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33 Cards in this Set
- Front
- Back
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Types of Epilepsy
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Partial and generalized
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Drug of choice for new onset partial seizure
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Carbamazepine
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Types of generalized seizures
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-Absence seizure
-Generalized tonic clonic seizures |
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Drug of choice for Absence seizures
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-Ethusuximide
-If pt. has both absence and generalized seizures: lamotrigine for all pts, and valproic acid for <2 yrs old -Ethusuximide can provoke tonic-clonic. Valproic acid can cause fatal hepatotoxicity in <2 yrs |
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Drug of choice for tonic clonic generalized seizures
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-carbamazepien
-Phentoin -topiramate -valproic acid |
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Medications that can cause seizures
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-methylphenidate/cocaine/ETOH
-normeperidine(renal pts) -imipenem -metoclopramide/tricyclics -Ethosuximide causes tonic-clonic, carbamazepine, phenytoin, and phenobarbital cause absence seizures |
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General side effects of anticonvulsants
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-take with food or milk if stomach upset
-blurred vision/drowsiness -Consult MD before pregnancy -Decrease effect of BC -Full effect takes weeks -Women take folic acid -Do not drink alcohol or CNS depressants |
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Phenobarbital
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-Neonatal seizures
-generalized (except absence) -Primidone metabolizes to phenobarbital and is active |
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Phenobarbital Adverse Effects
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Chronic tx:
-hyperactive -decreased cognition -folate deficiency -Vitamin K deficient hemorrahgic disease -Hepatic failure -Stevens Johnson -Teratogenic (category D) |
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Phenytoin
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-All seizure types but absence and febrile seizures
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Phenytoin Pharmakokinetics
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-Very high protein binding
-Michaelis Menton (saturable absorption) -Reference range: 10-20 mg/L -Metabolism: liver |
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Phenytoin Side Effects
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-GI/CNS/Peripheral neuropathy
-acne,hirsutism,osteomalacia -Vit-k deficient hemor disease -folic acid deficiency -hepatic failure -stevens johnson -teratogenic (Category D) -Gum hyperplasia |
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Phenytoin DI with other anticonvulsives
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-May increase valproic acid levels
-May decrease phenobarbital levels |
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Carbamazapine Pharmakokinetics
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-Low protein binding
-Hepatic metabolism -Reference range: 4-12 mg/L -active metabolite -induces its own metabolism, peaks at 21 days |
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Carbamazepine
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-GI/CNS
-At initiation: reversible rash, not serious -SIADH,Osteomalacia,folate deficiency -Direct hepatotoxicity -aplastic anemia -Teratogenic -Do not use with MAOIs |
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Black Box Warning for Carbamazepine
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-Direct hepatotoxicity: presents within a month,fatality, D/C if >3xUNL
-Aplastic anemia: D/C if WBC<2000=3000 |
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Valproic acid Pharmacokinetics
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-high protein binding
-Reference range: 50-150mg/L |
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Valproic acid adverse events
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-GI,weight gain, alopecia
-tremor -thrombocytopenia -fatal hepatotoxicity -fatal hemorrhagic pancreatitis -teratogenic (D) |
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Black Box Warnings for Valproic acid
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-Fatal hepatotoxicity (most common in <2yrs old)
-Fatal hemorrhagic pancreatitis -teratogenic (D) |
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Felbamate use
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-rare
-Lennoux-Gastaut -tonic-clonic,tonic-myoclonic -significant weight loss -hepatotoxicity(BBW),aplastic anemia (BBW) -Inducer and inhibitor, can increase levels of active metabolite of CBZ |
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Gabapentin
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-renal elimination
-food/antacids may decrease absorption -no interactions -pregnancy category C |
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lamotrigine
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-Pregnancy category C
-Side effect: rash-->titrate dose, D/C if rash -Increased rash if used with valproic acid |
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DI with lamotrigine
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-Valproic acid increases serum concentration
-CBZ, PHT,PB, primidone decrease levels |
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topiramate
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-renally eliminated
-SE: GI/CNS, loss of apetite/focus, kidney stones, oligohidrosis |
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Tiagabine
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-Gabitril
-hepatic metabolism -Valproic acid can increase levels |
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zonisamide
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-sulfa moeity
-similar to topiramate -kidney stones -wieght loss -oligohidrosis |
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Levetiracetam
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-no significant SE (CNS)
-no significant DDI |
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Status Epilepticus
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-seizure more than 5 minutes or 2 seizure with no complete recovery in between
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Status Epilepticus treatment
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-lorazepam, diazepam
-25g glucose + 100 mg thiamin -load with IV phenytoin 15-20 mg/kg and maintain doses -Load with IV phenobarbital -Start induced coma |
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IV phenytoin
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-Must be mixed with saline
-Contains propylene glycol which is cardiotoxic -->give at a rate of no more than 50mg/min -Very alkaline: NO IM |
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IV phosphenytoin
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-Phenytoin prodrug
-Can be mixed with any IV solution -Must be dosed in phenytoin equivalent: 1mg phenytoin=1.5 mg fosphenytoin -Can be given at a rate of 150mg/min |
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Medically-induced coma
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-Achieved with pentobarbital
-For severe refractory Status E. -Can cause hypotension: give dopamine or slow rate -Causes burst suppression on EEG |
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Renally eliminated anticonvulsants
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-Keppra
-Topiramate -Gabapentin |
