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20 Cards in this Set
- Front
- Back
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whats better about 2nd gen over 1st gen |
fewer drug interactions lower side effect rate reduced or no need for serum level monitoring |
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RF for recurrent seizures |
partial seizure as 1st seizure abnl EEG hx os serious brain injury brain lesion focal abnl on neuologic examination mental retardation |
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drug of choice for: -primary generalized tonic clonic -partial including secondary generalized -absence -atypical absence, myoclonic, atonic
-alternative |
-valproate -carbamazepine -ethosuximide, valporate -valproate
-alternative: levetiracetam (Kepra) |
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drugs that AEDs interact with |
cancer chemo corticosteroids theophylline cyclosporine digoxin warfarin haloperidol OC |
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SE of AED |
suicide, SJS, toxic epidermal necrolysis |
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AEDs in: women of childbearing age pregnancy post stroke seizures
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-increase folate rx, reduces effect of OC (5-fold incr of failure) -withdrawl AED if possible or mono therapy of lowest dose -carbamazepine or phenytoin
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AEDs in elderly |
-therapy not needed if due to med w/d or metabolic abnl -caution in hepatic and renal dysfunc and decr plasma PRO -SE = CNS: sedation, dizziness, impaired gait, bone loss in women |
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why would you stop an AED |
SE, expense, confounding therapy, "cure" |
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what MUST you do when discontinuing |
TAPER |
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what is a good predictor of success of discontinuation of AED? |
3yrs being drug free (the longer the better) |
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what are the sodium channel blockers |
Phenytoin (Dilantin) Carbamazepine (Tegretol) Valproate Topiramate (Topamax) Lamotrigine (Lamictal) |
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MOA of sodium channel blockers |
depolarizes neuronal membrane causing increase sodium ions thru voltage gated Na channels
prevent neurons from firing rapidly |
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Valporate: indication SE dose |
generalized and partial seizures
weight gain, insulins resistance, n/v, hair loss, thrombocytopenia, hepatic failure
initial: 15mg/kg/d in 3 divided doses incremental: 5-10mg/kg/d q week PRN |
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Carbamazepine (Tegretol) indication SE dose |
partial and generalized seizures, initial therapy for primary generalized tonic-clonic seizures; partial seizures with/out secondary generalization
early rash, HA, dizziness, nausea, blood dyscrasias including leukopenia, aplastic anemia
initial: 2-3mg/kg/d divided into 2,3,4 doses maintenance: 10mg/kg/d |
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what are the GABA activity drugs |
Clonazepam (Klonopin) Vigabatrin Tiagabine (Gabitril) Phenobarbital |
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MOA of GABA activity drugs |
GABA = inhibitory neurotransmitter acts on GABA transaminase (Vigabatrin) and neurotransmitter reuptake pump (Tiagabin) |
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Clonazepam (Klonopin) indication SE Rx |
adjunctive therapy of myoclonic and atonic sz
depression, ataxia, sedation, irritability
0.5-1mg/d with weekly increments of 0.5-1mg/d max daily dose = 20mg |
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what is used for infantile spasms |
Vigabatrin |
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what is the concern with status epilepticus |
cerebral hypoxia |
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tx for status epilepticus |
Lorazepam (Ativan) 4mg IV slowly at 2mg/m
Fosphenytoin (Cerebyx) Phenytoin sodium (Dilantin) |
