TPX Epilespy & Migraine& Pain Flashcards
Focal seizures
Treatment of choice:
Levetiracetam
Lamotrigine
Oxcarbazepine
Others:
Carbamazepine
Lacosamide
Carbamazepine
Tegretol
Na channel blocker
Enzyme Inducer
Side effects:
Black box warning for rash (HLA Variants)
helps with depression
sedation
Drugs with rash cross sensitivity
Lamotrigine
Carbamazepine
Phenytoin
Phenobarbital
Dose reduction with GFR reduction
Pregabalin
Gabapentin
Levetiracetam
Oxcarbamazepine
Phenobarbital
Luminal
Barbiturate
Prolong GABA openings
sedation
Benzodiazepines
Increase frequency of GABA openings
Tiagabine
Gabatril
Inhibits GAT-1
causes sedation
Vigabatrin
- Sabril*
Inhibits GABA-T
Phenytoin
Dilantin
Sodium channel blocker
causes sedation
Lamotrigine
Sodium channel blocker
Zonisamide
Na channel blocker
Calcium channel blocker
CA inhibitor
Weight loss
depression
Lacosamide
Vimpat
Slow inactivation of Na channels
Helps depression
Valproate
Depakote
GABA enhancement
Na channels
Ca channels
helps w/ depression
weight gain
Gabapentin and pregabalin
Ca channels
Weight gain
Renally dosed
Topiramate
Na channels
Ca channels
Antagonizes glutamate
CA inhibitor
Weight loss
Depression
Sedation
Ethosuximide
Zarontin
T-type Ca channels
Perampanel
Fycompa
antagonist of AMPA receptor
Levetiracetam
keppra
binds SV2A
depression
renally dosed
Felbamate
blocks NDMA
GABA enhancement
Generalized Seizures
Lamotrigine
Levetiracetam
Valproate
Others:
Topiramate
Zonisamide
ASMs and depression
Positive impact: Carbamazepine, Lamotrigine, Valproate, Lacosamide
Negative: Levetiracetam, Topiramate, Zonisamide
Absence Seizures
Ethosuximide
Valproate
Other:
Lamotrigine
ASM weight gain
Valproate
Oxcarbamazepine
Gabapentin
Pregablin
Weight loss
Zonisamide, topiramate
ASMs that do not affect bone density
Lamotrigine, levetiracetam, zonisamide
Sedation
Carbamazepine, Oxcarbamazepine, Phenytoin, Phenobarbital, Topiramate, Tiagabine
Oxcarbamazepine
Renally dosed
Weight gain
Sedation
Tension Headaches (prophylaxis)
1st line: non-pharmacological
2: Amitriptyline 30-75 mg nightly
Alternatives:
Mirtazapine 30 mg nightly
Venlafaxine 150 mg nightly
Migraines (Acute treatment)
1st Line:
analgesics
2nd Line:
Triptans
Alternatives:
CGRPs
Ergots
Ergot derivatives
Black box warning: ischemia if taken with CYP3A4 inhibitors
Contraindications: PVD, IHD, renal or hepatic impairment
Migraines (preventative)
1st Line:
Beta-blockers, anticonvulsants, Frovatriptan (for menstrual related migraines only)
2nd Line:
Amitriptyline
Venlafaxine
Alternatives:
CGRP
Botox
Cluster Headaches
1st Line:
Oxygen therapy
2nd Line:
Sumatriptan
Zolmitriptan
Alternatives:
Intranasal Lidocaine
Ergot
Opioids to avoid in renal impairment
morphine
hydromorphone
Opioids to avoid in hepatic impairment
codeine
tramadol
hydrocodone
Opioid Tolerance
> 60 mg OME for >1 week
Codeine DDI
CYPD2D6 phenotypes
Tramadol DDI
CYPD26 & CYP3A4 inducers/inhibitors
CYPD2D6 phenotypes
Buprenorphine DDI
CYP3A4 inducers/inhibitors
Neuropathic pain agents
Gabapentinoids, TCAs, SNRIs
Tapentadol DDI
MAOIs
Asthma Diagnosis
-FEV1 and FVC increases from baseline by 12% and 200 mL after SABA
-FEV1 increases from baseline by 10% from predicted FEV1 after SABA
-PEF increases by 20% in adults or 15% in children
GINA score for adults
-Step 1-2: infrequent asthma symptoms or asthma symptoms less than 3-5 days/wk
-Step 3: asthma symptoms most days, waking due to asthma once a week or more
-Step 4: daily asthma symptoms, waking at night, current smokers
GINA score for children
Step 1: infrequent symptoms (1-2 days/wk)
Step 2: 3-5days/wk
Step 2-3: most days, waking due to asthma
Step 4: daily asthma symptoms
