Seizures

Question 1

parampanel

Answer 1

Enhances GABA by activating GABA a receptor
C-III
SE: psychosis, gait disturbances, somnolence

Question 2

clobazam

Answer 2

Enhances GABA by activating GABA a receptor
C-IV
Used for Lennox-Gastaut
metabolized by 3A4

Question 3

clonazepam

Answer 3

Enhances GABA by activating GABA a receptor
used in myoclonic seizures
C-IV
SE: antereograde amnesia, paradoxical reactions

Question 4

carbamazepine

Answer 4

Decreases Na influx
Serum concentration 4-12 mcg/mL
DRESS if Northern European and HLA3101
SJS if Asian HLB1502

Question 5

Ezogabine

Answer 5

D/C soon

Question 6

Lacosamide

Answer 6

Decreases Na influx

SE: cardiac convention (increases PR interval), 2C19 inhibitor

Question 7

Oxcarbazepine

Answer 7

Decreases Na influx

if switching from carbamazepine, increase dose by 1.5x

Question 8

phenobarbital

Answer 8

Activates GABAa receptor
C-IV
Target serum concentration: 15-40 mcg/mL
SE: somnolence, confusion, Ca metabolism
2C9 substrate, induces many other Cyps

Question 9

phenytoin

Answer 9

Decreases Na influx
Target serum conc. 10-20mcg/mL
SE: hypotension, arrhythmias, purple glove syndrome, osteoporosis, SJS, nystagmus, etc.

Question 10

pregabalin

Answer 10

Increases GABA release
C-V
100% RENALLY CLEARED
Renal dosing available
SE: angioedema, peripheral edema, increased PR interval

Question 11

primidone

Answer 11

metabolized to phenobarbital

Question 12

tiagabine

Answer 12

inhibits GABA transporter
3A4 substrate
Target conc. 0.02-0.2 mcg/mL
Avoid off-label use (can cause seizures)

Question 13

topiramate

Answer 13

antagonist of kainate/AMPA receptors
renal dosing, use caution in renal pts
SE: visual field abnormalities, hyperthermia, BMP q3-6 months

Question 14

vigabatrin

Answer 14

Inhibits GABA transaminase
Used for refractory seizures
SE: vision loss, neuropathy

Question 15

gabapentin

Answer 15

Increases GABA release
renal dosing 600-1800 mg/day
SE: somnolence, peripheral edema, renally cleared

Question 16

felbamate

Answer 16

NMDA receptor antaonist
SE: aplastic anemia, hepatic failure
Used for Lennox-Gastaut
Monitor LFTs and bone marrow supression

Question 17

lamotrigine

Answer 17

Decreases sodium influx AND calcium influx
watch for cyp inducers for dosing
Can cause SJS
Dosing:
starting dose x 14 days, double x 14 days, double x 7 days, final dose
If on valproate, must cut in 1/2
If on phenytoin or carbamazepine, must double

Question 18

levetiracetam

Answer 18

Binds to SV2A and interferes with neurotransmitter release
Status dosing: 1000-3000mg IV
Renal dosing
SE: psychosis and related side effects

Question 19

valproate

Answer 19

Broad spectrum, decreases Na and Ca influx and increases GABA levels
Target serum conc 50-125
Status dosing: 20-40mg/kg
SE: PCOS, alopecia

Question 20

zonisamide

Answer 20

SULFA ALLERGY

Question 21

rufinamide

Answer 21

Used in Lennox-Gastaut/Refractory seizures
CI if short QT syndrome
DRESS