Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
44 Cards in this Set
- Front
- Back
|
Goals of antiepileptic drugs (AEDs)
|
inhibit Na or Ca influx, increase GABA, decrease glutamate
|
|
|
Which AEDs are highly bound to plasma proteins?
|
Phenytoin and Valproic Acid
|
|
|
How are AEDs cleared?
|
liver, entire class is black boxed
|
|
|
MOA of Phenytoin
|
Prolongs the inactived stat of Na channels so inhibits the generation of repetitive action potentials
|
|
|
Phenytoin, Fosphenytoin routes
|
oral, IV so more potent than phenytoin
|
|
|
What drugs at increaed blood levels have zero order kinetics?
|
Phenytoin, Alcohol, and Asprin
|
|
|
Phenytoin toxicity side effects
|
Diplopia, ataxia, nystagmus, gingival hyperplasia (DANG), hirsutism, Hypotension and cardiac arrhythmias with rapid infusion
|
|
|
Carbamazepine route
|
oral only
|
|
|
Carbamazepine MOA
|
similar to phenytoin
|
|
|
Carbamazepine toxicity side effects
|
black boxed for blood dyscrasias and Stevens-Johnson syndrome in patients with asian ancestry
|
|
|
Phenobarbital MOA
|
Enhancement of inhibitory NT like GABA, binds to GABAa receptor, not 1st line
|
|
|
Primidone MOA
|
parent drug with 2 active metabolites (Phenobarbital and Phenylethylmalonamide PEMA) so blocks Na channel like phenytoin and increases GABA like phenobarbital
|
|
|
Primidone use
|
seizures in elderly and kids
|
|
|
Primidone dosage
|
start small and increase over weeks to avoid GI upset and sedation
|
|
|
ViGABAtrin MOA
|
irreversible inhibitor of GABA aminotransferase which would breakdown GABA
|
|
|
Vigabatrin side effect
|
vision loss which is permanent
|
|
|
Which drug requires a SHARE program?
|
Vigabatrin
|
|
|
Lamotrigine use
|
adjuctive or monotherapy if partial
|
|
|
Lamotrigine side effects
|
skin rash, life-threatening dermatitis in 1-2% of pediatric pts
|
|
|
Gabapentin, Pregabalin MOA
|
both block voltage-gated Ca channels
|
|
|
Lacosamide
|
has no effect on CY450s so very little drug interactions
|
|
|
Only drug for myoclonic seizures in juvenile myoclonic epilepsy
|
Levetiracetam
|
|
|
TiaGABine MOA
|
inhibits the reuptake of GABA in both neurons and glia
|
|
|
Tiagabine side effects
|
severe skin reactions
|
|
|
Topiramate side effects
|
urolithiasis, only AEDs to cause kidney stones
|
|
|
Zonisamide side effects
|
metabolic acidosis
|
|
|
Felbamate use and side effects
|
never 1st line because causes aplastic anemia and severe hepatitis
|
|
|
Rufinamide MOA
|
same as phenytoin
|
|
|
Ruginamide side effects
|
shortens the QT interval
|
|
|
Ezogabine MOA
|
opens K channels and suppresses epileptic activity
|
|
|
Only treament for Abscence seizure
|
Ethosuximide (Methsuximid more toxic and Phensuximide less effective)
|
|
|
Valproic Acid use
|
used for every type of seizure so not a DOC for any particular seizure type
|
|
|
Valporic Acid toxicity side effects
|
Hepatotoxicity esp, <2, increased risk of spina bifida if taken while pregnant
|
|
|
Treament of hepatotoxicity from Valporic Acid
|
L-carnitine
|
|
|
Benzoidiazepines
|
Diazepam, Lorazepam
|
|
|
Diazepam route and effect
|
given IV or orally, stops continuous seizure activity
|
|
|
Lorazepam affect
|
stops continuous seizure activity
|
|
|
Other Benzodiazepines
|
Cloazepam, Clorazepate dipotassium, and Clobazam
|
|
|
Who gets Vagus nerve stimulatoin
|
pts with refractory partial seizures and pts who do no tolerate meds
|
|
|
Treatments for Status Epilepticus
|
First: IV Diazepam or Lorazepam; Second: Phenytoin, then Phenobarbital if no response to phenytoin
|
|
|
Teratogenic AEDs
|
phenytoin, valporate, topiramate
|
|
|
Phenytoin congenital malformation
|
fetal hydantoin syndrome (cleft lip and palate, microcephaly, brain malformations)
|
|
|
Valproate congenital malformatoin
|
spina bifida
|
|
|
Topiramate congential malformation
|
hypospadias in males
|
