Antiepileptic Drugs Flashcards by michelle anne

Cause fewer cognitive impairments (2)

Gabapentin and Lamotrigine

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May cause substantial cognitive impairments esp. when given at high or rapid doses

Topiramate

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Most widely used AEDs (4)

Carbamazepine, Phenobarbital, Phenytoin, Valproic Acid

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Superior to valproic acid for efficacy in the treatment of
partial seizures

Carbamazepine

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Newer generation agents (3)

Lamotrigine, Oxcarbazepine, Topiramate

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Received FDA approval for use as monotherapy in patients
with partial seizures (3)

Lamotrigine, Oxcarbazepine, Topiramate

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Lamotrigine, Oxcarbazepine, Topiramate are FDA approved as _____________

monotherapy in patients
with partial seizures

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traditional treatment for Tonic-Clonic Seizures

Phenytoin

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increasingly used due
to lower incidences of side effects and with equal efficacy compared to phenytoin in treating Tonic-Clonic Seizures (2)

Carbamazepine and Valproic acid

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Generally considered the drug of first choice for atonic seizures and for juvenile myoclonic epilepsy
(JME)

Valproic acid

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FDA-approved as adjunctive treatment of myoclonic seizures in patients with JME

Levetiracetam

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Alternative agents (3)

Lamotrigine, Topiramate, Zonisamide

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Levetiracetam is FDA-approved as _________

adjunctive treatment of myoclonic seizures in patients with JME

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viewed as a tool with which to optimize therapy for an individual patient not as a therapeutic endpoint in itself

Serum concentrations of the older AEDs

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Serum concentration is a target that should be correlated with ______

clinical response

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First-line therapy for patients with newly diagnosed partial seizures and for patients with primary generalized convulsive seizures

Carbamazepine

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Associated with a 1% risk of spina bifida when ingested during
the first trimester of pregnancy

Carbamazepine

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congenital disability condition which affects the spine as a type of neural tube defect; can happen anywhere along the spine if the neural tube does not close entirely in the membranes of the spinal cord

spina bifida

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Most Common Adverse Effects include neurosensory side effects (diplopia, blurred vision, nystagmus, ataxia, unsteadiness, dizziness and headache); seen in 35%
to 50% of px

Carbamazepine

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Most Common Adverse Effects include Hematologic side effect (leukopenia - 10% incidence)

Carbamazepine

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double vision

diplopia

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rapid or uncontrollable eye movement

nystagmus

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loss of muscle control or coordination

ataxia

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Drug Interactions of Carbamazepine are _________

very significant

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Drugs that inhibit CYP3A4 potentially may increase this AED's serum concentrations

Carbamazepine

Second-line agent for patients with partial seizures who have failed initial treatment

Gabapentin

Shown to be useful for chronic pain and other non-epileptic conditions

Gabapentin

we can also find benefits in this AED for px with less severe seizure disorders in the elderly

Gabapentin

Minimal CNS adverse effects and few drug interactions due to broad therapeutic index

Gabapentin

CNS adverse effects include ataxia, somnolence, dizziness and fatigue

Gabapentin

T/F Drug Interactions are not likely to occur in Gabapentin since this drug does not induce or inhibit liver enzymes

Gabapentin therapeutic index makes it a (safer/less safer) option

safer

Useful as both monotherapy and adjunctive treatment in patients with partial seizures

Lamotrigine

Useful alternative for primary generalized seizure types

Lamotrigine

Adjunctive therapy for primary GTC seizures

Lamotrigine

as monotherapy, it has comparable efficacy with more traditional AEDs such as carbamazepine and phenytoin

Lamotrigine

Most frequently reported A/E: diplopia, drowsiness, ataxia, headaches

Lamotrigine

A/E are more common when given in combination with other AEDs

Lamotrigine

observed more in carbamazepine + lamotrigine

diplopia

manifested more in lamotrigine + valproic acid

tremors

diplopia is common in the combination of ____________

carbamazepine + lamotrigine

tremors is common in the combination of ____________

lamotrigine + valproic acid

Drug has Low potential for pharmacokinetic drug interactions and Do not induce or inhibit liver enzymes

