Epilepsy Flashcards
(28 cards)
DOC: Partial Simple Seizure
- Phenytoin
- Carbamazepine
DOC: Partial Complex Seisure
- Phenytoin
- Carbamazepine
DOC: Generalized Tonic Clonic Seizure
- Phenytoin
- Carbamazepine [TQ]
DOC: Generalized Absence Seizure
-Ethosuximide
DOC: Generalized Myoclonic Seizure
-Carbamazepine
DOC: Status Epilepticus
-Phenytoin + Diazepam
Phenytoin
1st Generation AED
- MOA: decreases Na and Ca ions, reducing propagation of abnormal impulses in brain
- Uses: partial seizures, tonic/clonic seizures, SE
- ADRs: CNS depression, GI, gingival hyperplasia, megaloblastic anemia
- DO NOT TREAT ABSENCE SEIZURES [TQ]
Fosphenytoin
1st Generation AED
- MOA: prodrug for phenytoin [TQ], IV only
- Pros: faster, reduced ADRs
- Cons: 5 day max use
Carbamazepine
1st Generation AED
- MOA: blocks Na channels
- Uses: partial seizures, tonic/clonic seizures, trigeminal neuralgia
- ADRs: stupor, coma, respiratory depression, aplastic anemia
- Autoinduction, takes 3-5 weeks [TQ]
Ethosuximide
1st Generation AED
- MOA: reduces threshold for Ca currents in thalamic neurons
- Uses: absence seisuzes
- ADRs: N/V, anorexia, drowsiness
Phenobarbital
1st Generation AED
- MOA: barbituate, enhanced GABA inhibition, increasing seizure threshold
- Uses: partial seizures, tonic/clonic seizures
- ADRs: sedation, nystagmus, megaloblastic anemia, osteomalacia
- Interactions: warfarin, valproic acid, phenytoin
- Primidone/Mysoline: metabolized to phenobarbital
Valproic Acid
1st Generation AED
- MOA: elevated levels of GABA, effects Na channels
- Uses: absence seizures, partial and generalized seizures
- ADRs: N/V, sedation, ataxia
- Interactions: phenobarbital, phenytoin
Benzodiazepines
1st Generation AED
- MOA: enhances GABA transmission
- Uses: rapid/temporary SE seizures termination, adjunctive for all seizures
- ADRs: drowsiness, lethargy, CNS depression (narcotics, TCAs)
- Drugs: diazepam, lorazepam, midazolam, clonazepam
- Acute toxicity is low vs. dosage
Felbamate
2nd Generation AED
- MOA: GABA
- Uses: 3rd line partial seizures, 2nd line Lennox-Gastaut
- ADRs: 2 black box warnings (aplastic anemia, hepatic failure), insomnia, dizziness
Gabapentin
2nd Generation AED
- MOA: GABA agonist
- Properties: anticonvulsant, anxiolytic, neuroprotectant
- Uses: adjunct partial seizures, neuropathic pain, psych disorders
- ADRs: somnolence, dizziness, ataxia
Lamotrigine
2nd Generation AED
- MOA: blocks Na channels
- Uses: adjunct partial and generalized seizures, bipolar
- ADRs: rash (black box), dizziness, ataxia
- Interactions valproic acid, carbamazepine, phenytoin, phenobarbital
Levetiracetam
2nd Generation AED
- MOA: derivative of piracetam (improves cognition), similar to gabapentin
- Uses: adjunct in partial and generalized seizures
- ADRs: somnolence, psychosis, agitation
- RDA for renal dysfunction
Oxcarbazepine
2nd Generation AED
- MOA: blocks Na channels
- Uses: adjunct partial seizures
- ADRs: hyponatremia, ataxia, HA, less than carbamazepine
- Prodrug and carbamazepine analogue [TQ]
Pregabalin
2nd Generation AED
- MOA: binds Ca channels, inhibits excitatory neurotransmitter release
- Uses: peripheral neuropathies, fibromyalgia, adjunct partial seizures (decreases frequency)
- ADRs: somnolence, dizziness, dry mouth, weight gain
- RDA and taper upon withdrawal
Tiagabine
2nd Generation AED
- MOA: GABA mediated
- Uses: adjunct partial seizures, infantile spasm, psych disorders
- ADRs: CNS, abdominal pain
- Interactions: does NOT interact with hepatic enzymes
Topiramate
2nd Generation AED
- MOA: blocks Na, enhances GABA
- Uses: adjunct partial and generalized seizures
- ADRs: CNS, weight loss, nephrolithiasis
- Interactions: phenytoin, VPA, birth control
Zonisamide
2nd Generation AED
- MOA: Blocks Na and Ca channels
- Uses: adjunct partial seizures, Lennox-Gestaut, not for kids
- ADRs: dizziness, oligohydrosis, not for sulfa allergies
- Interactions: carbamazepine, phenybarbitol, valproic acid
Vigabiran
2nd Generation AED
- MOA: analog to GABA
- Uses: DOC for infantile spasms
- ADRs: psychoses, irreversible vision damage
- Interactions: phenytoin
- Restricted distribution (SHARE) program
Drugs that block Na channels:
- Phenytoin
- Carbamazepine
- Oxcarbazepine
- Lamotrigine
- Topiramate
- Zonisamide
- Felbamate
- Valproic Acid
COLT PFVZ