Anti Epileptic Drugs

Question 1

Absorption of carbamazepine is ______ by food

Answer 1

accelerated

Question 2

carbamazepine is metabolized by ______, _____, _______

Answer 2

3A4/ 1A2/ 2C8

Question 3

name four drugs that inhibit the metabolism of carbamazepine

Answer 3

ketoconazole/ fluconazole/ erythromycin/ diltiazem

Question 4

what is the major metabolite of carbamazepine? Is it active or inactive?

Answer 4

10, 11 epoxide/ active

Question 5

Carbamazepine is an ___. This process begins within ________ and takes ____ to complete.

Answer 5

auto-inducer/ 3-5/ 21-28

Question 6

the auto-induction of carbamazepine reverses _____ when the drug is discontinued

Answer 6

rapidly

Question 7

what is the half life of carbamazepine?

Answer 7

20-50 hours after the first dose, 10-25 hours after completion of the auto-induction phase

Question 8

what is the time to peak for carbamazepine?

Answer 8

2-24 hours

Question 9

what is a therapeutic range for carbamazepine levels in the blood?

Answer 9

4-14 mcg/ml

Question 10

Explain how to dose carbamazepine

Answer 10

Begin with 200 mg twice daily with meals. Increase in 200 mg increments every other day. Final range usually 600-1600 mg/day, but some patients require 2,000-3,000 mg/day.

Question 11

read this list of carbamazepine side effects

Answer 11

cognitive effects, anemia, agranulocytosis, leukopenia, moderate weight gain, overflow incontinence, GI upset, risk of bone disorders, SJS, TEN, partial or complete heart block

Question 12

you should discontinue carbamazepine if ANC is less than

Answer 12

1,000

Question 13

Is carbamazepine one of our 6 decreased efficacy of OCP drugs?

Answer 13

yes

Question 14

for what indication is clonazepam a best evidence drug?

Answer 14

myoclonic seizures

Question 15

clonazepam is 2nd line treatment for ___

Answer 15

absence seizures

Question 16

what is the brand name for carbamazepine?

Answer 16

tegretol

Question 17

name two side effects of clonazepam

Answer 17

cognitive effects/ urge incontinence

Question 18

name two side effects of diazepam

Answer 18

cognitive effects/ urge incontinence

Question 19

how do you dose diazepam for status epilepticus?

Answer 19

0.2 mg/kg at 5 mg/min

Question 20

diazepam is _____ lipophilic than lorazepam, and has a ____ duration of action

Answer 20

more/ shorter

Question 21

what is the brand name of eslicarbazepine?

Answer 21

Stedesa

Question 22

how does eslicarbazepine work?

Answer 22

blockade of fast-acting, voltage-gated sodium channels. It has a greater affinity for the inactive state of sodium channels rather than the resting state, which may make it more selective for rapidly firing neurons

Question 23

what is eslicarbazepine used for?

Answer 23

adjunct therapy in patients whose seizures are uncontrollable

Question 24

what is the brand name for ethosuximide?

Answer 24

zarotin

Question 25

what is ethosuximide used for?

Answer 25

absence seizures

Question 26

are the following adverse drug effects of ethosuximide dose dependent or idiosyncratic? aplastic anemia, granulocytopenia, hepatotoxicity

Answer 26

idiosyncratic

Question 27

read this about ethosuximide side effects

Answer 27

SJS, Lupus-like reaction, and rash, as well as aplastic anemia, granulocytopenia, and hepatotoxicity are all idiosyncratic side effects of ethosuximide

Question 28

name two chronic side effects of ethosuximide

Answer 28

behavioral changes, parkinsonian movements

Question 29

what is the brand name of ezogabine?

Answer 29

potiga

Question 30

what is the mechanism of ezogabine?

Answer 30

stabilizes K+ channels in the open position by an unknown mechanism. Augments GABA-mediated currents

Question 31

what is ezogabine used for?

Answer 31

adjunctive treatment of partial-onset seizures in ages 18+

Question 32

how is ezogabine metabolized?

Answer 32

glucuronidation and acetylation

Question 33

should ezogabine be taken with or without food

Answer 33

it doesn't matter

Question 34

describe ezogabine dosing:

Answer 34

100 mg three times per day, increase by no more than 50 mg three times daily, at weekly intervals. Max dose is 400 mg three times daily

Question 35

name a side effect of ezogabine that may go away in the first 6 months

Answer 35

urinary retention

Question 36

can ezogabine make you sleepy?

Answer 36

yes

Question 37

name a cardiac side effect of ezogabine

Answer 37

QT interval effect

Question 38

does ezogabine have a risk of suicidal behavior/ ideation?

Answer 38

yed

Question 39

how does felbamate work?

Answer 39

it inhibits nmda, potentiates GABA

Question 40

what is felbamate used for?

Answer 40

monotherapy for parital seizures, 2nd line for absence seizures

Question 41

does felbamate cause weight gain or loss?

Answer 41

loss

Question 42

name two idiosyncratic adverse effects of felbamate

Answer 42

aplastic anemia, acute hepatic failure

Question 43

felbamate is only used in patients that

Answer 43

are refractory to other AEDs

Question 44

there is a risk of ______ damage with felbamate

Answer 44

hematologic

Question 45

what is the brand name for gabapentin?

Answer 45

neurontin

Question 46

how does gabapentin work?

Answer 46

increases GABA and blocks Ca channels. May also block glutamate release through a GABA-B mechanism.

Question 47

Gabapentin is the one AED for which absorption

Answer 47

is not essentially complete

Question 48

explain the metabolism of gabapentin

Answer 48

it is not metabolized, it is excreted nearly 100% unchanged by the kidneys

Question 49

gabapentin can be used for

Answer 49

monotherapy for partial seizures (better tolerated)

Question 50

gabapentin is a substrate of

Answer 50

l-amino acid carrier protein in the gut

Question 51

the dose of gabapentis is dependent on

Answer 51

bioavailability, which varies between individuals

Question 52

explain dosing of gabapentin

Answer 52

300 mg at bedtime on the first day, increasing to 900 mg/day over 3 days. Should be given at least 4 times a day.

Question 53

is gabapentin effective at higher doses for refractory patients?

Answer 53

yes

Question 54

does slower titration of gabapentin result in reduced ADEs?

Answer 54

yes

Question 55

gabapentin has a ______ effect on mood

Answer 55

positive

Question 56

does gabapentin cause weight gain or loss?

Answer 56

moderate weight gain

Question 57

describe urination issues due to gabapentin

Answer 57

CNS micturition stimulation

Question 58

what is the brand name of lacosamide?

Answer 58

vimpat

Question 59

what is lacosamide used for?

Answer 59

monotherapy for partial seizures, add on therapy for partial seizures, ages 18+

Question 60

how is lacosamide dosed?

Answer 60

50 mg BID, increased weekly by 100 mg/day to target dose of 200-400 mg/ day

Question 61

what dose supplement of lacosamide is needed after hemodialysis?

Answer 61

50%

Question 62

How long do you give an IV dose of lacosamide over?

Answer 62

30-60 minutes

Question 63

what is the PO: IV conversion for lacosamide?

Answer 63

1:1 (F=100%)

Question 64

lacosamide is a substrate of _______

Answer 64

CYP2C19