Seizures: Part 2 (Drugs) Flashcards
(27 cards)
Lamotrigine (Lamictal)
BBW:
-Serious skin rxn (SJS/TEN)
Warning:
-DRESS, aseptic/viral meningitis, blood dyscrasia, cardiac rhythm abnormalities, HLH (immune rxn)
AE:
-Alopecia (supplement biotin/zinc/selenium)
-Ataxia
If d/c for 5+ more half lives = restart initial dosing titration (usually 6+ days)
= LAM ABC SHAM 5
Valproic acid and Lamotrigine
Valproic acid can INCREASE lamotrigine concentrations more than two-fold
Use lower dose starter kit (blue box)
Lamotrigine: Starter Kits By Color
Blue
-Lower starting dose
-Use if taking valproic acid (enzyme inhibitor)
Orange
-Standard starting dose
-Use if no interacting meds
Green
-High starting dose
-Use if taking inducer (carbamazepine, phenytoin, phenobarbital, primidone) and NOT taking valproic acid
Levetiracetam (Keppra)
Warnings:
-Psychiatric reactions (psychotic syndrome, somnolence, fatigue, aggression, anxiety, suicide)
-SJS/TEN/DRESS
-Anemias
IV to PO ration is 1:1
NO significant drug interactions
KEPPRA SNAPs
Topiramate (Topamax)
CrCl < 70: decrease dose by 50%
Warnings: MF NO TOP or VAG x70
-Metabolic acidosis
-Oligohidrosis (reduced perspiration/hyperthermia)
-Nephrolithiasis (kidney stones)
-Angle closure glaucoma
-Hyperammonemia
-Visual problems
-FETAL HARM
AE:
-Memory/concentration/attention issues
-Weight loss/anorexia
Monitor:
-Electrolytes (BICARB), eye (IOP), renal, hydration
MF NO TOP or VAG x70
Trokendi XR Contraindication
alcohol use 6 hours before or after dose
Qudexy XR Contraindication
patients with metabolic acidosis who are taking metformin
Valproic Acid and Divalproex (Depakote)
Divalproex is a valproic acid derivative
BBW:
-Hepatic failure (monitor LFTs frequently in the first 6mo)
-Fetal harm (neural tube defects and dec IQ scores)
-Pancreatitis
Warnings:
-Hyperammonia (tx with carnitine in adults)
-Thrombocytopenia (dose related)
-DRESS
AE:
-Alopecia (supplement BSZ)
-NV, weight changes (gain > loss)
-Somnolence, tremor
VAL = PH FAT (and fat for wt gain > loss)
Lacosamide (Vimpat)
CONTROL V MED
Warnings:
-Prolongs PR interval
-Arrhythmias risk
-DRESS
loco need 5 PADs
Carbamazepine (Tegretol)
Range 4-12 mcg/ml
BBW:
-SJS/TEN
-HLA-B*1502 ALLELE testing is required for Asian descent pts (if + cannot be used)
-Aplastic anemia, agranulocytosis
CI: myelosuppression
Warnings:
-Hyponatremia (SIADH)
-Fetal harm
**CARB = MF HASAN eat CARBs **
REMEMBER N is for low NA bc CARBS ARE SALTY (GO BACK TO MOA - BLOCKS NA CH)
Carbamazepine (Tegretol): PK
Enzyme inducer and autoinducer
-can decrease levels of other drugs and itself
HLA-B*1502 Positive
DONT USE
-Carbamzepine (Tegretol)
-Phenytoin (Dilantin) and Fosphenytoin (Cerebyx)
Oxcarbazepine (Trileptal)
CI: sensitive to eslicarbazepine
Warnings: same as carb
-SJS/TEN
-HLA-B*1502 (Asian, if + = no use)
-Hypnatremia
CrCl < 30: start 300 mg daily (not BID)
-just this
Carbamazepine to Oxcarbazepine Conversion
Carbamazepine to oxcarbazepine dose
conversion:
1.5x carbamazepine dose
Phenytoin (Dilantin): Thera Range
10-20 mcg/mL (total level)
1-2 mcg/mL (free level)
Phenytoin (Dilantin) and Fosphenytoin (Cerebyx)
BBW:
-IV admin rate (other cards)
Warnings:
-Extravasation (purple glove syndrome)
-Avoid if HLA-B*1502 positive and if had a severe rash with carbamazepine
-Fetal harm
AE:
-Nystagmus (eye movements), ataxia, diplopia (double vision)
-Gingival hyperplasia, hepatotoxicity
PHENY = CHEF PLEG
Phenytoin: BBW + IV
IV admin rate should not exceed 50 mg/min for phenytoin
*if faster: hypotension and arrhythmias can occur
Continuous cardiac and respiratory function monitoring when on IV
Requires FILTER
Dilute in NS, stable 4 hours, do not put in fridge
Fosphenytoin: BBW + IV
IV admin rate should not exceed 150 mg PE/min (or 2 mg PE/kg/min)
*if faster: hypotension and arrhythmias can occur
Continuous cardiac and respiratory function monitoring when on IV
Requires FILTER
Dilute in NS, stable 4 hours, do not put in fridge
NG-Tube Phenytoin
Enteral feedings (e.g., tube feeds)
-decrease phenytoin absorption
Hold feedings 1-2 hours before and after administration
Adjusting Phenytoin Dose
Phenytoin: Michaelis-Menten kinetics, also called saturable kinetics
-If enzymes become saturated, a small increase in dose can cause a large increase in drug level
If albumin is LOW < 3.5 and CrCl 10+ = adjust as below
Phenytoin correction = Total phenytoin measured / ( 0.2 x albumin ) + 0.1
FREE LEVELS do not require correction
Use serum phenytoin in mcg/ml and albumin in g/dL
Phenobarbital (Sezaby)
C-IV
Range: 20-40 mcg/ml for adults
Warnings: BARBS get an STD
-Potential for drug dependency (caution in SUD)
-Fetal harm
AE:
-Tolerance
-Residual sedation (hangover effect)
Clobazam: Indication
Lennox-Gastaut syndrome or refractory epilepsy
All other BZDs: stop an actual seizure
Ethosuximide (Zarontin)
Warning:
-SJS/TEN/DRESS
-Blood dyscrasia
Used for ABSENCE seizures
Ethan and Sabrina (ETHO SAB)
Vigabatrin (Sabril, Vigadrone): BBW
BBW
-Permanent vision loss (30% of patients)
