Anti Epileptic Drugs Flashcards Preview

PHARM II, QUIZ 2 > Anti Epileptic Drugs > Flashcards

Flashcards in Anti Epileptic Drugs Deck (45):
1

Seizure treatment steps

1. Determine type of seizure (Focal, Generalized/absence, tonic, clonic)

2. Choose AED based one
- Type of seizure
- Side effect profile
- Cost, Dosing preferences

2

Stopping AED Tx

- When seizure free for 2-4 years

- Normal neuro / EEG

- Withdraw slowly over 6 months

- 25-29% relapse in 1-2 yrs

3

Excitation seizure

Too Much Go - GLUTAMATE, ASPARTATE

Ionic Currents: Inward Na+& Ca++

4

Inhibition seizure

Not Enough Stop - GABA

Ionic Currents: Inward Cl-, Outward K+

5

Warning for All AEDs

Suicidal ideation, thoughts, action

6

1st Line Meds, Focal & Generalized (Tonic-Clonic)

Carbamazapine CYP3A4

Valproic Acid (Depakote)

Topiramate

Phenytoin (Dilantin)

7

2nd Line Meds, Focal

- Lamotrigine

- Zonisamide
- Lacosamide
- Perampanel

Barbituates - GABA enhancers
- Phenobarbital
- Primidone

- Lyrica (Pregabalin)
- Gabitril (Tiagabine)

8

2nd Line, General Tonic-Clonic

Perampanel
Primidone
Gabapentin

9

1st Line, Lennox Gastaut Syndrome

- Lamotrigine
- Valproic Acid
- Topiramate

10

1st Line, Mixed

- Carbamazepine CYP 3A4
- Valproic Acid

11

Absence Tx, 1st & 2nd

1st
- Valproic Acid
- Ethosuxamide
- Lamotrigine

2nd
- Clonazepam

12

Myoclonic Tx

Keppra (Levetiracetam)

13

1st line, Status Epilepticus

Diazepam
Lorazepam
Midazolam

Phenobarbital

14

Carbamazepine, CYP 3A4

1st line for Focal, Generalized, Mixed

MOA: unclear - Na+ channel blocker

**Also used for Trigeminal Neuralgia Pain**

15

Alternative use for Carbamazepine?

Trigeminal Neuralgia Pain

16

Carbamazepine , CYP3A4

ADRs

COMMON
Drowsiness
Headache
Dizziness
Ataxia (loss of control of body movements)

N/V/D

Leukopenia
Hyponatremia
Rash

SERIOUS
Aplastic Anemia
Hepatitis
Pancreatitis
SJS
Preg D (spina bifida)

17

When is Carbamazepine CI?

Asian patients (increased SJS risk)

H/o bone marrow problems

18

Lamotrigine

Na+ Channel blocker

(originally adjunctive) but in practice used 1st line
Focal / GCT, Lennox Gastaut

2nd line mono therapy Focal Seizures

Alt:
2nd line Bipolar

19

Lamotrigine - Specific Warnings/ADRs

(Common ADRs same as Carba)

SJS in Pediatrics

Aseptic meningitis

**Decreases OCP efficacy, progesterone**

**Valproate increases Lamotrigine effect**

20

Valproic Acid (Depakote)

aka Valproate

GABA Enhancer

Indicated for EVERYTHING
- 1st line for Focal, Generalized, Mixed, Absence, Lennox Gastaut

21

Valproic Acid (Depakote) CI

Liver Disease

Pregnancy
- neural tube defects

22

Valproic Acid (Depakote)

COMMON ADRs

- N/V
- Fatigue
- Dizziness
- Hair loss
- Weight gain
- Depression

- Hyperammonemia

- Irregular periods
- Bone loss

23

Valproic Acid (Depakote)

SERIOUS ADRs

Liver toxicity (esp Peds)

