Epilepsy Drugs

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Author:
mminnick
ID:
134438
Filename:
Epilepsy Drugs
Updated:
2012-02-12 17:23:52
Tags:
Regis University
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Description:
IP7
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  1. Carbamazepine
    • CBZ
    • **leukopeina risk**
    • prego D, teratgenic
    • serum levels 4-12mcg/mL
    • iminostilbens drug class
    • binds to Na channels and prolongs inactivation period
    • epoxide and iminoquinone intermiediate --> toxic and unstable
    • induces own metabolism, autoinduction
  2. Clobazam
    CLB
  3. Ethosuximide
    • ETS
    • **GI discomfort risk**
    • reduced T-type Ca channels
    • ONLY absence seizures
  4. Felbamate
    • FBM
    • **aplastic anemia risk**
    • inhibits glutamate, and enhances GABA
  5. Gabapenitin
    • GBP
    • doesnt act as GABA agonist
    • increases brain GABA conc and blocks N type Ca channels
    • renal dosing required (CrCl <60)
  6. Lacosamide
    • LCM
    • VGSC--> fast to slow inactivated
  7. Levetiracetam
    • LEV
    • binds to SV2A (??)
  8. Lamotrigine
    • LTG
    • binds to Na channels and prolongs inactivation period
    • inhibits glutamate release
  9. Oxcarbazepine
    • OXC
    • ** hyponatremia risk**
    • binds to Na channels and prolongs inactivation period
  10. Pregabalin
    PGN
  11. Phenobarbital
    • PHB
    • **impaired cognition rsk**
    • dose range 15-40mcg/mL
    • binds allosterically to increase GABA effect
    • high doses can cause GABA effect w/o GABA
    • alsp suppresses glutamate-mediated activity
    • prego D ONLYs
    • broad spec inducer
  12. Phenytonin
    • PHT
    • must be adjustd to pH 12 (> than pKa of 8.3)
    • phlebitis
    • given with .22 micron filter
    • admin rate must not exceed 50mg/min
    • range of 10-20mcg/mL
    • binds to Na channels and prolongs inactivation period
    • gingival hyperplasia, hirsutism and nystagmus
    • prego D, and teratogenic
    • nonlinear pharmokinetcs
    • unstable epoxide intermediate--> toxicity
    • broad spec inducer
  13. Rufinamide
    • RFM
    • binds to Na channels and prolongs inactivation period (thought so)
    • Only approved for LGS
  14. Tiagabine
    • TGB
    • inhibits GABA reuptake @ GAT-1, keeping it in cleft longer
  15. Topiramate
    • TPM
    • -prolongs fast-inactivation state of Na channels
    • -enhance GABA currents
    • -limits glutamate receptors
  16. Valproic Acid
    • VPA
    • **Thrombocytopeina risk**
    • Na Valproate -IV formulation
    • Divalproex Na - PO dimer to help with GI effects
    • -reduced T type Ca channels
    • -prolongs the fast-inactivates state of Na channels, delaying repolarization
    • -GABAergic effect
    • prego D, teratogenic
    • inhibition of gluconronadition
  17. Zonisamide
    • ZNS
    • binds to Na channels and prolongs inactivation period
    • reduces T type Ca channels
  18. corrected PHT equation
    Normal PHT level = measured PHT level / (X * albumin) + 0.1

    • X= 0.1 for CrCl <10 w/ hypoalbumnia
    • 0.2 for hypoalbumnia
    • 0.25 for nursing home or critical ill w/ hypoalbumnia

    normal albumin is 3.1-4.3
  19. Drugs that commenly cause lowering of sezire threshold at therapeutic doses
    • meperidine
    • phenothiazine antipsychotics (chlorpromazine)
    • clozapine
    • radio contrast dye
  20. Drugs that OCCASIONALLY cause lowering of sezire threshold at therapeutic doses
    • anesthetics
    • beta lactams(penicillin, cefazolin)
    • carbapenems
    • isoniazid
    • theophyline
    • immunomodulators (cyclosporin, interferon, tacrolimus)
    • butyropheone antpshycotics (haloperidol)
  21. drugs that inhibit and bind to Na channels and prolong the inactivation period
    • CBZ
    • OXC
    • PHT
    • LTG+++
    • RFM
    • ZNS+++
  22. MOA of valproic acid
    • 1)prolongs fast Na channels, delaying repolarization
    • 2)reduced T type channels
    • 3) GABAergic effect
  23. First line for LGS (3)
    • LTG
    • TPM
    • VPA
  24. First line for Juvenile Myoclonic Epilepsy
    VPA
  25. first line for Tonic Clonic
    • TPM
    • VPA
  26. First line for absence
    • LTG
    • ETS
    • VPA
  27. First line for partial (simple, complex and 2nd generalized)
    • CBZ
    • GBP
    • OXC
    • PHT
    • PHB
    • TPM
    • VPA
    • LTG

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