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;
78 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Name the 5 traditional AEDs.
|
Phenytoin
Carbamazepine Valproate Phenobarbital Ethosuximide |
|
|
|
Name 8 2nd generation AEDs.
|
Gabapentin
Leviracetam Lamotrigine Oxcarbazepine Tiagabine Topiramate Zonisamide Felbamate |
|
|
|
Which AEDs work by affecting Na channels?
|
Carbamazepine
Oxcarbazepine Phenytoin Lamotrigine Zonisamide |
|
|
|
Which AED works by affecting Ca currents?
|
Ethosuximide
|
|
|
|
Which AEd's affect GABA metabolism
|
Phenobarbital
Tiagabine |
|
|
|
What is carbamazepine indicated for other than seizures?
|
bipolar disorder
chronic pain (e.g. trigeminal neuralgia) |
|
|
|
What are the cytochrome interactions of carbamazepine?
|
3A4 substrate
2C9, 2C19, and 3A4 inducer |
|
|
|
Which antiepileptics are autoinducers?
|
carbamazepine
|
|
|
|
Which antiepileptics can cause SJS and TEN?
|
Carbamazepine
Oxcarbazepine Phenytoin Lamotrigine Zonisamide Phenobarbital Valproic acid Felbamate (all the traditionals plus oxcarb, zonisamide, and felbamate) |
|
|
|
When is SJS or TEN most common in the course of carbamazepine treatment?
|
within the 1st 8weeks
|
|
|
|
What are 2 serious side effects of carbamazepine? (reason you need a baseline and follow up CBC)
|
Leukopenia
Aplastic anemia (dose related) both usually w/in 1st 3 mo |
|
|
|
What are the indications for the use of oxcarbazepine? what is it used off label for?
|
mono or adjunct therapy for tx of partial seizures; off label for peripheral neuropathies
|
|
|
|
What side effects are shared by both carbamazepine and oxcarbazepine?
|
N/V, drowsiness, dizziness, blurred/double vision, sedation, HA
SJS TEN SIADH |
|
|
|
What is the difference between phenytoin and fosphenytoin?
|
fosphenytoin is a prodrug of phenytoin -
fosphenytoin can be administered by IV faster with fewer complications and without a filter |
|
|
|
Which AED is used most often for prevention of seizures following head trauma and neurosurgery?
|
phenytoin
|
|
|
|
What are the cytochrome interactions of phenytoin?
|
2C9 and 2C19 substrate
Inducer of 2C9, 2C19, and 3A4 |
|
|
|
Will you need a higher or lower dose of warfarin if taking phenytoin?
|
higher
|
|
|
|
Which AED can cause a lupus like reaction?
|
phenytoin
|
|
|
|
Which AED can cause werewolf syndrome? What does that mean?
|
phenytoin; hypertrichosis
|
|
|
|
What two drugs cause hypertrichosis?
|
minoxidil and phenytoin
|
|
|
|
Which AED can cause drug fever?
|
phenytoin
|
|
|
|
What are some drugs that can cause drug fever?
|
H2 blockers
beta lactams phenytoin (there are others) |
|
|
|
What are the side effects of phenytoin?
|
osteomalacia
hepatotoxicity SJS/TEN hypertrichosis drug fever peripheral neuropathy gingival hyperplasia nystagmus blurred/double vision ataxia slurred speech sedation bone marrow suppression |
|
|
|
What are the side effects of IV phenytoin?
|
hypotension
bradycardia CV collapse venous irritation thrombophlebitis |
|
|
|
Which AED is a class Ib antiarrhythmic when given IV?
|
phenytoin
|
|
|
|
Which Na channel AED can be used for absence seizures?
|
Lamotrigine
|
|
|
|
What is the interaction between lamotrigine and valproate?
|
valproate inhibits glucuronidation which will increase lamotrigine
|
|
|
|
What can lamotrigine be used for other than epilepsy?
|
bipolar disorder
|
|
|
|
Which AED should not be used in pts <16 b/c inc risk of SJS/TEN?
|
lamotrigine
|
|
|
|
which AED is a sulfonamide derivative?
|
zonisamide
|
|
|
|
Which AED has is chemically/structurally unrelated to other AEDs?
|
zonisamide
|
|
|
|
What are the clinical indications for zonisamide?
|
adjunctive for partial and generalized seizures
|
|
|
|
WHat are the cytochrome interactions of zonisamide?
|
3A4 substrate
|
|
|
|
What are the side effects of zonisamide?
|
ataxia, abnormal thinking, somnolence, confusion, dizziness, SJS/TEN
|
|
|
|
What are the cytochrome interactions of ethosuximide?
|
3A4 substrate
|
|
|
|
What are the most common adverse rxns of ethosuximide?
|
N/V, drowsiness, and hyperactivity
|
|
|
|
What AED extends GABA-mediated chloride channel openings?
