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58 Cards in this Set
- Front
- Back
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What are the First Line meds for Partial Seizure?
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DoC: Carbamazepine
Phenytoin Phenobarbital Primidone |
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What are the meds for Absence/Petit Mal?
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DoC: Ethosuximide
Methsuximide Valproic Acid |
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MoA of Barbiturates? Drugs?
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MoA: Enhances GABA
Dx: Phenobarbital & Primidone |
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MoA of Benzodiazepines? Drugs?
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MoA: Enhances GABA
Dx: Clonazepam, Lorazepam, Diazepam |
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MoA of Valproic Acid?
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Increases GABA by inhibiting enzymes that break down GABA.
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What medications work by inhibiting Na+?
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Carbamazepine
Oxcarbazepine Zonisamide (Zonegran) Topiramate (Topamax) |
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What are the general SE for all seizure medications?
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***B-NAGS
Bone Marrow Suppression Nystagmus Ataxia GI effects Sedation |
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General SE of Barbiturates?
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***BARB
Bone Marrow Suppression Ataxia Rash Respiratory Depression Behavior changes Bradycardia |
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What forms does Phenobarbital come in?
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Tabs
Elixir: protect from light Injection (IV/IM/SC): contains alcohol & propylene glycol |
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What is the rate if IV infusion for Phenobarbital? Monitor?
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<50mg/minute
Monitor: Cardiopulmonary functions, CBC, LFT's |
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What is the target Phenobarbital serum concentration?
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15-40mcg/mL
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What is Mysoline? Dose? Therapeutic range?
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Mysoline (Primidone), is metabolized to phenobarbital.
Max: 2g/day Therapeutic range: 5-12 mcg/mL |
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Benzos' SE?
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CNS depression: sedation, ataxia
Respiratory depression |
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List the different dosage forms for Phenytoin
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Injection: dilute in NS, administer <50mg/min, use an in-line 0.22-5 micro filter
Capsules (ER): Dilatin, Phenytek Infatab: chew tabs Suspension: 125mg/5mL |
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What is the therapeutic range for Phenytoin?
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10-20mcg/L
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Phenytoin starting dose? Max dose?
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Start: 4-5mg up to 18mg/kg QD
Max: 600mg QD |
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What's the maintenance dosing for Phenytoin?
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300mg QD if ER
100mg TID (IR) |
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What happens to Phenytoin levels with a burn victim?
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Phenytoin levels go up since the medication is highly protein/albumin bound
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List 3 medications that need an in-line filter
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***PAP
Phenytoin Amiodarone Paclitaxel |
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What is Cerebyx? Forms?
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Fosphenyoin (Cerebyx) comes in IV/IM
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Dosing for Cerebyx? Storage? Diluted with?
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Load: 15-20mg PE/kg
Maintenance: 4-6 PE/kg QD - Don't exceed rate of 150mg PE/min Refrigerate Mix with NS or D5W |
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SE for Phenytoin/Fosphenytoin
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***ARHOG
Ataxia (uncordinated muscle mvmt) Rash Hisutism Osteomalacia - Vit D deficiency Gingival hyperplasia |
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Contraindications for Fosphenytoin use
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Sinus bradycardia
2nd or 3rd degree AV block |
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What do you monitor when using Phenytoin/Fosphenytoin?
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Blood pressure
Levels: 10 - 20mg/L CBC LFT's If giving IV: ECG Respiratory function |
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Patient counseling for Phenytoin
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Take with food!!!
Susp: shake well Maintain good oral hygiene Susp should not be given with tube feedings. |
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What is Peganone?
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Ethotoin
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Valproic Acid SE?
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***PHAT DETS
Pancreatitis Hepatotoxicity Ammonia = CNS effects Thrombocytopenia Deafness/Tinnitus Encephalopathy Teratogenic SIADH |
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Therapeutic range for Valproic Acid? Is it an inhibitor, substrate or inducer?
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Range: 5 - 100mcg/mL
Inhibitor and Substrate |
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Monitoring parameters for Valproic Acid?
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Valproic Acid levels: 50 - 100mcg/mL
Serum ammonia LFT's CBC PT/PTT |
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What happens to Carbamazepine levels within 2 - 4 weeks?
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Levels drop off because Carbamazepine is an auto-inducer.
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Therapeutic Range for Carbamazepine? Max dose?
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Max: 1200 - 1600mg QDay
Therapeutic range: 4 - 12mcg/mL |
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Contraindications for Carbamazepine
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Hypersensitivity to TCA
Bone marrow suppression Use within 14 days of MAOi |
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Carbamazepine SE?
