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Neuro > Epilepsy drugs > Flashcards

Epilepsy drugs Flashcards

1
Q

What are 1st line drugs for focal/partial seizures?

A 
Phenytoin 
CBZ/OxCBZ
VPA
Keppra
Lamictal
Zonisamide
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2
Q

What are the 1st line drugs for absence?

A

Ethosuximide

VPA

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3
Q

What are the 1st line drugs for myoclonic, atonic, atypical absence?

A

VPA

Keppra

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4
Q

What are the 1st line drugs for tonic-clonic?

A 
VPA
Keppra
Lamictal
OxCBZ
Topamax
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5
Q

What is the MOA of pheny?

A

Stabilizes neuronal membranes by decreasing sodium influx/increasing sodium efflux through voltage-gated dependent sodium channel blockade

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6
Q

What enzymes metabolize phenytoin?

A

2C9, 2C19

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7
Q

Is phenytoin protein bound?

A

Highly 90%

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8
Q

What is the therapeutic range of phenytoin?

A

10-20 Total

1-2 free

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9
Q

What is the initial dose of phenytoin?

A

5mg/kg/d divided 1-3x/d

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10
Q

What drugs cause an increased risk of SJS and TEN if HLA-B*1502 positive?

A

Phenytoin

CBZ

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11
Q

What are the systemic SE of phenytoin?

A 
Gingival hyperplasia
Hirsutism
Vit D deficiency
Folic acid deficiency
Impaired cognition
Osteomalacia
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12
Q

What are the neurologic SE of phenytoin?

A 
Confusion
Slurred speech
Diplopia
Ataxia
Neuropathy
Lethargy
Nystagmus
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13
Q

What are the rare SE of phenytoin?

A

Rash

LDA

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14
Q

What is the DOC for neonatal seizures?

A

Phenobarbital

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15
Q

What is the MOA of phenobarb?

A

Elevate seizure threshold by decreasing postsynaptic excitation, possibly by stimulating postsynaptic GABA receptors

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16
Q

What is the therapeutic range of phenobarbital?

A

10-40

17
Q

What is the dosing for phenobarb?

A

1-3 mg/kg/d

18
Q

What are the systemic SE of phenobarb?

A

Nausea

Rash

19
Q

What are the neurologic SE of phenobarb?

A 
Altered sleep cycles
Sedation, lethargy
Behavioral changes, confusion
Hyperactivity
Ataxia
Tolerance
Dependence
Depression
Decreased libido
20
Q

What is the MOA of ethosuximide?

A

Inhibits T-Type ca channels

21
Q

What is the brand name of ethosuximide?

A

Zarontin

22
Q

What is the therapeutic range of ethosuximide?

A

40-100

23
Q

What is the dosing for zarontin?

A

500-1000mg BID (max 1500)

24
Q

What are the AE for zarontin?

A

N/V, hiccups
Sleep disturbance, drowsiness, HA
Blood dyscrasias

25
Q

What are the second generation AEDs?

A

CBZ (tegretol, carbatol)

VPA (depacon, depakene, stavor)

26
Q

What are the 3rd gen AEDs?

A 
Felbamate (Felbatol)
Gaba (neurontin)
Pregaba (Lyrica)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
OxCBZ (Trileptal)
Tiagabine (Gabitril)
Topiramate (Topamax)
Zonisamide (Zonegran)
Lacosamide (Vimpat)
Vigabatrin (Sabril)
Clobazam (Frisium, Onfi)
Perampanel (Fycompa)
Eslicarbazepine (Aptiom)
Brivaracetam (Briviact)
27
Q

What AEDs may cause OC failure?

A

OxCBZ
Pheny
Phenobarb
CBZ

28
Q

Why are seizures increased in pregnancy?

A

Estrogen has seizure activating effect
Progesterone has a seizure protective effect
Menstruation and ovulation may lower seizure threshold

29
Q

What happens to AEDs during pregnancy?

A

Increased clearance of many AEDs

Altered protein binding of some AEDs

30
Q

What do phenobarb and pheny cause in pregnancy?

A

Congenital heart malformation and orofacial clefts

31
Q

What do VPA and CBZ cause in pregnancy?

A

Spina bifida and hypospadias

VPA associated with impaired cognitive development in children exposed in utero to VPA

32
Q

What do we supplement in women on AEDs of child bearing potential?

A

Folic acid

33
Q

What is the safest AED?

A

Lamictal

34
Q

When can we WD AED therapy?

A

2-4 years seizure free
Single type of partial seizure or single type of primary generalized tonic-clonic seizures
EEG normalized w/tx

35
Q

How should AED WD be done?

A

Over 3-6 months

36
Q

What are non pharm therapies for seizures?

A

Ketogenic diet
Surgery
VNS

37
Q

What is a ketogenic diet?

A

High fat, low carbs/protein
No sugar
Vit and mineral supp
Fluids controlled

38
Q

What is VNS?

A

Vagal nerve stimulation
Implanted medical device
>12 yo

Neuro (13 decks)

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