|
phenobarbital
|
|
|
|
What is the limiting side effect of phenobarbital for seizures?
|
sedation
|
|
|
|
What are the cytochrome interactions of phenobarbital?
|
2C19 substrate
2C9 and 3A4 inducer |
|
|
|
What ADR is unique to phenobarbital?
|
bone marrow suppression
|
|
|
|
what AED works by inhibiting GABA reuptake into presynaptic neurons?
|
tiagabine
|
|
|
|
What is tiagabine used for?
|
adjunctive tx for partial seizures
|
|
|
|
What are the cytochrome interactions of tiagabine?
|
3A4 substrate
|
|
|
|
Which AED has been associated with new-onset seizures and status when taken off-label?
|
tiagabine
|
|
|
|
What are the ADRs of tiagabine?
|
dizziness, somnolence, nausea, nervousness, tremor, difficulty concentrating
|
|
|
|
What two forms of valproate are available?
|
valproic acid and divalproex
|
|
|
|
What two things is valproate indicated for beside seizures?
|
mania associated w/bipolar disorder
migraine prophylaxis |
|
|
|
What three AEDs are indicated for absence seizures?
|
ethosuximide
lamotrigine valproate |
|
|
|
What 3 AEDs can cause bone marrow suppression?
|
phenytoin
phenobarbital valproate |
|
|
|
What are the ADRs of valproate?
|
SIADH (like carbamazepine/ox)
somnolence dizziness insomnia tremor ataxia pancreatitis weight gain N/V/D alopecia bone marrow suppression dysmenorrhea SJS/TEN |
|
|
|
Which AED may cause neural tube defects?
|
valproate
|
|
|
|
With which AED must you monitor LFTs b/c potential for hepatotoxicity/hepatic failure?
|
valproate
|
|
|
|
Which AED for partial seizures should really NOT be used?
|
felbamate
|
|
|
|
Why is there almost never an indication to use felbamate?
|
associated w/fatal aplastic anemia and hepatic failure
|
|
|
|
What are the three mechanisms of action of topiramate?
|
blocks Na channels
enhances activity of GABA NMDA antagonist |
|
|
|
What side effect is unique to topiramate?
|
dec sweating --> heat intolerance/hyperthermia
also. . . metabolic acidosis |
careful when using with anticholinergic drugs
|
|
|
How can topiramate cause metabolic acidosis?
|
dose-related renal bicarb loss b/c it has an inhibitory effect on carbonic anhydrase
|
|
|
|
what are the most likely clinical manifestations of topiramate induced acidosis?
|
tachypnea and calcium phosphate nephrolithiasis
|
|
|
|
what are the monitoring requirements for topiramate?
|
measure bicarb at baseline and again every 2-4mo.
|
|
|
|
How does pregabalin work?
|
modulates calcium currents and the release of glutamate, norepinephrine, and substance P
|
|
|
|
what is pregabalin indicated for?
|
adjunct for partial seizures
neuropathic pain (not DM neuropathy) |
|
|
|
What are the side effects of pregabalin?
|
dizziness, somnolence, ataxia, weight gain, blurred or double vision, euphoria
|
|
|
|
which AED is a schedule V controlled substance?
|
pregabalin
|
|
|
|
Which AED crosses the BBB and mimics the physiologic effects of GABA?
|
gabapentin
|
|
|
|
What are the clinical indications for use of levetiracetam?
|
add-on for refractory partial seizures
|
|
|
|
What are the interactions of gabapentin and levetiracetam?
|
fairly clean
|
|
|
|
What are the side effects of levetiracetam?
|
fatigue, somnolence, dizziness, behavioral changes
|
|
|
|
Which AED is associated with diarrhea, hyponatremia, a rash, and pruritis?
|
carbamazepine
|
|
|
|
which AEDs may cause weight loss?
|
felbamate, topiramate
zonisamide causes anorexia |
|
|
|
which AEDs may cause weight gain
|
pregabalin, valproate
|
|
|
|
which AED may cause lymphadenopathy?
|
phenytoin
|
|
|
|
which AED may cause renal stones?
|
topiramate
|
|
|
|
which AED is associated with easy bruising, hair loss, and weight gain?
|
valproate
|
|
|
|
Which AED is associated with tremor?
|
valproate, and topiramate
|
|
|
|
which AEDs may cause hyperactivity?
|
ethosuximide
|
|
|
|
which AED can cause aplastic anemia?
|
felbamate
(and zonisimide, and valproate and phenytoin and ethosuximide, and carbamazepine. . .but mostly felbamate) |
|
|
|
which AEDs can cause agranulocytosis?
|
carbamazepine
ethosuximide phenytoin primidone/phenobarbital valproate zonisamide (all the "traditionals" plus zonisamide) |
|
|
|
which AEDs are rarely associated w/serum sickness?
|
carbamazepine
ethosuximide phenytoin valproate phenobarbital |
|