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Anticholinergic effects
Arrythmias Aplastic anemia Agranulocytosis Hepatotoxic Rash (Steven Johson Syndrome) SIADH Check the eyes |
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Monitoring parameters for Carbamazepine
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CBC
LFT Ophthalmic exam CBZ levels: 4 - 12mcg/mL |
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What is Oxcarbazepine? Therapeutic range?
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Oxcarbazepine (Trileptal)
Therapeutic range: 12 - 30mcg/mL |
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Trileptal SE
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Hyponatremia
Similar to CBZ |
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What is Zarontin? Celontin?
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Zarontin (Ethosuximide)
Celontin (Methsuximide) |
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What is Zonegran? SE?
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Zonisamide (Zonegran), is a carbonic anhydrase inhibitor similar to Topamax.
SE: Stones (kidney), Steven-Johnson's Syndrome (rash), Aplastic anemia |
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MoA Felbatrol? SE?
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FeLbAmate (Felbatrol) inhibits Na+ channels.
SE: Hepatotoxicity & Aplastic Anemia |
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Brands for Gabapentin? Max dose for Neurontin?
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Gabapentin (Neurontin, Horizant)
Max: 3600mg divided TID or QID |
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What is Horizant? Indication? Dose?
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Gabapentin ER used for Restless Leg Syndrome.
Dose: 600mg tabs QDay with food |
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SE for Lyrica.
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***DOVES
Dry mouth Ocular effects Visual effects Edema Somnolence |
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Precautions for Lyrica
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Always taper >1 week, D/C if angioedema.
Myopathy (muscle pain) Elevated CPK |
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Indications for Lyrica
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***>18 yo
Painful diabetic peripheral neuropathy: 50 - 100mg TID Postherpetic neuralgia: Start with 150mg/d divided BID/TID, increase to max of 600mg/d Fibromyalgia: 75 - 225mg BID Adjunctive to partial seizures: see postherpetic neuralgia |
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Dosage forms for Lamictal?
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***ICOX
IR tabs - 25mg, 100mg, 150mg, 200mg Chewable tabs - 2mg, 5mg, 25mg ODT - 25, 50, 100, 200mg XR (only form not for bipolar) - 25, 50, 100, 200mg |
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What are the different Lamictal kits?
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Blue Kit: Patients taking VA will start with 25mg QOD x 2 wks then increase to MD of 100 - 200mg/day
Green Kit: Patients taking inducers will start with 50mg QD x 2 wks then 50mg BID x 2 wks up to 250mg/day Orange Kit: Patients not taking either inhibitors or inducers will start with 25mg QD x 2 wks then 50mg QD x 2 wks then increase up to 375mg/day in divided doses (BID) |
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What's the effect of OCP to Lamictal levels?
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Estrogens decrease levels of Lamictal by 50%
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Dosing for Keppra? SE?
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Levetiracetam (Keppra) (Renal)
Dose: 500mg BID up to 3g/day SE: ***PADS Psychosis, anxiety, depression, somnolence |
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What is Gabitril? Dosing?
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Tiagabine (Gabitril) is a 3A4 substrate.
Dose has to be titrated and needs to be taken WITH FOOD. |
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Topamax dose with CrCl <70mL/min? Max dose?
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CrCl <70mL/min, 1/2 the dose.
Max: 200mg BID |
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Topamax SE?
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Weight loss
Nephrolithiasis Hyperthermia Metabolic acidosis (Li+ decreases serum bicarbonate concentrations) which leads to kidney stone formation |
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Patient counseling for Topamax
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Drink plenty of fluid
Don't break tabs. |
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What is Vimpat? Age? Initial and max dosing?
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Lacosamide (Vimpat) is for patients >17 yo.
Initial: 50mg BID Max: 200mg BID |
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Points to remember with Lacosamide?
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Lacosamide (Vimpat)
AV block (ECG) IV/PO V - controlled subs |
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What is Banzel? Dosing? Age?
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Rufinamide (Banzel) is an CYP3A4 inducer and substrate.
Max: 3200 mg/d divided BID taken WITH FOOD Age: >4 yo |
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What is Sabril? Max? SE?
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Vigabatrin (Sabril) is last line for infantile spasms
Max: 3g/day SE: loss of vision |
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Sabril dosing for renal patients?
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CrCl 50 - 80mL/min, decrease by 25%
CrCl 30 - 50mL/min, decrease by 50% CrCl 10 - 29mL/min, decrease by 75% |
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List some drugs which only qualified physicians can prescribe
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Sabril (Vigabatrin)
Tikosyn (arrythmia) Tysabri (Natalizumab) (MS) Lotronex (alosetron) |
