AEDs Flashcards Preview

Clinical Pharmacology > AEDs > Flashcards

Flashcards in AEDs Deck (36)
Loading flashcards...
1

Ethosuximide

-MOA: inhibits Ca++
-Indications: tx of absence seizures
-ADRs: Hyperactivity/psychotic behaviors

2

Gabapentin

-MOA: analog of GABA
-Indications: Adjunct for seizures, PHN, RLS
-Interactions: not metabolized
-ADRs: somnolence/dizziness
-Pearls: may exacerbate myoclonic seizures, must taper to avoid withdrawal sx (anxiety, insomnia, pain, etc)

3

Pregabalin

-MOA: modulates calcium--> affects release fo glutamate, NE, Substance P*
-Indications: fibromyalgia, peripheral neuropathy (DM/PHN), RLS, off-label GAD
-ADRs: weight gain (bad for fibro), euphoria with withdrawal (C-V)
-Pearls: same as gabapentin

4

Phenobaribtal

-Uncommon drug
-MOA: Binds GABAa and hyperpolarizes neuron
-Autoinducer
-ADR: sedation

5

Clobazam

-MOA: see BZD
-Used in Lennox-Gastaut
-ADR: like benzos, but less sedating

6

Clonazepam

-MOA: see BZD
-Used in Lennox-Gastaut

7

Tiagabine

-MOA: enhances GABA
-ADR*: new-onset seizures and status epilepticus have been associated when taken for unlabeled indications (ex. bipolar, anxiety, neuropathic pain)

8

Vigabatrin

-MOA: increases CNA GABA
-Indications: monotherapy for infantile spasms (orphan drug)--> effective for infantile spasms r/t tuberous sclerosis
-ADRs*: irreversible retinal toxicity

9

Perampanel

-MOA: AMPA antagonist (glutamate receptor)
-ADRs: euphoria/abuse potential (C-III), BBW* for homicidal ideation/threats

10

Valproate

-MOA: many, main one is inc GABA
-Indications: Most are not for seizures--> bipolar and migraine prophy
-Monitoring: Serum ammonia
-Interactions: inhibits multiple enzymes (including 2D6)--> careful with lamotrigine
-ADRs: Lethargy (hyperammonemia), Parkinsonism, weight gain, **hepatotoxicity/hepatic failure (kids)
-MOST TERATOGENIC AED- ONLY USE IF PT HAS SEIZURES AND ABSOLUTELY NEEDS DRUG

11

Topiramate

-MOA: enhances GABA at nonBZD GABAa receptor
-Indications: Lennox-Gastaut, migraine prophy, chronic weight mgmt
-Monitoring: HCO3 q2-4 mo
-Systemic ADRs: wt loss, olioghidrosis/hyperthermia, heat stroke (kids), metabolic acidosis/kidney stones
-Neurotoxic ADRs: "Dopamax," blurred vision, eye pain
-Teratogen

12

Felbamate

-Indications: Lennox-Gastaut
-ADRs*: fatal aplastic anemia and hepatic failure--> written consent required prior to therapy

13

Levetiracetam

-Indications: prevention after TBI/NS
-ADRs: suicidality, depression, agitation, aggression, anxiety, etc

14

Brivaracetam

-Analog of levetiracetam
-ADRs: suicidality, depression, C-V

15

Cannabidiol

-Dravet syndrome and Lennox-Gastaut
-Put some in your old fashioned

16

Drug-Induced Seizures

-Bupropion
-Tramadol
-Antipsychotics (clozapine/chlorpromazine)
-CPHs, PCNs, FQs
-Tx: d/c drug and IV/IM lorazepam

17

AEDs and Suicide

-Must screen for depression/anxiety before initiation of AED

18

AEDs and Bone Density

-Prolonged used ass with decreased bone density
-Phenytoin, CBZ, phenobarbital, valproate

19

AEDs and Child-Bearing Women

-may induce OCPs
-All women on AEDs of child-bearing age should be on 1 mg folic acid
-Refer for preconception counseling
-VALPROATE CATEGORY X FOR DISORDERS OTHER THAN SEIZURE

20

AEDs and generic substitution

-Bioequivalence with generics may not be true with epilepsy
-Pearl: if seizure occurs in otherwise controlled patient, ask about recent generic substitution

21

Carbamazepine

- chemically related to amitriptyline (cyclobenzaprine)
- treatment of chronic pain syndromes (e.g. trigeminal neuralgia)
- acute manic or mixed episodes of bipolar I disorder

22

CBZ side effects / ADRs

- may make absence or myoclonic seizures worse
- do NOT store in humid conditions (concretion)
- monitor concentration (autoinduction)
- common neurotoxic ADRs
- common ADR: SJS, vit D def, SIADH
- severe ADR: leukopenia, aplastic anemia
- teratogen: neural tube defects

23

Oxcarbazepine / Eslicarbazepine

- similar chemical structure to carbamazepine
- may make absence or myoclonic seizures worse
- ADRs: 20-30% of pt w/skin rxn to CBZ may react to Oxcarbazepine; more hyponatremia than CBZ (SIADH)

24

Fosphenytoin compared to phenytoin

- Fosphenytoin: phenytoin prodrug - faster admin, less complications, safer than phenytoin (esp w/cardiac), no in-line filter required

25

Phenytoin / fosphenytoin

- prevention of "early" seizures following TBI/NS*
- monitor levels (autoinduction)

26

What's "a huge pearl to remember" regarding phenytoin toxicity d/t high concentration?

Conduct EOM
- lateral nystagmus
- middle nystagmus

Must put patient on cardiac monitoring asap.

Can lead to death .

27

Lamotrigine

- tx newly dx absence seizures**
- may be less effective than ethosuximide / VPA, but better tolerated
- LGS
- maintenance tx of bipolar disorder

28

What's the most important interaction to remember with lamotrigine?

Do not ever prescribe VPA and lamotrigine together - will induce SJS.

VPA increases lamotrigine concentration > 2x

29

Phenytoin / fosphenytoin ADRs

- ADRs: gingival hypertrophy, rash, drug fever
- IV infusion ADR: venous irritation / thrombophlebitis (minimize w/fosphenytoin)
- teratogen: fetal hydantoin syndrome (FLK Paxton)

30

Lamotrigine ADRs

- rash: SJS, TEN
- Aseptic meningitis*