Lamotrigine

Indicated for patients with partial seizures who have failed initial therapy

Levetiracetam

Approved for adjunctive treatment of myoclonic seizures in patients with JME

Levetiracetam

Adjunctive treatment of primarily generalized seizures in patients with idiopathic generalized epilepsy

Levetiracetam

Adverse Effects of this AED Appears to be modest

Levetiracetam

Most common CNS effects (sedation, fatigue, and coordination difficulties)

Levetiracetam

drug Does not induce or inhibit liver enzymes and does not appear to interact with other AEDs, warfarin, digoxin, or oral contraceptive drugs

Levetiracetam

T/F Oxcarbazepine is indicated for use as monotherapy

Adjunctive therapy in the treatment of partial seizures in adults and children as young as four years of age

Oxcarbazepine

Potential first-line drug for patients with primary generalized convulsive seizures

Oxcarbazepine

May also be effective in patients not demonstrating a response to carbamazepine

Oxcarbazepine

fewer S/E than phenytoin, carbamazepine, and valproic acid

Oxcarbazepine

Most frequently reported S/E: dizziness, nausea, headache, diarrhea, vomiting, URTI, constipation, dyspepsia, ataxia, and nervousness

Oxcarbazepine

Decreases the bioavailability and pharmacologic activity of ethinyl estradiol and levonorgestrel

Oxcarbazepine

ethinyl estradiol and levonorgestrel drug class

oral contraceptives

Drug of choice for neonatal seizures

Phenobarbital

Reserved for patients who have failed therapy with other AEDs

Phenobarbital

May be useful given IV in refractory status epilepticus

Phenobarbital

life-threatening condition when seizures persist despite administration of both 1st line and 2nd line medications

status epilepticus

advantage: available in Multiple dosage forms available

Phenobarbital

T/F phenytoin is available in oral solid, oral liquid, IM, IV

F - phenobarbital

Most inexpensive AED

Phenobarbital

primary factors limiting the use of phenobarbital

CNS side effects

Adverse Effects: Hyperactivity in children

Phenobarbital

May also cause porphyria and rashes as serious as SJS

Phenobarbital

Potent enzyme inducer (increases elimination of any drug metabolized by CYP450)

Phenobarbital

First-line AED for primary generalized convulsive and partial seizures

Phenytoin

CNS depressant effects (lethargy, fatigue, incoordination, blurred vision, higher cortical dysfunction, and drowsiness)

Phenytoin

adverse effects on CNS are usually transient, can be minimized by slow dosage titration

Phenytoin

T/F if newer AEDs are available, phenytoin would be a lower priority

T/F Phenytoin is Associated with minimal drug interaction

F - numerous drug interaction

drug interactions Involve altered absorption, metabolism, protein binding; May enhance or reduce its effects

Phenytoin

Dosing Must be in mg PE

Phenytoin

dosing unit of phenytoin

mg phenytoin equivalents or PE

75 mg fosphenytoin is equal to ____ mg phenytoin sodium

Second-line agent for patients with partial seizures who have failed initial treatment

Pregabalin

Useful for chronic neuropathic pain and generalized anxiety disorder

Pregabalin

Most frequently reported A/E: dizziness, ataxia, blurred vision, and weight gain

Pregabalin

Drug Interactions are Unlikely to happen, predominantly excreted unchanged in the urine and undergoes negligible metabolism

Pregabalin

First-line AED for partial seizures as an adjunct and/or monotherapy

Topiramate

Approved for the treatment of tonic-clonic seizures in primary generalized epilepsy

Topiramate

T/F most A/Es occur irregardless of how topiramate is administered; whether in high doses or rapid titration

Slow dosage titration and increments (increments must be assessed in 1 to 2 weeks)

Topiramate

Main: ataxia, impaired concentration, memory difficulties, attentional deficits, fatigue, paresthesia, somnolence, and “thinking abnormally” which rarely has included psychosis

Topiramate

Cognitive dysfunctions in concomitant therapy with topiramate, valproic acid, or phenobarbital

Topiramate

Cognitive dysfunctions from Topiramate arise in concomitant therapy with _________, __________, or ________

topiramate, valproic acid, phenobarbital

First-line therapy for primary generalized seizures including myoclonic, atonic, and absence seizures