AEDs

Card Set Information

Author:
DaBrainz
ID:
174612
Filename:
AEDs
Updated:
2012-10-01 00:36:20
Tags:
Seizure Drugs
Folders:

Description:
Antiepileptic Drugs
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user DaBrainz on FreezingBlue Flashcards. What would you like to do?


  1. Epilepsy
    • common neurological disorder
    • unprovoked seizures or abnormal electrical storms in the brain
    • commonly occurs in children

    • generalized: involves entire brain
    • focal/partial: one part and may or may not spread
    • NEVER DC meds abruptly due to seizure risk
  2. Partial Seizures Drugs
    • 1st line 
    •       Carbamazepine
    •       Lamotrigine
    •       Levetiracetam
    •       Oxcarbazepine
    • 2nd line
    •       Ezogabine, gabapentin, phenytoin, pregabalin, topiramate, valproate, zonisamide
  3. Absence (Petit-mal)
    • 1st line
    •      Ethosuximide
    •      Valproate
    • 2nd line
    •      Clonazepam, levetiracetam, zonisamide
  4. Atypical Absence, Myoclonic, Atonic
    • 1st line
    •      Lamotrigine
    •      Levetiracetam
    •      Valproate
    • 2nd line
    •      Clonazepam, felbamate, topiramate, zonisamide
  5. Generalized Tonic Clonic
    • 1st line 
    •     Lamotrigine
    •     Levetiracetam
    •     Valproate
    • 2nd line
    •     carbamazepine, oxcarbazepine, phenytoin, topiramate, zonisamide
  6. PHENYTOIN (DILANTIN)
    • DOSE: 100 mg TID (Max 600 mg/day)
    • Tx Range: 10-20 mcg/ml
    • AE: Sedation, Cognitive Impairment

    • NOTE: Mix Injection in NS ONLY
    • Max Infusion Rate: 50mg/min
    • Faster Infusion Rate can LEAD to: Severe Bradycardia, Hypotension
    • IV to Oral Ratio is 1:1
    • Phenytoin ER caps contain 8% less drug than chewable & suspension
    • Enteral Feeding MAY DECREASE dose; must separate
  7. TOXICITY SYMPTOMS (PHENYTOIN)
    • Ataxia/slurred speech
    • Nystagmus(wobbly eye balls)
    • Blurred vision, diplopia
    • Lethargy, drowsiness, headache
  8. Adverse Effects (Chronic Tx) with PHENYTOIN
    • Skin thickening of facial features
    • Lupus-like syndrome
    • Connective tissue disorders, gingival hyperplasia
    • Hirsutism
    • Peripheral neuropathies
    • Osteomalacia, osteoporosis
    • Vitamin D, calcium deficiency-causes bone loss, folate deficiency-can cause anemia: consider supplementation of each
  9. PHENYTOIN(DILANTIN)

    ADJUSTMENT with LOW ALBUMIN(<3.5 g/dL)
    • PHT correction=
    • PHT measured/((0.2 x alb) + 0.1)
  10. CARBAMAZEPINE(Tegretol, Tegretol XR, Carbatrol, Epitol)
    Indication: DOC for Partial Seizure; ALT Generalized Tonic Clonic, Trigeminal Neuralgia

