Antiepileptics

Front 1

Antiepileptics

Back 1

*women taking antiepileptics should use non-hormonal contraception such as copper-releasing IUD

all antiepileptics cause ‘RADS’ = rash, ataxia, dizziness, sedation
all adjuvants (gabapentin, lamotrigine, levetiracetam) have labels 1, 9

Front 2

Phenytoin:
Prevents repetitive neuronal discharge by blocking voltage-dependent and use dependent (inactivated) sodium channels.

Back 2

*100 mg phenytoin sodium contains approximately 92 mg phenytoin
D: 200-500mg daily (initially 4-5mg/kg d and ↑ 30mg q2w)
Max. 500 mg daily

I: Simple/complex partial seizures
Generalised tonic-clonic seizures
Status epilepticus.

SE: SE: n/v
gum hyperplasia
acne
hirsutism
facial coarsening
dec. BP
neurotoxic (drowsiness, tremor, cognitive difficulties visual disturbances)
agitation
teratogenic

picture ugle chick

Hint 2

1, 5, 9, 12+, 13
! this medicine may increase the
effects of AlOH
! fever, sore throat, rash, mouth
ulcers, bruising or bleeding occurs
% see Dr (blood dyscrasias)
! Visit your dentist regularly for
good dental hygiene to avoid
enlarged gums caused by
phenytoin
! do not stop taking this medicine
abruptly
! interacts with many other drugs
! may affect mental
alertness/coordination ! if affected
do not drive or operate machinery
! have you been stabilised on this
dose for a while now? (non-linear
PK ! small ( dose = large (
[phenytoin])
Self Care Cards: Epilepsy

MONITOR:
-plasma conc (10-20mg/L) [dose can be INC. by 100mg if the total plasma phenytoin is 5mg/L or less, BUT no more than 30mg is the concentration is higher)
-BMD
-Vit D & Ca²+

Front 3

Carbamazepine:
MOA same as phenytoin

Back 3

D: 400mg-1.2g d (M=2g d) seizures
Neuro pain: 200-600mg d (M=1.2g)
Trigm & Bipolar: Max 1.6g (divided doses)
I: Simple/complex partial seizures
Generalised tonic-clonic seizures
Trigeminal neuralgias
Acute mania and prevention of bipolar disorder
Neuropathic pain

SE: no “carbs” so get
anorexia, not eating
bread so get Dec. Na, not
eating properly so get
leucopenia,
thrombocytopenia
SJS

Hint 3

C: A, B, 5, 9, 12+, 13, 18
! swallow whole with food
! do not lie down for 15-30min after taking to avoid throat irritation
! fever, sore throat, rash, mouth ulcers, bruising or bleeding occurs
% see Dr
! this medicine may also increase the effects of AlOH
! may cause drowsiness, dizziness or blurred vision, if affected avoid driving
! interacts with many other drugs
! do not stop taking this medicine abruptly
! avoid grapefruit

autoinduction – dose may need to be increased

MONITORING:
- check FBC @ baseline and people with low WCC monitor every 2 weeks
- BMD
- VitD and Ca
- Skin reactions

Front 4

Valproate
MOA same as phenytoin
Max 2.5mg daily; same
as lithium which is also
mood stabiliser in bipolar

Back 4

S: 20-30mg/kg d (M=2.5g d);
Bipolar: 1-2g (20-30mg/kg) d;
Migraine: 200-400mg BD

I: 1o generalised seizures
Simple/complex partial seizures
Myoclonic
Bipolar disorder*
Migraine prevention*
*last line

SE: “V” for vampire % bleeding disorder (10a), hair loss, hungry, fat,
tremoring for next feed, swallow whole with food

Hint 4

C; A, B, 9, 10a, 12+, 13
! take regularly at same time(s) each day – space out doses
! can increase your appetite so may need to pay attention to your diet to avoid weight gain
! abdo pain, n/v, bruising, bleeding, sore throat, fever, rash % see Dr

Self Care Cards: Epilepsy, Weight
and Health

MONITOR:
therapeutic range: 40-150mg/L
- signs of toxicity ( jaundice, abdo pain, n/v, bruising, bleeding, sore throat, fever, rash)
- INC. LFTs
- BMD, Vit D, Ca

Front 5

Gabapentin:
Unknown MOA –
structurally related to GABA

Back 5

S: 900-3600mg d in 3 divd doses
Neuro Pain: 1.8-3.6g d

I: Adjuvant treatment of partial seizures refractory to mono treatment.
Neuropathic pain

SE: Gaba “grabber” % fat person sitting at table grabbing at food, eating, getting fat since forget how much eating (amnesia, abnormal
thinking), peripheral oedema in legs

Hint 5

C: 1, 9
Self Care Cards: Epilepsy

MONITOR: RF, BP, vision acuity

Front 6

Lamotrigine:
stabilises presynaptic neuronal membranes by blocking voltage-dependent and use-dependent
(inactivated) sodium channels.

Back 6

100-700mg d (2 divd doses)
+ valproate then RED. to 100-200mg d

I: Partial and generalised seizures (adjuvant or monotherapy)
SE: Used more in kids since less sedation than others % SJ, think of
nerdy kid with glasses (blurred vision and diplopia) and hyperkinesias ! more prone to scratch and rashes
Blood dyscrasia

Hint 6

1,9
self care card

MONITOR: skin rxns and vision
RASH seek medical advice

Front 7

Levetiracetam
Unknown

Back 7

D: 500-1500mg bd
I: Partial seizures (initially as adjuvant)
SE: Psychos who wear
“kappa pants” (hostility, emotional liability, depression), hunt in packs ! weak

Hint 7

1, 9
self care card
MONITOR: behaviour or psychological health