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53 Cards in this Set

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Partial seizure DOC (drug of choice)
Carbamazepine, also phenytoin & phenobarbital
Absence seizure/petit mal DOC
ethosuximide (Zarontin), also clonazepam
Grand mal seizure/tonic-clonic DOC
Carbamazepina (tegretol) phenytoin, phenobarbital, also valproic acid, topiramate (topamax), adjunt Lamotrigine (lamictal). Extreme cases Felbamate
Atonic seizure DOC
Valproic Acid, also Clonazepam, Lamotrigine (adjunt)
Lenox-gastuat syndrome DOC
Valproic Acid, Clonazepam
Lenooux-gastuat syndrome > 30 minutes TTO
inminent CNS damage. 100 mg thiamine complex, 25 g glucosa (50 ml 50%) Diazepam IV 10-20 mg 2-5 min, Phenytoin 18 mg/kg to reach therapeutic levels, but less than 50 mg/min or cadiac risk (propylen glycol)
Seizures drugs discontinuation
Slow over 6 weeks to 3 month, or risk of status epilepticus
Drugs that may cause seizures
wellbutrim (bupropion)alcohol, cocaine, theophylline in high doses, lidocaine, meperidine(demerol), diazepam, tramadol, meropenem carbopenem, meropenem, ganziclovir, penicillin, ROH and barbituric withdrawal
Phenytoin (Dilantin)IM?
No, slow, erratic absortion, painful local reaction. Use cerebyx instead IM, IV.
Cerebryx drug, via of administration, storage and type of drug
Fosphenytoin, IV, IM, REFRIGERATE and prodrug
Patient counceling with phenytoin and fosphenytoin
Take it with food or milk to avoid GI symptoms, good dental care (gingival hyperplasia), do not take a discolored capsule
DOC to prevent seizure
Phenytoin
Phenytoin dose, loading dose, therapeutic range, IV caution. Pharmacology
4-6 mg/kg/day TID or Kapseals QD, 18 mk/kg, 10 - 20 mg/liter. no more that 50mg/min, only with normal saline use filter. Dose dependent First order kinetic first order to 0 order (dose dependent)
Funnytoin Adverse effects
gingival hyperplasia, NAGS (nistagmis, ataxia, GI, sedation, osteomalacia(vitamin D deficiency)
Phenytoin drug interaction
Fluconazole, omeprazole, cimetidine increase phenytoin toxicity. Disulfiram increase phenytoin effect. Phenytoin decrese contraceptive and corticosteroid (dexamethasone)effects
Valproic Acid drug, brand name, indication
depakene, tto absence and complex partial seizure
Divalproex sodium brand name, indication
Depakote EC (enteric coat), FDA approved for Mania (bipolar, and Migrain)
Valproic Acid, Divalproex sodium side effects
Hepatotoxicity, pancreatis,bone marrow problems(trombocitopenia, anemia, neutropenia) hair loss, weight gain
Seizure drugs with possible hepatic complication
valproic acid, carbamazepina, phenytoin
Seizure drugs with possible renal complication
Neurontin (gabapentin), Topamax (topiramate) Keppra (levetiracetam)
drugs that will decrece valproic acid (substrate) levels
carbamazepine, phenobarbital, phenytoin
Depakote EC drug interactions
Antiacids will increase stomach pH and will disolve the enteric coat faster
Valproic acid: substrate or inducer?
Substrate
Carbamazepine brand name, dose & pharmacology
Tegretol, 100 -200 mg QPm blood levels fall in 2-4 weeks (autoinducer)
Carbamazepine adverse effects
AAAA: aplastic anemia, agranulocitosis, antiarrithmic, anticholinergic. NAGS:Nistagmis, ataxia, GI, sedation.
Carbamazepine drug interaction
Drugs that will increase CBZ(carbamazepine):erythromycin, clarithromycin, ketoconazole, itraconazole, diltiazem, verapamil, norvir (ritonavir). Reduce effects of contraceptives
Seizure medication that may cause kidney stones
Zonisamide (Zonegran) and Topiramate (Topamax)
Seizure medication that may cause weight loss
Topiramate (topamax)
Seizure medication that may cause weight gain
All but topiramate (topamax)
Seizure medication that goes thru the liver
All but gabapentin and levetiracetam (keppra)
Seizure medication that goes thru kidneys
Levetirocetam (keppra) and Gabapentin (neurotin). Renal Failure
Felbamate indications
ONLY ON PATIENT WITH NO RESPONSE TO OTHER THERAPIES. LIVER
Felbamate Side effects
Aplasic anemia and Hepatoxicity, liver failure
Gabapentin loading dose and dose. Indication
start with 100 mg TID increase until effects reached. 900 - 4800 mg daily. Partial seizures adjunt. RENAL
Lamotrigine brand name and side effects
Lamictal, rash and photosensitivity
Lamotrigine and valproic acid
Valproic acid is an inducer of lamotrigine, so we have to lower the dose to a 100 -200 mg qh when administer with valproic acid. LIVER
Levetiracetam brand name, side effects
Keppra, somnolence and psychiatric symptoms
topiramate brand name, side effects, counceling
Topamax, Nephrolithiasis (kidney stones), weight loss (anorexia). don't brake pill (bitter taste) drink lots of water (kidney stones)
Carbamazepine & tricyclics antidepressants
They are related in terms of structure, so patients allergics to tricyclics antidepressants may be allergic to carbamazepine
If a pregnant woman in epileptic and is taking valproic , what should she use to avoid congenital malformations on her baby
Folic acid, because anticonvulsivants normally reduces folic acid, and this is a major cause of spina bifida
Topiramate & weight
Topamax (topiramate) can cause significant weight loss (anorexia)
Valproic acid & weight
Depakene can cause significant weight gain
Rash and Seizure medications
All of the anticonvulsivants are assoicated with life threatening rash.
Carbamazepine drug interactions
Because it is an inducer it has a lot of drug-drug interactions
Anti-seizure medications with black box warning
carbamazepine and felbamate (aplastic anemia and hepatic failure)
absence seizure medication for a 1 year old baby
Ethosuximide (zarontin)
Complex febrile seizures duration and complications
Last for >15 min recurrent in 24 hours and do not have any consecuenses like epilepsy
Meperidine & renal failure
Meperidine accumulates in patients with renal failure and causes seizures
Wich drug has Michaelis-Menten parmacokinetics
Phenytoin, because of its dose, goes from first order kinetis to 0 order kinetics
Drugs that decreaces phenytoin
Antiacids, cisplatin, ritonavir(norvir), zodovudine, kava kava and valerian
Drugs that increases phenytoin
alcohol abuses, diaepam, estrogens, salicilates, sulfas, warfarin.
Phenytoin and weight
Phenytoin do not have a effect on patients weight
Primidone is a metabolite of...?
Phenobarbital