusion
Lamotrigine
brand + indications
Lamictil
bipolar disorder
safe in pregnancy, elderly pts
Lamictil ADRs
Lamotrigine
rash, CKD dose adjust
Valproate/Valproic Acid
brand + indications
Depakote
migraine HA prophylaxis, bipolar disorder
Depakote ADRs
Valproate
N/v, tremor, sedation, confusion, irritability, weight gain
increased bleeding, SIADH, insulin resistance, sex hormone changes, pancreatitis and hepatotoxic
Valproate BBW
pregnancy
causes fetal cognitive impairment
drugs induced by Valproate
Benzos
other AEDs
increase these doses
drugs inhibited by Valproate
sulfonylureas = decrease dose
inducers of Valproate
other AEDs, carbapenems
increase VPA dose
inhibitors of Valproate
Tagamet
e-mycin
decrease dose
Topiramate
brand + indications
Topamax
migraine prophylaxis
Topiramate ADRs
ataxia, impaired concentration, confusion, dizziness, fatigue, paresthesia, somnolence, depression, agitation, slowed speech
weight loss (appetite suppression)
renal calculi
Topiramate DDI
Induced by: PHT, CBZ
Induce metabolism of estrogens
Levetiracetam
Brand + indications + DDI + ADRS
Keppra
Indications: adults, DOC in children, elderly
ADRs: few - dizziness, somnolence, asthenia, URI
Drug-Drug: no significant DDI, can cross placenta
Gabapentin
brand + indication + ADR
Neurontin
Indication: neuropathic pain, migraine HA
ADRs: Somnolence
Pregabalin
brand + indication
Lyrica
migraine HA, neuropathic pain
pregabalin
ADR
dizziness drowsiness weight gain difficulty concentrating angioedema
Zonisamide
brand + indication + adr
Zonegran
long half life = good for non compliance
ADRs: sulfa drug allergy
lacosamide brand
vimpat
