AED adverse effects

Question 1

What are the most common dose-dependent adverse effects

Answer 1

somnolence, fatigue, dizziness, visual changers, nystagmus, ataxia, nausea, behavioral changes

Question 2

How should dosing for AEDs be done

Answer 2

Start low and then titrate up slowly

Question 3

T/F: For AEDs a patient should only be given one if possible because polytherapy is more likely to cause in tolerable side effects

Answer 3

True

Question 4

What are options that can be done if there are too many adverse effects of AEDs

Answer 4

Switch to extended release of tablets, more frequent dose administration, administer with food, reduce total daily dose

Question 5

What should be done if VPA capsules or VPA enteric coated tablets are switched to extended release tablets

Answer 5

Dosing should be increased by 20% due to decreased bioavailability

Question 6

What are cognitive problems from AEDs

Answer 6

difficulty thinking, impaired memory or comprehension, word finding difficulties, slowed thinking

Question 7

What are behavioral changes from AEDs

Answer 7

Anxiety,hyperactivity, irritability, aggressiveness, altered mood, depression

Question 8

Which newer AEDs are less likely to cause effects on behavior and cognition

Answer 8

Lamotrigine, oxacarbemazepine, Lacosamide

Question 9

Which newer AEDS have minimal effects on cognition but may alter behavior

Answer 9

Levitracetam and Vigabatrin

Question 10

T/F: AEDs are more likely to cause suicide

Answer 10

False: Though there is labeling for it there are more factors to suggest a link between epilepsy and sucide

Question 11

What is the primary risk factor for suicidality with AEDs, what should be monitored for

Answer 11

Prior or family history of psychiatric disorders, monitor for depression or unusual changes in behavior (anxiety,agitation, loss of interest, hostility, mania)

Question 12

What AEDs are not associated with serious hypersensitivity adverse effects

Answer 12

Gabapentin, levitracetam, topiramate, vigabatrin

Question 13

What is the only AED that can cause pancreatitis and has low risk of causing hepatoxicity

Answer 13

Valporic acid

Question 14

What is the mechanism that is believed to cause hypersensitivity reaction to AEDs, what is the drug associated withmechanism of direct toxic effect of metabolies

Answer 14

Delayed Hypersensitivity reaction for Aromatic Ring AEDs, Valporic Acid

Question 15

What is the believed mechanism of Aromatic ring AEDs, what are symptoms,

Answer 15

Drug-specific activation of cytotoxic T-cells increasing of cytotoxic T-cells/ rash, fever, high eosinophils

Question 16

What are AEDs that are theorized to cause aromatic Ring delayed hyper

Answer 16

Carbazmezapine, lamotrigine, oxacarmezapine, phenytoin

Question 17

Which HLA alleles are associated with hypersensitivity reactions, what are the drugs associated

Answer 17

HLA-B 1502/ Carbamazepine, lamotrigine, oxacarbazepine, phenytoin

Question 18

What risk factors make it more likely that a patient will have a hypersensitive reaction to Valporic acid

Answer 18

fatty acid or amino acid metabolism, concurrent treatment with enzyme inducing AEDS

Question 19

What AED drug-drug interaction should be watched for closely

Answer 19

Lamtrogine and Valporic Acid

Question 20

What group of people is more likely to react badly to AEDs

Answer 20

Asians

Question 21

T/F: Baseline labs should betaken before a patient is given AEDs

Answer 21

True

Question 22

What symptoms indicating a possible serious AED reaction

Answer 22

ash, fever or swollen lymph nodes/ nausea, vomiting,lethargy, jaundice/ excruciating abdominal pain and nausea/ abnormal bruising or bleeding with persistent infection

Question 23

What AEDs are associated with severe skin rashes

Answer 23

carbamezapine, lamotrigine, oxcarbamazepine, phenytoin, phenobarbital

Question 24

What AEDs are associated with aplastic anemia (abnormal bleeding with persistent infection)

Answer 24

Carbamazepine and phenytoin

Question 25

What is the management if a patient has an AED induced skin rash

Answer 25

Stop AED, administer antihistamines for symptomatic relief, re-examine within 24 hours, AEDs should be avoided that cause skin rash

Question 26

T/F: If an AED causes a skin rash a new one should be started immediately to control epilepsy symptoms

Answer 26

False: There should be a delay in starting a new AED for 3-7 days because the body hasn't fully cleared the drug yet

Question 27

What AEDs can be given as alternatives AEDs that cuase skin rash

Answer 27

Levitracetam, Valporic acid, Topiramate

Question 28

T/F: Vigabatrin causes ocular toxicity

Answer 28

True

Question 29

Which AED is most likely to cause birth defects (spina bifida), what other AEDs can be teratogenic

Answer 29

Valporic acid/ Lamotrigine Leveitracetam, phenytoin, carbamezapine, topiramate, phenobarbital

Question 30

T/F: pregnant women should never take AEDs

Answer 30

False: Pregnant women are less likely to have problems with their babies after the first trimester of pregnancy

Question 31

Which AEDs are known to cause metabolism of hormonal contraception quicker, which AED has its metabolism induced by ethinyl estradiol

Answer 31

Carbamezapine,oxcarbemezapine, phenytoin, topiramate/ Lamotrigine