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Pharmacology PaxFlan > AEDs > Flashcards

AEDs Flashcards

1
Q

“1st line” drugs for partial (focal) seizures

A

carbamazepine
lamotrigine
levetiracetam
oxcarbazepine

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2
Q

“1st line” drugs for primary generalized tonic-clonic seizures

A

lamotrigine
levetiracetam
valproate

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3
Q

“1st line” drugs for absence seizures

A

ethosuximide

valproate

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4
Q

“1st line” drugs for atypical absence, myoclonic, atonic seizures

A

lamotrigine
levetiracetam
valproate

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5
Q

when should one check [anti-seizure drug]

A

in AM before next dose

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6
Q

What is the leading cause of tx failure with AEDs

A

ADRs

titrate up to prevent severe ADRs

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7
Q

AEDs that affect Na+ channels

A 
Carbamazepine 
oxcarbazepine/eslicarbazepine 
phenytoin/fosphenytoin 
lamotrigine 
lacosamide
zonisamide
rufinamide
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8
Q

CBZ (carbamazepine) indications

A

partial and mixed seizures, chronic pain syndromes (trigeminal neuralgia), acute manic/mixed episodes in bipolar I

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9
Q

what is the importance of dosing CBZ

A

it is an autoinducer so you want to check [CBZ] through 3, 6, 9 weeks (over time may need to increase dose)

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10
Q

cytochrome interactions of CBZ

A

inducer of 2C9 and 3A4

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11
Q

ADRs of CBZ

A 
sedation/impaired cognition, dizziness/ataxia, blurred or double vision, HA --> may interfere with learning 
Rash (SJS/TEN/DRESS), vitamin D deficiency, hypocalcemia (osteomalacia)
mild hyponatremia (elderly >)
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12
Q

who needs to undergo allelic screening before CBZ is given

A
  • northern Europeans

- pts of Asian ancestry&raquo_space;

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13
Q

CBZ and pregnancy

A

teratogen

neural tube defects!

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14
Q

Oxcarbazepine/Eslicarbazepine indications

A

partial seizures

bipolar disorders + neuropathic pain

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15
Q

monitoring for oxcarbazepine/eslicarbazepine

A

LFTS, serum Na

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16
Q

interactions of oxcarbazepine/eslicarbazepine

A

CNS depressants

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17
Q

ADRs of oxcarbazepine/eliscarbazepine

A

similar to CBZ (better tolerated)

more hyponatremia than CBZ

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18
Q

phenytoin/fosphenytoin indications

A

prevention of “early” seizures following TBI

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19
Q

what is important about dosing of phenytoin

A

autoinducer

check concentrations 2-3 weeks after initiation and 5-7 days after change

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20
Q

monitoring in phenytoin

A

VS, CBC, LFTs, Ca2+ and vitamin D

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21
Q

ADRs of phenytoin that are not related to the concentration

A

gingival hypertrophy**, rash (as with CBZ), vitamin D deficiency/hypocalcemia, drug fever, hepatotoxicity
(less common = hypertrichosis/werewolf, bone marrow suppression, peripheral neuropathy, drug-induced SLE)

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22
Q

ADRs of phenytoin that ARE related to concentration

A

nystagmus, ataxia, decreased mentation, death

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23
Q

phenytoin/fosphenytoin + pregnancy

A

teratogen (clefting)

