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72 Cards in this Set
- Front
- Back
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type of seizure due to a lesion
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focal
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type of seizure that is primarily genetic
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generalized
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types of partial seizures
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simple and complex
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simple partial
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no loss of consciousness
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complex partial
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loss of consciousness
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generalized seizures
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absence, myoclonic, tonic, clonic, tonic-clonic, atonic, secondary generalized
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Carbamazepine Indications
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seizure disorders, trigeminal neuralgia, bipolar disorder, alcohol withdrawal prophylaxis
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Carbamazepine dose related AEs
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CNS: sedation, fatigue, dizziness, confusion GI: n/v
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CBZ non-dose related AE
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SIADH, aplastic anemia, thrombocytopenia, anemia, leukopenia
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Pts with HLA-B1502 and take CBZ
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will develop a RASH
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OXCBZ vs CBZ
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hyponatremia is more common with CBZ; blood dyscrasias are less common with OXCBZ; no autoinduction and rash = 30% cross rxn with cbz
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phenytoin suspension
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must shake very very well
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dose related AEs-phenytoin
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nystagmus, ataxia, drowsiness, cognitive impairment
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non-dose related AEs-phenytoin
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gingival hyperplasia, hirsutism, acne, rash, hepatotoxicity, coarsening of facial features
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Fosphenytoin indications
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parenteral formularion for loading or maintenance dosing of phenytoin; status epilepticus
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Dosage forms of fosphenytoin
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IM, IV-in PE
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Fosphenytoin AEs
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hypotension, itching,
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Rufinamide PKs
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dose-dependent absorption. Food Increases absorption, low protein binding-metabolism is increased by inducers. Renal elimination
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Rufinamide Indication
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Lennox-Gastaut Syndrome
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Rufinamide CI
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in pts with familial short QT syndrome
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Rufinamide AEs
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somnolence, coordination problems, ataxia
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Drugs that enhance fast Na channel inactivation
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Rufinamide, Phenytoin, OXCBZ, CBZ
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Locosamide MOA
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Enhances slow Na channel invactivation. Binds to the collapsin-response mediator protein 2 (CRMP-2): may help prevent rearragement of neuronal connections and may protect neurons from excitatoxicity and apoptosis.
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Locosamide common AEs
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common-sedation, dizziness, nausea, ataxia, nystagmus
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Locosamide rare AEs
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PR interval prolongation
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Locosamide AE @ 800 mg dose
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Euphoria
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FDA-approved schedule 5 for adjuncative therapy of…
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partial-onset seizures
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Lamotrigine MOA
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dec glutamate and aspartate release, delays repetitive firing of neurons, enhances fast Na channel inactivation, inibits Ca channels
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Lamotrigine AE
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RASH-TITRATION
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GABA
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receptor mediates chloride influx, chloride influx causes hyperpolarization and inhibits firing
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Phenobabital MOA
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increases GABA mediated Cl influx
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Phenobarbital AEs
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sedation, hyperactivity, cognitive impairment
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Tiagabine MOA
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blocks GABA reuptake in the presynaptic neuron
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Tiagabine AEs
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generalized weakness (1%), new onset seizures in non-epiplepsy pts (usually takin other meds known to lower the seizure threshold)
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Topiramate MOA
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enhances fast sodium channel inactivation, enhances GABA activity, anatagonizes AMPA/kainate activity, weak carbonic anhydrase inhibitor
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Common Topiramate AEs
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dizziness, drowsiness, parasthesis, psychomotor slowing (titrate), wt loss
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Rare Topiramate AEs
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renal stone (2-4 x greater incidence-more common in men, FH, other carbonic anhydrase inhibitors, ketogenic diet…prevent with hydration); oligohydrosis/hyperthermia, acute angle glaucoma, metabolic acidosis
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Zonisamide MOA
