Seizures Flashcards
What are the 1st gen anti epileptic drugs?
- Valproate (Depakote)
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin)
What are the 2nd gen anti epileptic drugs (AED)?
- Topiramate (Topamax)
- Oxcarbazepine (Trileptal)
- Lamotrigine (Lamictal)
What are the different ways that AEDs work?
- Enhancement of sodium channel inactivation
- Reducing current through T-type calcium channels
- Enhancement of GABA activity
- Antiglutamate activity
How do doctors decide what medication a pt gets for seizures?
depends on the type of seizure; may be on one drug, and may be on many
- if a pt is on a drug and have a continued amount of time without seizures, MD may taper off drug and seizures may not return
What are the common side effects of AEDs?
- Drowsiness
- Dizziness
- Cognitive Dulling
Side Effects:
- Initiation: nausea, vomiting, drowsiness, dizziness
- Chronic: peripheral neuropathy, hydantoin facies, gingival hyperplasia, osteomalacia
- Severe/Life Threatening: hepatic failure, Stevens-Johnson syndrome (skin rash; damage to large portion), Teratogenic
Phenytoin (Dilantin) - Drug Interactions: Carbamazepine (AED), Valproate (AED) Fluoxetine Warfarin many others (CNS depressants)
Side Effects:
- Initiation: nausea, vomiting, drowsiness, dizziness, neutropenia
- Chronic: osteomalacia, low sodium and water retention
- Severe: Direct Hepatotoxicity- Black Box Warning
Carbamazepine (Tegretol) - Drug interactions--MANY: Oral contraceptives Most other AEDs Erythromycin Warfarin
Side effects:
Dizziness
Nausea and vomiting
Hyponatremia
Oxcarbazepine (Trileptal)
- Drug interactions:
Potential for contraceptive failure
Phenytoin (AED)
Side Effects:
- Initiation: nausea, vomiting
- Chronic: weight gain, alopecia, tremor, thrombocytopenia
- Severe/Life Threatening: Fatal Hepatotoxicity, fatal hemorrhagic pancreatitis
Valproic Acid (depakote) - Drug Interactions: Phenytoin (AED) Carbamazepine (AED) Lamotrigine (AED) Many others
Used for different reasons, adverse effects are less severe and has less drug interactions than other AEDs
Side Effects:
Peripheral edema, Myalgia, Dizziness, Nystagmus, Somnolence, Mood swing, Fatigue
Gabapentin (neurontin)
- Drug Interations:
Aluminum/magnesium-containing antacids** may decrease the absorption
Side Effects:
Rash , Abdominal pain, Indigestion, Nausea, Vomiting, Pain, Ataxia, Dizziness, Headache, Somnolence, Blurred vision, Diplopia
- Severe Life Threatening Side Effect: Skin rash (Black Box Warning)
Lamotrigine (Lamictal) - Drug Interactions: Valproic Acid (increased concentration of lamictal) Carbamazepine (AED) Phenytoin (AED) Phenobarbial Primidone
Side Effects:
- Initiation: Drowsiness, dizziness, mood changes, loss of appetite
- Chronic: Metabolic acidosis, Kidney stones, word finding difficulties, significant weight loss
- Severe Life Threatening: Oligohidrosis (may not sweat)
Topiramate (Tomapamax)
Drug Interactions:
- Drugs that increase the effect/concentration of Topiramate (CNS depressants, acetazolamide)
- Drugs that decrease the anticonvulsant effect of topiramate (Phenobarbital, phenytoin, valproic acid)
- Low potential for drug interactions (High doses may alter action of oral contraceptives)
Side effects:
- Abdominal pain, Diarrhea, Indigestion, Loss of appetite, Nausea Taste sense altered
- Confusion, Dizziness, Insomnia, Memory impairment, Somnolence, Unable to concentrate
- Diplopia
- Agitation, Depression
- Disturbance in speech
Side effects with chronic therapy: - Kidney stones - Weight loss Severe/Life threatening: - Oligohidrosis
Zonisamide (Zonegran)
Drug Interactions:
- Drugs that decrease the effect of zonisamide: carbamazepine, phenobarbital, phenytoin, valproic acid
Side effects:
- Upon Initiation: dizziness, fatigue, sedation
- Chronic therapy: none
- Severe Life threatening: none
Drug Interactions:
- No significant interactions noted to date
Levetiracetam (Keppra)