Pancreatitis

Thrombocytopenia

Teratogenicity

24

Topiramate

1st line Focal, General, Lennox Gastaut

Also for **weight loss**

Na+ channel

25

Topiramate Warnings

Angle Closure Glaucoma

Hyperthermia, lack of sweating

Metabolic acidosis

Suicidal ideation

SJS

Cleft palate if used during pregnancy

26

Topiramate ADRs

Somnolence

Ataxia (loss control body movements)

Speech / Psychomotor / Memory

Vision changes

27

Topiramate Drug Interactions

P450, 3A4, 2C19

Topiramate concentration decreased by:
Valproic Acid
Phenytoin
Carbamazepine
Lamotigrine

*possible decrease in OCP efficacy*

28

Ethosuxamide (Zarontin)

Absence Seizures

Ca+ channel blocker

ADRs
GI: N/V/D, abdo pain, decreased appetite
CNS: drowsy, dizzy, headache,

*pink-brown urine*

29

Ethosuxamide (Zarontin), serious ADRs

Liver, kidney, hemo problems

SLE

SJS

Neuropsych

30

Phenytoin (Dilantin)

1st line Focal, GCT

Slows Na+ recovery

Very tight dosing, clearance decreases as dose increases

Interacts with all the drugs

31

Phenytoin common ADRs

Sedation
Dizziness
Headache

Impaired cognition / Confusion
Slurred speech
Decreased coordination
Nystagmus

32

Phenytoin serious ADRs

Osteomalacia (long term)
Lymphadenopathy
Dermatitis (SJS, SLE)

33

Phenobarbital

Barbituate

Prolongs GABA

Use limited by side effects and drug interactions
- 1st line alternative for Status

- short term sedative

34

Phenobarbital Warnings

Addictive

Hyperalgesia (increased sensitivity to pain)

Respiratory depression

35

Phenobarb drug interactions

**induces hepatic microsomal enzymes**

Decreases anticoagulant activity

Enhances metabolism of exogenous steroids

*Doxycycline - reduces half life, even 2 weeks after pheno DC'd*

*Decreases OCP efficacy*

CNS depressants ++

36

Phenobarbital ADRs

CNS depressant:
- decreased cognition
- resp depress
- brady
- fatigue

- ED / libido

- Anemia
- Bone loss
- Rash

37

Primidone

Barbituate - metabolized to phenobarbital in liver

38

Benzodiazepines

More GABA (more stop)

Clonazepam (Klonopin) - Lennox Gastaut

Diazepam (Valium) - Status

Lorazepam (Ativan) - Status

Midazolam (Versed) - Status

39

Gabapentin

Ca++ channel blocker - prevents presynaptic release

Pain control
(allodynia, hyperalgesia, peripheral pain, inflammatory pain)

Used for
peripheral neuropathy
Bipolar

40

Gabapentin, Warnings / ADRs

Warnings
- Pancreatic cancer, possible
- Hypersensitivity

ADRs
- Sedation
- Somnolence
- Dizziness
- Weight Gain

41

Pregabalin (Lyrica)

Son of Gabapentin > better absorbed, faster onset = lower dose and less side effects

diabetic peripheral neuropathy
postherpetic neuralgia
Adjunctive therapy for adult patients with focal seizures
fibromyalgia
neuropathic pain associated with spinal cord injury

42

Pregabalin (Lyrica) ADRs

Dizziness
Somnolence
Weight gain

Angioedema
Peripheral Edema

43

Tiagibine (Gabitril)

More GABA

- 2nd line for Focal Seizures
- Anxiety
- Bruxism
- Migraine
- Neuropathic pain

44

Tiagibine (Gabitril) Warnings / ADRs

Warnings
- new onset seizure in pts without h/o epilepsy

ADRs
- Dizziness
- Cognitive bleh
- Depression

- Aphasia
- Asthenia (weakness)
- Tremor
- Nervousness

45

Vigabatrin (Sabril)

More GABA

NOT REALLY USED BC
CAN CAUSE PERMANENT VISION LOSS