Pharm24 Antiseizure Drugs

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1st line treatments for Tonic-Clonic seizures

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Phenytoin, Carbamazepine, Valproic Acid

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1st line prophylaxis for Status Epilepticus

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Phenytoin

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1st line for acute Status Epilepticus

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Diazepam or Lorazepam (Benzodiazepines)

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1st line for seizures of Eclampsia

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MgSO4

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1st line in treatment of pregnant women and children

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Phenobarbital

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Used for Trigeminal Neuralgia

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Carbamazepine

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Antiseizure drugs NOT metabolized hepatically

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Gabapentin
Vigabatrin

levetiracetam
pregabalin

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Common resistance to antiseizure drugs

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increased expression of transporters @ BBB

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Seizure drugs especially capable of inducing hepatic enzymes

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Carbamazepine
Phenytoin

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drug with shift from first order kinetics to zero order kinetics @ moderately high doses

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Phenytoin

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Drugs which compete for Phenytoin Plasma Protein binding

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Carbamazepines
Sulfonamides
Valproic Acid

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P450 Inducers

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Quinidine, Barbituates, St. John's Wart, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic Alcoholism

Queen Barb STeals PhenPhen but Refuses Greasy Carbs Chronically

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P450 Inhibitors

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HIV protease inhibitors, Ketoconazole, erythromycin, grapefruit juice, Acute alcohol use, Sulfonamides, Isonaizid, cimetidine

Inhibit yourself from drinking a KEG because it will make you Acute SICk

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inhibitors of carbamazepine metabolism

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Propoxyphene
Valproic Acid

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antiseizure drug which competes for phenytoin PP binding sites and inhibits metabolism of rest

metabolite is hepatotoxic

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Valproic Acid

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elimination of lamotrigine is via

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hepatic glucuronidation

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GAT-1 inhibitor, prolonging GABA action by decreasing reuptake

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Tiagabine

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irreversible GABA-aminotransaminase inactivator

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Vigabatrin

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blocks t-type Ca channels (especially in pacemaker cells of thalamus)

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Ethosuximide

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First Line therapy for Grand-mal (generalized tonic-clonic) seizures in infants

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Phenobarbital

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First line therapies for partial seizures (3)

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Carbamazepine
Lamotrigine
Phenytoin

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Why is ethosuximide first line for Absence seizures?

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causes minimal sedation

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adjunct therapy in myclonic seizures that causes hematotoxicity and hepatotoxicity

(ignore if can't remember)

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Felbamate

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Why is parenteral fosphenytoin preferable to phenytoin as propylaxis in Status Epilepticus

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phenytoin causes cardiotoxicity

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First Line for Status Epilepticus in children

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Phenobarbital

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also used in manic period of bipolar disorder

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Valproic Acid

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used in postherpetic neuralgia

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Gabapentin

pain of neuropathic origin

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Causes NTDs (Spina Bifida)

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Valproic Acid

also causes fatal hepatoxicity

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Diplopia
Ataxia
Blood Dyscrasias
Teratogenesis
SJS (rare)

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Carbamazepine

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Caues Fetal Hydantoin Syndrome

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Phenytoin

also nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, SLE-like syndrome, megaloblastic anemia

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Antitode for Benzodiazepine overdose

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Flumenazil

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Fatal hepatotoxicity
NTDs

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Valproic Acid

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Causes SJS

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Lamotrigine

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Toxicity of Ethosuximide

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Fatigue
GI distress
Headache

EFGH

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Barbituates contraindicated in

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porphyria

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Most frequent route of metabolism of antiseizure drugs

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hepatic enzymes

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MOA of phenytoin, carbamazepine, lamotrigine

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Na channel blockade

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MOA benzo/barb

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GABA related targets

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MOA Ethosuximide

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Ca channels

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MOA Valproic acid @ high doses

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Ca, K, and Na channels

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DOCs for Generalized Tonic-Clonic and partial seizures

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Valproic Acid and Phenytoin

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DOC Febrile Seizures

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Phenobarbital

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DOC Absence Seizures

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Ethosuximide
Valproic Acid

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DOC myoclonic seizures

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Valproic Acid

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DOC status epilepticus

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IV Diazepam acute

phenytoin prolonged therapy

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Drugs that can be used for infantile spasms

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corticosteroids

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Antiseizure drug also used for Bipolar Affective Disorder

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Valproic Acid
Carbamazepine
Phenytoin
Gabapentin

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Antiseizure drug used also for trigeminal neuralgia

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Carbamazepine

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Antiseizure drugs also used for neuropathic pain

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Gabapentin

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Antiseizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism

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Phenytoin

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SE of pheyntoin

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Gingival hyperplasia
nystagmus
diplopia
ataxia

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Antiseizure agent that induces formation of liver drug metabolism enzymes, is teratogen, and can cause craniofacial anomalies and spina bifida

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Carbamazepine

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Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and GI distress

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Valproic Acid

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Laboratory value required to be monitored for patients on valproic acid

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Serum ammonia and LFTs

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SE for Lamotrigine

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SJS

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SE for Felbamate

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Aplastic Anemia and Acute Hepatic failure

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Antiseizure medication also used in the prevention of migraines

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Valproic Acid

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Carbamazepine may cause

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agranulocytosis

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Antiseizure drugs used as alternative drugs mood stabilization

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carbamazepine
gabapentin
lamotrigine
valproic acid