    • Initial Dose: 100-200 mg BID, or daily if XR
    • Maintenance Dose: 400-1600 mg/day
    • Tx Range: 4-12 mcg/ml
    • SE: N, dizziness, drowsiness, HA, Fatigue, Blurred vision, diplopia
    • Black Box Warning: Serious skin rxns(SJS, TENS)
    • If Asian ancestry MUST be tested HLA-B1502; if POSITIVE DO NOT USE DRUG; Aplastic Anemia & Agranulocytosis
    • Monitor: LFTS, CBC & platelets
    • Potent CYP 450 Inducer & Autoinducer
    • Occasional/Rare SE:
    • Hepatotoxicity, check LFTs, Lupus Like Syndrome, SIADH/Low Na level
  11. OXCARBAZEPINE (TRILEPTAL)
    • Indication: Partial Seizures
    • Dose: 300-600 mg BID
    • Renal Dosing: CrCl <30 ml/min reduce dose(start 300 mg daily)
    • SE: Sedation, GI effects, diplopia, ataxia
    • Serious Skin Reactions: SJS TENS
    • **If rash with carbamazepine 20-30% chance with oxcarbazepine)
    • Hyponatremia: Monitor serum Na levels esp during first 3 mos, signs of CNS depression and seizure frequency
    • Potent 3A4 Inducer
  12. VALPROATE or VALPROIC ACID
    (DEPAKENE, STAVZOR)
    • Indicated: DOC for Absence(petit-mal), Atypical, Myoclonic, Atonic & Generalized Tonic Clonic. ALT: Partial  Formulation: solution or liquid filled capsules
    • Initial Dose: 125-250 mg BID
    • Maintenance Dose: 15-45 mg/kg/day
    • Tx Range: 50-100 mcg/ml
    • SE: GI upset, alopecia(treat with selenium and zinc), sedation, tremor and weight gain
    • Adverse Reaction: Thrombocytopenia
    • Black Box Warnings (3)
    •        1. Hepatic Failure-LFTs must be checked prior to start, frequently during the 1st 6 months, and periodically thereafter
    •        2. Teratogenicity-including neural tube defects(spina bifida)
    •        3. Pancreatitis-Fatal in children and adults

    MONITOR: LFTs, CBC, platelets
  13. LAMOTRIGINE (LAMICTAL, LAMICTAL ODT(orally dispersable), LAMICTAL CD(chewable), LAMICTAL XR)
    Indication: Adjucnt Tx for Partial seizures, or conversion to primary therapy from older drugs

    • Dose: Wk 1 and 2: 50 mg/day
    •          Wk 3 and 4: 100 mg/day
    •          Wk 5: 200 mg/day
    •          Wk 6: can increase by 100 mg every 1-2 wks, max 400 mg/day

    • ** Divide BID, unless using XR***
    • SE: N, diploplia, sedation, ataxia, HA
    • Black Box Warning: Serious Skin Rxns(SJS, TENS); Chances INCREASED if used with VALPROIC ACID(increase levels of Lamotrigine 2 FOLD)

    INCREASE risk of ASEPTIC MENINGITIS(FDA 2010)

    PREGNANCY CATEGORY: C
  14. ETHOSUXIMIDE (ZARONTIN)
    • Indication: DOC for Absence Seizures
    • Dose: Start 200-500 mg/d
    • SE: Blood dyscrasias, SLE, effects on renal and hepatic function
  15. TOPIRAMATE
    • TOPAMAX
    • Indication: adjunct for partial seizures
    • dose: Wk 1 - 25mg BID
    •          Wk 2 - 50mg BID
    •          Wk 3 - 75mg BID
    •          Wk 4 - 100mg BID
    •          Wk 5 - 150mg BID
    •          Wk 6 - 200mg BID
    • S/E: oligohydrosis/hyperthermia (mainly kids-limit sun;hydrate), Nephrolithiasis (hydrate); paresthesias, memory problems, attention deficit, weight loss
    • Decreases HCO3
    • acute myopia & secondary narrow-angle glaucoma
    • Pregnancy D: oral clefts if mother takes while pregnant

  16. CLONAZEPAM
    • KLONOPIN - Benzodiazepine (BZD) C IV
    • Use: Alt for absence, myoclonic, atonic
    • dose: 0.5mg BID-TID (max dose: 20mg/d)
    • S/E: somnolence, ataxia, cognitive impairment, depression, mood changes, dependence
    • Do NOT discontinue abruptly - seizures can result 
    • Panic attacks can occur if dosing interval missed
  17. LEVETIRACETAM
    • KEPPRA, KEPPRA XR
    • Use: adjunct for partial, atypical absence, myoclonic, atonic, tonic clonic
    • Use: alt for absence
    • dose: 500-1500mg BID
    • S/E: somnolence, behavior changes, vomiting, weight loss, hematologic/hepatotoxicity (rare)
    • No significant DDIs
  18. ZONISAMIDE
    • ZONEGRAN
    • Use: adjunct for partial
    • dose: 100-600mg/d
    • S/E: HA, confusion, anorexia, weight loss, somnolence, serious skin rxns (SJS, TEN) oligohydrosis/hyperthermia (mainly kids-limit sun;hydrate); nephrolithiasis; aplastic anemia, metabolic acidosis
    • Do NOT use if SULFA allergy

What would you like to do?

Home > Flashcards > Print Preview