-
carbamazepine
- 1st gen, NS
- MOA: enhances GABA receptors - enhances Cl flow and hyperpolarizes the membrane, stabalizes the inactivaiton gate of Na channels
- USES: partial and generalized tonic-clonic seizures, bipolar disorder, trigeminal neuralgia, neuropathic pain - DOC, acute mania
- AE: drowsiness, vertigo, ataxia, blurred vision
- best risk ratio in pregnancy, increased metabolism of OC
-
phenytoin
- 1st gen, NS
- MOA: Na channel blocker, slows recovery of Na channels from inactivaiton
- USES: effective against partial seizures
- AE: facial hair, skin problems, gingival hyperplasia, osteoporosis, megaloblastic anemia, teratogenic
- valporate competes for protein binding and can greatly increase free phenytoin plasma levels
- enzyme inducer - enhances the metabolism of OCs or inhibits warfarin
-
phenobarbital
- 1st gen, NS
- MOA: increases GABA A receptors, enhances Cl flow and hyperpolarizes the membrane
- USES: effective in generalized tonic clonic and partial seizures
- AE: sedation, nystagmus, ataxia, agitation, and confusion
- significant birth defects and cognitive impairment
-
ethosuximide
- 1st gen, NS
- MOA: reduces the low threshold of Ca currents
- USES: Absence seizures
- AE: divided doses needed to avoid nausea, PD-like symptoms, photophobia
-
valproic acid
- 1st gen, BS
- MOA: inhibits sustained repetative firing by depolarization, prolongs recovery of Na channels
- USES: partial, myoclonic, tonic-clonic and absence seizures
- AE: anorexia, sedation, weight gain, rare fatal hepatic disease seen in pts <2
- teratogen, highly bound to albumin - displaces phenytoin
-
clonazepam
- 1st gen, BS,
- MOA: increase the freq of GABA A activated Cl channels, increasing Ca, decreases the ability to produce an action potential
- USES: long acting BZ, absence seizures, lennox-gastaut syndrome
- AE: amnesia when used as a sedative, drowsiness, lethargy, cognitive effects
- used in emergency situations
-
oxcarbazepine
- 2nd gen, NS
- MOA: prodrug of carbamazepine, less potent enzyme inducer (doesn't interfere with anticoagulant effects)
- USES: best efficacy in idiopathic partial epilepsies
- AE: increase risk for polycystic ovaries
-
gabapentin
- 2nd gen, NS
- MOA: possibly act at the Ca channel - may lead to increase GABA transport, inhibit excitation of muscles
- USES: partial seizures, some generalized seizures, neuropathic pain
- AE: weight gain
- non-enzyme inducer
-
pregabalin
- 2nd gen, NS
- MOA: possibly act at the Ca channel - may lead to increase GABA transport
- USES: partial seizures, some generalized seizures, neuropathic pain
- AE: weight gain
-
lamotrigine
- 2nd gen, BS
- MOA: blocks sustained repetative firing and delays recovery from inactivation of Na channels
- USES: partial or secondary generalized seizures, lennox-gastaut syndrome
- AE: typical AE occur when titrated too fast, can get rash better side effects than valproic acid
- non-enzyme inducer
-
levetiracetam
- 2nd gen, BS
- MOA: unknown
- USES: partial, generalized, tonic-clonic myoclonic seizures
- AE: well tolerated, some somnolence, may cause mood changes
-
felbamate
- 2nd gen, BS
- MOA: inhibits NMDA responses and potentiates GABA evoked repsonses (inhibits glutamate receptors)
- USES: useful in partial and generalized seizures, used in refractory pts
- AE: toxicity issues when given in combo with other large doses of other anticonvulsants
-
topiramate
- 2nd gen, BS
- MOA: enhances GABA
- USES: partial and generalized seizures, migrane prevention, approved for weight loss
- AE: somnolence, fatigue, weight loss (can't be used in pregnancy)
- reduces OC plasma levels
-
zonisamide
- 2nd gen, BS
- MOA: inhibits T type Ca channels, prolongs inactivation state of Na channels
- USES: partial and generalized tonic-clonic seizures, includes absence seizures
- AE: somnolence, anorexia and dizziness
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