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Anticonvulsants Flashcards

(58 cards)

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1
Q

Lamotrigine (Lamictal) Dosing

A

Normal:
25mg QD x14, 50mg QD x14, 100mg QD x7, 200mg QD
Inducer:
50mg QD x14, 100mg QD x14, 200mg QD x7, 400mg QD
Inhibitor:
25mg QOD x14, 25mg QD x14, 50mg QD x7, 100mg QD

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2
Q

Lamotrigine (Lamictal) Adverse Effects

A

Stevens-Johnson Syndrome

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3
Q

Lamotrigine (Lamictal) Monitoring/Clinical

A

OC interaction: decrease effectiveness of OC’s and decrease lamotrigine conc.

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4
Q

Levetiracetam (Keppra) Dosing

A

Renal dosing adjustment needed

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5
Q

Levetiracetam (Keppra) Adverse Effects

A

Behavioral abnormalities, psychosis, suicidal thoughts/behaviors, unusual mood changes or worsening of depression - most commonly in younger patients

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6
Q

Valproate (Depakote, Depakene, Depacon) Dosing

A

Monitor serum concentrations: 50-125 mcg/ml

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7
Q

Valproate (Depakote, Depakene, Depacon) Adverse Effects

A

Hyperammonemia, thrombocytopenia, N/V, weight gain, alopecia, PCOS

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8
Q

Valproate (Depakote, Depakene, Depacon) Monitoring/Clinical

A

Pregnancy D

Monitor: CBC with platelets, LFTs, serum conc.

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9
Q

Zonisamide (Zonegran) Adverse Effects

A

CI’d in sulfa hypersensitivity, metabolic acidosis, renal calculi

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10
Q

Zonisamide (Zonegran) Monitoring/Clinical

A

Metabolized via glucuronidation (UDP-GT)

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11
Q

Clobazam (Onfi) C-IV Adverse Effects

A

Withdrawal symptoms

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12
Q

Clobazam (Onfi) C-IV Monitoring/Clinical

A

3A4 substrate (major), inducer (weak), may decrease efficacy of oral contraceptives

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13
Q

Clonazepam (Klonopin) C-IV Adverse Effects

A

Anterograde amnesia, paradoxical reactions, withdrawal symptoms

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14
Q

Clonazepam (Klonopin) C-IV Monitoring/Clinical

A

3A4 substrate (major), Pregnancy D

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15
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Dosing

A

Monitor serum concentrations: 4-12 mcg/ml

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16
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Adverse Effects

A

Boxed warning: Stevens-Johnson Syndrome (Asians who are HLA-B1502 +), DRESS (Northern European HLA-A3101 +), aplastic anemia, hyponatremia

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17
Q

Carbamazepine (Tegretol, Carbatrol, Epitol) Monitoring/Clinical

A

Pregnancy D, 3A4 substrate (major), strong inducers of 1A3, 2B6, 2C8, 2C9, 2C19, 3A4
Monitoring: CBC with platelets, electrolytes, may autoinduce own metabolism for several weeks after initiation and dose increases

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18
Q

Eslicarbazepine Acetate (Aptiom) Adverse Effects

A

Stevens-Johnson Syndrome, hyponatremia, same HLA-B/HLA-A as carbamazepine

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19
Q

Eslicarbazepine Acetate (Aptiom) Monitoring/Clinical

A

Rapidly metabolized to active metabolite eslicarbazepine, active metabolite of oxcarbazepine, 2C19 inhibitor (moderate)
Monitoring: electrolytes

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20
Q

Ezobagine (Potiga) C-V Dosing

A

Renal dosing: CrCl less than 50ml/min: 600mg

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21
Q

Ezobagine (Potiga) C-V Adverse Effects

A

Boxed warning: retinal abnormalities, may progress to vision loss
Warnings: urinary retention, grey-blue/brown skin discoloration (sign of toxicity), QTc prolongation, memory impairment, hallucinations

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22
Q

Ezobagine (Potiga) C-V Monitoring/Clinical

A

Baseline ophthalmic exam, repeat every 6 months

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23
Q

Felbamate (Felbatol) Adverse Effects

A

Boxed warning: aplastic anemia, hepatic failure

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24
Q

Felbamate (Felbatol) Monitoring/Clinical

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A

MUST monitor LFT’s at baseline and frequently after, D/C if evidence of bone marrow suppression