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24
Q

Lamotrigine indications

A

newly diagnosed absence seizures, LGS, maintenance of bipolar disorder

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25
lamotrigine interactions
VPA increases [lamotrigine] > 2x
26
lamotrigine ADRs
rash, aseptic meningitis
27
Lacosamide indications
monotherapy or adjunctive for partial-onset
28
monitoring of lacosamide
baseline ECG in pts with conduction problems/severe cardiac disease
29
lacosamide interactions
concomitant PR-prolonging drugs (B-blockers, CCBs)
30
lacosamide ADRs
neurotoxic - euphoria, small increase in mean PR interval
31
zonisamide indications
adjunctive for focal seizures
32
monitoring for zonisamide
BUN/Cr, baseline serum [HCO3]
33
Zonisamide ADRs
oligohidrosis, hyperthermia, heat stroke skin reactions (SJS/TEN) metabolic acidosis/renal stones neurotoxic ADRs as with CBZ
34
Rufinamide indications
LGS
35
monitoring for rufinamide
ECG
36
rufinamide interactions
additive effect with other drugs that shorten QT interval
37
AEDs that affect K+ channels
ezogabine
38
Ezogabine indications
partial-onset seizures (adjunctive)
39
monitoring of Ezogabine
ECG for QT interval
40
interactions of Ezogabine
concomitant QT prolongers
41
ADRs of ezogabine
neuropsychiatric - dizziness, hallucinations urinary retention - cath? euphoria
42
AEDs that affect Ca2+ channels
Ethosuximide Gabapentin Pregabalin
43
Ethosuximide indications
tx of absence seizures
44
monitoring of ethosuximide
CBC, LFTs
45
interactions of ethosuximide
CNS depressants
46
ADRs of ethosuximide
neuropsych - drowsiness, hyperactivity (psychotic behavior) | N/V, bone marrow suppression
47
Gabapentin indications
partial seizures (adjunct), management of postherpetic neuruopathy, restless leg syndrome
48
dosing of Gabapentin
300 mg TID with titration
49
ADRs of gabapentin
somnolence, dizziness (otherwise well-tolerated)
50
pregabalin indications
fibromyalgia, management of peripheral neuropathies, RLS, off-label for GAD
51
ADRs for pregabalin
weight gain, euphoria/withdrawl | schedule V
52
AEDs that modulate GABA activity
``` phenobarbital clobazam clonazepam tiagabine vigabatrin ```
53
phenobarbital indications
partial and secondarily generalized but now has limited use d/t sedating effect
54
monitoring in phenobarbital
CBC, LFTs, Ca2+ + vitamin D
55
phenobarbital interactions
induces 2C9 and 3A4 | CNS depressants
56
phenobarbital ADRs
sedation, rash, bone marrow suppression
57
clobazam indications
LGS (adjunctive)
58
clonazepam indications
LGS (adjunctive)
59
tiagabine indications
adjunct for partial seizures
60
monitoring for tiagabine
CBC, CMP
61
tiagabine ADRs
new-onset seizures & status epilepticus have been associated with taken for unlabeled indications
62
Vigabatrin indications
infantile spasms r/t tuberous sclerosis | orphan drug
63
vigabatrin ADRs
irreversible retinal toxicity
64
glutamate receptor antagonist AED
perampanel
65
perampanel indications + ADRs
no vital indications | Schedule III - homicidal ideation/threats
66
valproate MOA
blocks Na+ channels, acts against T-type Ca2+ currents, increase GABA at clinical doses
67
valproate indications
mania associated with bipolar depression | migraine prophylaxis
68
valproate monitoring
LFTs, CBC, serum ammonia
69
valproate interactions
lamotrigine
70
valproate ADRs
lethargy, dizziness, tremor, parkinsonism syndrome & cognitive decline weight gain, hepatotoxicity / hepatic failure (kids have increased risk)
71
valproate and pregnancy
teratogenicity (*most teratogenic over carbamazepine, phenytoin) *use only for seizures/bipolar, not migraines
72
topiramate MOA
blocks Na channels, enhances GABA at a nonBZD on GABA receptors, antagonizes NMDA-glutamate receptor
73
topiramate indications
migraine prophylaxis, chronic weight management
74
topiramate monitoring
serum [HCO3] at baseline & q2-4 months recommended
75
topiramate ADRs
wt loss oligohidrosis, hyperthermia, heat stroke carbonic anhydrase inhibitor --> metabolic acidosis/renal stones dizziness/ataxia, blurred vision/visual disturbances, reversible memory or concentration difficulties
76
Felbamate indications
LGS | monotherapy & adjunctive therapy for partial seizures & secondarily generalized seizures
77
felbamate ADRs
fetal aplastic anemia & hepatic failure --> written consent required before therapy
78
Levetiracetam indications
prevention of early seizures following TBI/NS (replaced phenytoin as gold standard)
79
levetiracetam monitoring
psychiatric effects (suicidal thoughts, depression)
80
brivaracetam indications
adjunctive tx of partial onset seizures
81
brivaracetam monitoring
``` psychiatric effects (same as levetiracetam) CBC, CMP ```
82
cannabidiol indications
seizures associated with dravet syndrome or LGS in pts >2 yrs
83
cannabidiol interactions
inhibitor of 2C9 & 2C19
84
cannabidiol ADRs
somnolence, decreased appetite, diarrhea, serum transaminase elevations
85
monitoring of CBZ
``` CBC CMP (Na, LFTS, BUN) lipid panel Vit D, calcium UA TFTs pregnancy test ```

Pharmacology PaxFlan (12 decks)

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