UNIT 2 SEIZURE AND EPILEPSY DRUGS Flashcards
What is the most widely used traditional AED?
- Phenytoin
What is the MOA of phenytoin?
- Causes selective inhabitation of sodium channel.
- It is the 1st to suppress seizures without depressing CNS
Phenytoin is active against which types of seizures?
- Partial and generalized tonic-clonic seizures
What are the adverse effects of phenytoin?
- Effects the CNS
-Nystagmus, sedation, ataxia, diplopia, cognitive impairment - Gingival hyperplasia
-Severe cases require surgical removal of gum tissues– oral care important - Dermatologic effects
-Morbilliform (measle like rash) - Effects pregnancy
- Cardiovascular effects
-Cardiac dysrhythmia and hypotension
What are some phenytoin drug interactions?
- Decrease effect of oral contraceptives, warfarin, glucocorticoids
- Increase Dilantin levels: diazepam, isoniazid cimetidine, acute alcohol, valproic acid
- Decrease Dilantin levels: Carbamazepine, phenobarbital, chronic alcohol
True or false: Phenytoin dosing is highly individualized?
True
True or false: Do not administer phenytoin with food?
False
What is the MOA of Carbamazepine (tegretol)
Same as phenytoin but minimal effects on cognitive function
causes selective inhabitation of sodium channels
also used for bipolar disorder and trigeminal neuralgia
What is the MOA for valproic acid (depakene, depakote)?
- Same as phenytoin but with minimal effects on cognitive function– causes selective inhabitation of sodium channels
What are the adverse effects of carbamazepine?
Bone marrow suppression
True or false: Valproic acid (depakene, depakote) is the 1st line drug for all patients & generalized seizures?
True
What is the adverse effects of valproic acid (depakene, depakote)
Hepatoxicity and pancreatitis.
What is the MOA of Phenobarbital?
Reduce seizure without causing sedation.
What are the adverse effects of phenobarbital?
- Drowsiness
- Interferes w/metabolism of vitamin D and K
- Toxicity- nystagmus and Ataxia
- Can cause physical dependance (belongs to barbiturate family)
What is the MOA of Oxcarbazepine (trileptal) (newer AED)
Blockage of voltage sensitive sodium channels
Oxcarbazepine (trileptal) (newer AED) is used in the management of what types of seizures?
Partial
What else should we know about oxcarbazepine (trileptal) newer AED
- Can be used with adults and children and is a derivative of carbamazepine
What are the adverse effects of Oxycarbazepine (trileptal) (newer AED)
- Dizziness, drowsiness, avoid driving and other hazardous activities
What should we know about lamotrigine (lamictal) (newer AED)
- Broad spectrum or antiseizure activity
- Used also with bipolor disorder
What is the MOA of lamotrigine (Lamictal) Newer AED
- Block sodium and calcium channels
What are the adverse effects of Lamotrigine (Lamictal) newer AED?
- Life threatening rash
- Risk for suicide– will not be given to patients who have a history of suicide.
What should we know about gabapentin (neurotin) (newer AED)?
- Adjunct therapy for partial seizure therapy
- Off label uses for this drug include: neuropathic pain, prophylaxis of migraine, fibromyalgia and post-menopausal hot flashes
- very well tolerated
- NOT USUALLY GIVEN FOR SEIZURES BY ITSELF TYPICALLY PAIRED WITH A PRIMARY AED
What are common side effects of Gabapentin
- Somnolence, dizziness, ataxia, fatigue, nystagmus, peripheral edema
What should we know about pregabalin (lyrica) (newer AED)
- Useful for neuropathic pain, postherpetic neuralgia
- is regulated under the controlled substance act
- Adjunct therapy for partial seizures
What is a major side effect of pregabalin (lyrica) new AED?
- Can cause life threatening angioedema
What should we know about Levetiracetam (Keppra)? a newer AED
- Does not interact with other AED’s
- MOA: unkown
What should we know about Toprimate (topamax)?
- Broad-spectrum antiseizure meds
- Migraine treatment.