25
Gabapentin (Nuerontin, Gralise, Fanatrex) Dosing
Renal dosing: CrCl 30-60 ml/min: 600-1800 mg/day | Not recommended CrCl less than 30 ml/min
26
Gabapentin (Nuerontin, Gralise, Fanatrex) Adverse Effects
Somnolence, peripheral edema
27
Gabapentin (Nuerontin, Gralise, Fanatrex) Monitoring/Clinical
Renal clearance: 100% | Monitor renal function at baseline and routinely
28
Lacosamide (Vimpat) Adverse Effects
Use with caution in patients with cardiac conduction abnormalities, prolongs PR interval, dermatological reactions, visual disturbances, idiosyncratic reactions: hepatic impairment, 1st degree AV block
29
Lacosamide (Vimpat) Monitoring/Clinical
2C19 substrate and inhibitor (major)
30
Oxcarbazepine (Trileptal, Oxtellar) Dosing
Oxcarbazepine is 1.5 times the dose of carbamazepine if converting
31
Oxcarbazepine (Trileptal, Oxtellar) Adverse Effects
Same HLA-B/HLA-A as carbamazepine, hyponatremia
32
Oxcarbazepine (Trileptal, Oxtellar) Monitoring/Clinical
3A4/5 substrate/inducer (major/strong), 2C19 inhibitor (moderate) Monitoring: electrolytes
33
Perampanel (Fycompa) C-III Adverse Effects
Boxed warning: dose-related serious and/or life threatening neuropsychiatric events, use with caution in patients with pre-existing behavioral problems or psychosis, gait disturbances, somnolence
34
Perampanel (Fycompa) C-III Monitoring/Clinical
3A4/5 substrate (major)
35
Phenobarbital C-IV Dosing
Monitor serum concentrations 15-40 mcg/ml
36
Phenobarbital C-IV Adverse Effects
Somnolence, confusion, cognitive impairment, impaired calcium metabolism
37
Phenobarbital C-IV Monitoring/Clinical
Pregnancy D, 2C9 substrate (major), 1A2, 2C, 3A, and UGT inducer (strong)
38
Phenytoin (Dilantin) Dosing | Fosphenytoin (Cerebyx) Dosing
Monitor serum concentrations 10-20 mpg/ml (phenytoin), conversion from fosphenytoin to phenytoin occurs 0.5-1 hour post-dose
39
Phenytoin (Dilantin) Adverse Effects | Fosphenytoin (Cerebyx) Adverse Effects
Fospheytoin IV: hypotension, arrhythmias Phenytoin IV: arrhythmias, hypotension, purple glove syndrome CI'd with sinus bradycardia or 2nd/3rd degree heart block Decreased BMD, dermatological reactions, nystagmus, ataxia, double vision, hepatotoxicity, hirsutism, gingival hyperplasia, cardiac arrhythmias, Stevens-Johnson Syndrome, alteration of Vit D metabolism, osteoporosis
40
Phenytoin (Dilantin) Monitoring/Clinical | Fosphenytoin (Cerebyx) Monitoring/Clinical
Pregnancy D, 2C9/2C19 substrate (major), 1A2, 2C19, 3A4, and UGT inducer (strong), serum conc (obtain albumin with same blood draw)
41
Pregabalin (Lyrica) C-V Dosing
Renal dosing adjustment needed
42
Pregabalin (Lyrica) C-V Adverse Effects
Angioedema, peripheral edema, PR interval prolongation
43
Pregabalin (Lyrica) C-V Monitoring/Clinical
Renal clearance 100%
44
Primidone (Mysoline) Adverse Effects
Metabolized to phenobarbital, same side effects as phenobarbital
45
Primidone (Mysoline) Monitoring/Clinical
Pregnancy D
46
Rufinamide (Banzel) Dosing
Indicated for Lennox-Gastaut Refractory Seizures
47
Rufinamide (Banzel) Adverse Effects
CI'd if familial short QT syndrome | DRESS, Stevens-Johnson Syndrome
48
Tiagabine (Gabitril) Dosing
Special dosing for concomitant enzyme inducing drugs and concomitant valproate therapy Monitor serum concentrations 0.02-0.2 mcg/ml
49
Tiagabine (Gabitril) Adverse Effects
Use with caution off-label for patient without seizure disorder and with hectic disease - may trigger seizures, cognitive impairment
50
Tiagabine (Gabitril) Monitoring/Clinical
3A4 substrate (major)
51
Topiramate (Topamax) Dosing
50% reduced dose with CrCl less than 70 ml/min
52
Topiramate (Topamax) Adverse Effects
Use with caution in patients with nephrolithiasis, renal impairment, hepatic disease CNS depression, metabolic acidosis, oligohydrosis/hyperthermia, acute myopia, secondary angle-closure glaucoma, nephrolithiasis, visual field defects, cognitive impairment, hyperchloremic non-anion gap metabolic acidosis
53
Topiramate (Topamax) Monitoring/Clinical
Pregnancy D, 2C19 inhibitor (moderate), 3A4 substrate/inducer (moderate-strong, dose dependent) Monitoring: basic metabolic profile, urinalysis every 3-6 months
54
Vigabatrin (Sabril) Dosing
Indicated for Refractory Seizures, dosing needs renally adjusted
55
Vigabatrin (Sabril) Adverse Effects
CI'd in patients with other risk factors for irreversible vision loss Boxed warning for vision loss Peripheral neuropathy, depression, weight gain, insomnia, permanent loss of peripheral vision
56
Vigabatrin (Sabril) Monitoring/Clinical
SCr, vision assessment at baseline and every 3-6 months
57
Ethosuximide (Zarontin) Dosing
Indicated for Absence Seizures
58
Ethosuximide (Zarontin) Adverse Effects
Avoid in renal/hepatic dysfunction, SLE, Stevens-Johnson Syndrome, leukopenia, eosinophilia, psychiatric and sleep disturbances, aggression, hiccups

Therapeutics (7 decks)

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