neuro Flashcards
(23 cards)
Which Anti-Epileptics Have a Black Box Warning for Life-Threatening Rash (Stevens-Johnson Syndrome - SJS)?
Lamotrigine (has a black box warning for life-threatening rashes, including SJS and toxic epidermal necrolysis).
Carbamazepine (especially in patients with the HLA-B*1502 allele, commonly found in Asian populations).
Common Side Effects of Specific Anti-Epileptics:
Phenytoin: Gingival hyperplasia, dizziness, ataxia, cognitive issues, osteoporosis (decreases Vitamin D), rash.
Topiramate: Weight loss, cognitive issues (“dopamax” effect), kidney stones, fatigue, somnolence.
Gabapentin: Weight gain, sedation, dizziness, ataxia, peripheral edema.hu
Mechanism of Action (MOA) for phenytoin
Phenytoin: Sodium channel blocker, stabilizes neuronal membranes by decreasing sodium influx.
Populations That Require Therapeutic Drug Monitoring on Anti-Epileptics:
Pregnant women (some AEDs can cause birth defects, and pregnancy alters drug metabolism).
Patients requiring tight therapeutic control (narrow therapeutic index drugs like phenytoin, valproate, and carbamazepine).
Patients with hepatic or renal dysfunction (most AEDs are metabolized in the liver).
First-Line Treatment for Status Epilepticus (Seizure Lasting Longer Than 5 Minutes):
IV Benzodiazepines (e.g., Lorazepam (Ativan), Diazepam (Valium)).
Food or Juice to Avoid in a Patient on Carbamazepine:
Grapefruit juice
Patient with Migraines and High BP Not on Antihypertensives – Possible Cause and Treatment:
Uncontrolled hypertension may be triggering the headaches.
First-line antihypertensives for migraine prevention: Beta-blockers (propranolol, timolol), calcium channel blockers (verapamil), ACE inhibitors (lisinopril), or ARBs (candesartan)
When to Consult Neurology for Migraines:
If a patient has more than 2 migraines per week.
If OTC medications or triptans are not effective.
Education for Starting a Patient on Triptans for Migraines
Take at the onset of the migraine.
Limit use to no more than 2 doses per 24 hours.
Contraindicated in CAD and uncontrolled hypertension.
Monitor for serotonin syndrome if on SSRIs.
Patient on Sumatriptan Gets Only 3 Hours of Relief – Next Step?
Switch to a longer-acting triptan (e.g., naratriptan, frovatriptan).
Patient Has Migraines and CAD – What Medication Should Be Avoided?
Triptans (due to vasoconstriction, which can worsen CAD).
Common Side Effects of Anti-Epileptics in Patients of All Ages:
Sedation, dizziness, ataxia, cognitive slowing, GI upset, osteoporosis, mood changes, rash, weight gain.
Common Adverse Reactions of Triptans:
Chest tightness, flushing, dizziness, nausea, tingling, paresthesias.
Drugs That Enhance Inhibition of GABA (Increase GABA Activity):
gabapentin, topiramate, benzo, barbituates, vigabatrin
How Do Anti-Epileptics Affect Weight?
Most cause weight gain.
Exception: Topiramate and Zonisamide (cause weight loss).
Anti-Epileptic That Commonly Causes Hirsutism:
Phenytoin
Anti-Convulsants That Are Sodium Channel Inhibitors:
Phenytoin, Carbamazepine, Lamotrigine, Rufinamide, Zonisamide.
Medications Commonly Prescribed for Migraine Prevention
Beta-blockers (propranolol, timolol)
Antidepressants (amitriptyline, venlafaxine)
Anti-epileptics (valproic acid, topiramate)
CGRP antagonists (erenumab, fremanezumab)
ACE inhibitors/ARBs (lisinopril, candesartan).
- Common Side Effects of Tricyclic Antidepressants (TCAs)
Drowsiness, dry mouth, weight gain, constipation, orthostatic hypotension.
What Type of Patient Should Avoid Tricyclic Antidepressants
Patients with cardiovascular disease (due to risk of arrhythmias, tachycardia, QT prolongation).
MOA for benzos
Benzodiazepines: Enhance GABA activity, increasing neuronal inhibition and reducing excitability.
MOA for valproic acid
Obstructing entry of sodium ions into neurons, blockage of calcium channels
MOA for triptans
Triptans: Serotonin (5-HT1B/1D) receptor agonists, causing vasoconstriction and reducing neurogenic inflammation.
