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48 Cards in this Set
- Front
- Back
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Lamotrigine Mechanism of Action |
Inactivates Na+ channel Inhibits presynaptic voltage-gated Ca2+ channels = no excitatory NT release |
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Lamotrigine Indications |
Focal (partial) seizures Generalized tonic-clonic seizures Absence seizures |
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Lamotrigine Side Effects |
Rash - common in children |
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Lamotrigine Drug Interactions |
Decrease half-life: phenytoin, primidone, carbamazepine Increase half-life: valproate |
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Levetiracetam Mechanism of action |
Inhibits Ca2+-dependent excitatory NT release by interfering with vesicle fusion Protein ligand of synaptic vesicle protein 2A (SV2A) |
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Levetiracetam Indications |
Focal (partial) seizures Generalized tonic-clonic seizures
Myoclonic seizures |
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Levetiracetam Side Effects |
Dizziness, somnolence, weakness, serious derm issues Possible behavior changes (especially in pts with a psych condition) |
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Levetiracetam Drug Interactions |
No clinically significant drug-drug interactions |
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Carbamazepine Oxacarbazepine Mechanism of Action |
Inactivates Na channel Potentiates GABA response |
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Carbamazepine Oxacarbazepine Topiramate Indications |
Focal (partial) seizures Generalized tonic-clonic seizures |
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Carbamazepine Metabolism |
Highly bound to proteins Has an active metabolite |
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Carbamazepine Side Effects |
CNS side effects: diplopia, nystagmus, dizziness, ataxia Aplastic anemia, blood dyscrasias Rash (common) - derm issues in Chinese and South Asians |
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Carbamazepine Drug Interactions |
Drugs (cimetidine, propoxyphene, diltiazem, erythromycin, isoniazid, verapamil) inhibit hepatic metabolism = increased toxicity |
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Oxacarbazepine Metabolism/Toxicities/Drug Interactions |
Improved toxicity profile compared to carbamazepine (less induction of hepatic enzymes) |
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Ethosuximide Mechanism of Action |
Inhibits T-type Ca2+ channel activity in thalamic neurons |
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Ethosuximide Indications |
Absence seizures Myoclonic seizures |
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Ethosuximide Metabolism |
Not protein bound Metabolized by microsomal enzymes |
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Ethosuximide Side Effects |
Gastric distress: pain, nausea, vomiting Considered safe |
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Valproic Acid Mechanism of Action |
Inactivates Na+ channel Reduces T-type Ca2+ channel activity Increases GABA by inhibiting GABA-T |
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Valproic Acid Indications |
Complex focal (partial) seizures Generalized tonic-clonic seizures Absence seizures Myoclonic seizures |
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Valproic Acid Metabolism |
Well absorbed Not clear what the active drug is |
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Valproic Acid Side Effects |
Gastric distress: nausea, vomiting, other Little sedation Hepatotoxicity can be severe |
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Benzodiazepines Mechanism of action |
Increase affinity of GABA for GABA-A receptor |
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Benzodiazepines Indications |
Status epilepticus |
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Clonazepam Indications |
Absence seizures Generalized tonic-clonic seizures Myoclonic seizures |
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Benzodiazepines Metabolism |
Well-absorbed Widely distributed Metabolised in liver by microsomal enzymes |
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Benzodiazepines Side Effects |
Sedative Tolerance leads to withdrawal (limits usefulness in treating epilepsy) |
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Phenytoin Mechanism of action |
Inactivates Na+ channel |
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Phenytoin Indications |
Focal (partial) seizures Generalized tonic-clonic seizures Status epilepticus |
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Phenytoin Side Effects |
Arrhythmias with rapid infusion (for status epilepticus) Gingival hyperplasia Hirsutism Rash (5-10%) CNS depression, headache |
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Phenytoid Toxicities |
Acute oral overdose --> loss of balance |
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Gabapentin Mechanism of action |
Block voltage-gated Ca channel subunit --> decrease glutamate release Inhibits GABA-T (at phsyiological concentrations?) |
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Gabapentin Indications |
Focal (partial) seizures w/ or w/o secondary generalizations - adjuvant therapy Generalized tonic-clonic seizures |
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Gabapentin Metabolized |
Not protein bound Not metabolized |
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Gabapentin Drug Interactions |
Interacts with cimetidine and AI/Mg antacids |
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Gabapentin Alternative use |
Used in chronic pain management |
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Vigabatrin Mechanism of action |
Inhibits GABA-T |
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Vigabatrin Indications |
Refractory (to several other AEDs) complex focal (partial) seizures - adjuvant therapy Infantile spasms |
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Vigabatrin Drug Interactions |
Reduces plasma concentrations of primidone |
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Vigabatrin Side effects |
Potentially irreversible concentric visual field defect Drowsiness, dizziness, weight gain |
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Topiramate Mechanism of Action |
Inactivates Na+ channels Inhibits kainite and/or AMPA glutamate receptors Enhances action of GABA |
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Topiramate Side Effects |
Somnolence, fatigue, weight loss, nervousness, cognitive impairment |
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Topiramate Alternative use |
Used in migraine prophylaxis |
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Zonisamide Mechanism of action |
Inactivates Na+ channels - primary site of action Inhibits T-type Ca2+ channels |
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Zonisamide Indications |
Focal (partial) seizures - adjuvant therapy Absence seizures Myoclonic seizures Infantile spasms |
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Zonisamide Side Effects |
Drowsiness, cognitive impairment, potentially serious skin rashes |
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Zonisamide Drug Interactions |
Does not interact with antiseizure drugs |
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Epilepsy and pregnancy |
1. Epilepsy = 2-fold higher risk of birth defects 2. Antiepileptics implicated in birth defects 3. Lowest effective dose of monotherapy used 4. Drug withdrawal dangerous for fetus 5. Prophylactic folic acid 6. Some drugs cause vit K deficiency = risk of hemorrhage at birth |
