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30 Cards in this Set
- Front
- Back
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1st generation AED
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Barbiturates & Hydantoins
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2nd generation AED
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Carbamazepine, Valproate, Bezodiasepines
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3rd generation AED
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Ion channels, GABA, Glu
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Amygdala Kindling
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Chronic stimulation of the limbic system (@amygdala) produces features comparable to temporal lobe epilepsy --> complex focal seizures & generalized T/C seizures
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MOA: Fast inactivation of Na channel
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phenytoin
fosphophenytoin carbamazepine oxcarbasepine lamotrigine |
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MOA: Slow inactivation of Na channel
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lacosamid
rufinamide |
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MOA: N&L type Ca channel blocker (focal seizures)
High voltage |
gagapentin
pregbalin valproate topiramate |
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MOA: T-type Ca channel blocker (absence seizure)
Low voltage |
ethosuximide
valproate zonisamide |
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MOA: K channel blockers (slow-gated) (focal seizures)*
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ezogabine
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MONOTHERAPY: FOCAL SEIZURE (4)
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phenytoin
oxcarbazepine carbamazepine topiramate PH-O-C-T |
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MONOTHERAPY: GENERALIZED T/C SEIZURE
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topiramate
valproate T/V ALSO -phenytoin & carbamazepine (may exacerbate absence & myoclonic seizure) -lamotrigine (may exacerbate myoclonic or generalized seizure) |
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MONOTHERAPY: ABSENCE
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ethosuximide
valproate |
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MONOTHERAPY: MYOCLONIC
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valproate
levetiracetam clonazepam |
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MONOTHERAPY: LENNOX-GASTAUTE SYNDROME
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lamotrigine
rufinamide valproate topiramate felbamate clonazepam LA rufies val top fel clones |
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Status Epilepticus
1st line 2nd line 3rd line Last line |
1 = Benzodiazepines (diazepam: valium or lorazepam)
2 = Hydantoins (phenytoin/fosphenytoin/valproate) 3 = Barbiturates (phenobarbitol) Final = IV anes + barbiturates (phenobarbitol/pentobarb) |
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Principles of Adverse Effects of AEDs
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CNS effects are most common
Acute, DOSE RELATED --> reversible |
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Acute, Dose related ADR: neuro/psychiatric
MOOD & BEHAVIORAL CHANGE (decreased concentration) REVERSIBLE |
levatiracetam
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Acute, DOSE RELATED ADR: weight loss
REVERSIBLE |
topiramate
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Idiosyncratic ADR: Stevens-Johnson Syndrome
Rare, uncommon, potentially serious or life-threatening Blisters/erosions of skin (palms & soles)/fevers |
HIGH RISK = lamotrigine + valproate
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Chronic ADR : CT defects --> Gingival hyperplasia / facial coursing/ hirsutism
Reversible and serious |
barbiturates & phenytoin
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Drug Metabolism Drug INTERACTION:
Displacement of AED in plasma membrane by another AED --> causes increase in FREE/ACTIVE dose --> therapeutic effect at lower dose |
phenytoin + valproate
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3 principal hepatic enzymes
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CYP 2C9
CYP 2C1 CYP 3A3 |
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principal cytochrome enzyme for SEs
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CYT P450
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negligible or NO effect AEDs
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gabapentin
levetriacetam |
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ENHANCE GABA ACTIVITY (7)
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barbiturates
benzodiazepines topiramate tigabine vigabatrin felbamate zonisamide barbies, benzos, top down, tiga, viga, felbamate, zonisamide |
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INHIBIT GLUTAMATE ACTIVITY (13)
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felbamate, topiramate, zonisamide
gabapentin, pregabalin lacosamide, lamotrigine, levitiracetam rufinimide valproate phenytoin, carbamazepine, oxcarbazepine |
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Chronic Teratogenic ADR: Neural tube defect (in early development)
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valproate
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Chronic Teratogenic ADR: Cleft palate (if late in development)
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topiramate
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Effect of AED INHIBITORS on drug metabolism
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decrease clearance & increase steady-state concentration of drug
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Effect of AED INDUCERS on drug metabolism
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increase clearance & decrease steady-state concentration of other drugs
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