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enhances slow sodium channel inactivation, blocks T-type Ca currents, weak carbonic anhydrase inhibitor
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Zonisamide and Allergies
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CI in pts with hypersensitivity to sulfonamides-even non-arylamines
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Zonisamide AEs
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depression, psychomotor slowing, parasthesias, kidney stones, blood dyscrasias, oligohydrosis/hyperthermia, metabolic acidosis
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Valproic Acid (VA)-MOA
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blocks t-type Ca currents, enhances fast Na channel inactivation, increases GABA production
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VA indications
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seizure prophylaxis: partial seizures and absence seizures; also for bipolar and migraine prevention
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Common AEs-VA
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sedation, n/v, wt gain, tremor, alopecia
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AEs-rare-VA
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hepatotoxicity (monitor baseline and periodic LFTs), interference with platelet aggregation; pancreatitis (abd. Pain, n/v, anorexia); hyperammonemic encephalopathy
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Hyperammonemic Encephalopathy
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Rare AE assoc with VA. Occurs in pts with urea cycle disorders. May be increased with topiramate combo. Sxs: altered consciousness, vomiting, lethargy. Assess serum ammonia conc screen for urea cycle enzyme deficiency, EEG. Tx: d/c VA, carnitine
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Ethosuximide MOA
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blocks t-type Ca currents
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Ethosux Indication
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absence seizures
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Gabapentin MOA
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unknown-increases brain levels of GABA
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Gabapentin PKs
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eliminated renally-adjustments for renal dysfunction and hemodialysis
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Gabapentin AEs
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wt gain, pedal edema
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Gabapentin Pediatric AEs
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emotional instability, hostility, conc probs, hyperkinesia
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Pregabalin MOA
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unknown
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Pregabalin Indications
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postherpetic neuralgia, diabetic neuropathy, partial onset seizures-adjunctive therapy
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Pregabalin AEs
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drowsiness, blurred vision, wt gain, pedal edema (may be more common with concomitant thiazolidinedione antidiabetic agents), angioedema, creatinine kinase elevations
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Pregabalin schedule
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4-insomnia, n, ha, diarrhea, reported after abrupt d/c
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Levetiracetem and AED interactions
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NONE
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Levetiracetem AEs
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asthenia, somnolence, behavioral sxs (aggression, agitation, anger, apathy, etc), dizziness, depression, coordination difficulties
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Partial Seizure DOCs
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CBZ, Gabapentin, Lamotrigine, OXCBZ, Phenobarb, Phenytoin, Topiramate, Valproate, Lacosamide
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Tonic-Clonic Seizure DOCs
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same as Partial DOCs EXCEPT lacosamide
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Absence seizure DOCs
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ethosux, lamotrigine, valproate
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Atonic seizure DOCs
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lamotrigine, OXCBZ, phenytoin, topiramate, valproate
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Myoclonic seizure docs
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lamotrigine, OXCBZ, phenytoin, topiramate, valproate (same as atonic)
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Cat D AEDs
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CBZ, Phenobarb, phenytoin, VA … All others are Cat C
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CBZ cat D
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hand and face abnormalities
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Phenobarb Cat D
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10.7% risk major malformations, hand and face abnormalities, hemorrhagic dz of newborn, lower verbal IQ
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Phenytoin cat D
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fental hydantoin syndromw, hemorrhagic dz of newborn
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VA cat D
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10.7-17.% risk of major malformation, spina bifida, lower verbal IQ
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AED teratogenicity risk
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greater risk with polytherapy, VA, 5 or more convulsive seizures during prenancy lower verbal IQ. Seizures increase risk of fetal loss and injury.
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Pregnancy Recommendations and epilepsy
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seizure control is primary goal. Avoid VA in women of childbearing age. Serum conc should be used to adjust dose Q 1-3 mo, but every 2-4 wks or lamotrigine and OXCBZ. Folic acid at least 1gm/d to all women of childbearing potential
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Medication discontinuation criteria
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Seizure free for at least 2 yrs and normal neurological exam and EEG. Requires slow tapering
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Factors assoc with successful d/c AED
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seizure free for 2-4 yrs, seizure control within 1 yr, onset after 2 but before 35 yrs, normal exam and EEG
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Factors assoc with failure d/c AED
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high frequency of seizures, SE, combo of seizure types, abnl mental functioning
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