AEDs

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mp
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205475
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AEDs
Updated:
2013-03-06 18:08:53
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Pharmacology II AEDs
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AEDs
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  1. Phenobarbital -- moa
    • enhances GABA mediated Cl influx
    • also blocks glutamate AMPA receptors
    • may worsen absence
  2. Phenobarbital -- A/E
    • sedation
    • diplopia, ataxia, nystagmus
    • skin rxns
  3. Primidone (Mysoline)
    • active metabolites -- Pb and PEMA
    • may worsen absence
    • A/E -- sedation, N/V, blood dyscrasis
  4. Phenytoin (Dilantin)
    • block VSSCs
    • Gingival hyperplasia, hirsutism, skin rxns, osteomalacia, blood dyscrasias
  5. Fosphenytoin (Cerebyx)
    • prodrug of phenytoin
    • DOC in status epilepticus
  6. Ethosuximide (Zarontin)
    • Absence; may worsen grand mal
    • decreases low threshold T-type Ca current
    • sedation, HA, hiccough, photophobia
  7. Trimethadione (Tridione)
    • absence in pts refractory to ethosuximide
    • sedation, blood dyscrasias -- neutropenia (20%), SLE
  8. Carbamazepine (Tegretol) also TCA
    • DOC in simple and complex partial seizures
    • blockade of VSSC
    • induces microsomal enzymes
    • SJS -- 10x more common in asians with HLA-B 1502 allele
  9. Valproic Acid (Depakene)
    • broad spectrum drug, absence and mixed types with absence
    • blockade of VSSC and T-type Ca channels, also increases GABA
    • Hyperammonemic encephalopathy, hepatotoxicity, alopecia and blood dycrasias
  10. Lamotrigine (Lamictal)
    • blockade of VSSC and T-type Ca channels
    • may make myclonus worse
    • N/V, blood dyscrasias, skin rash can progress to SJS
  11. Felbamate (Felbatol)
    • block VSSC and may increase GABA may also block NMDA
    • treating refractory seizures -- reserved drug
    • aplastic anemia, acture liver failure
  12. Gabapentin (Neurontin)
    • increase of GABA and alter GABA transporters
    • partial seizures
    • somnolence, dizziness, ataxia, fatigue
  13. Tiagabine (Gabitril)
    • adjunct. therapy in pts >12 yo with partial seizures
    • inhibits GABA uptake in neurons and glia
    • nervousness, dizziness, tremor, psychosis
  14. Topiramate (Topamax)
    • blocks VSSC, also potentiates GABA, blocks glutamate AMPA receptors, also T-type Ca channels
    • fatigue, dizziness, drowsiness, acute myopia, glaucoma, urolithiasis
    • no wt gain
  15. Levetiracetam (Keppra)
    • partial and generalized tonic clonic
    • increase in GABA, block Na, K, Ca, channels and modulates SV2A
    • weakness, dizziness and somnolence
  16. Diazepam (Valium)
    • status epilepticus
    • tolerance develops quickly
  17. Clonazepam (Klonopin)
    absence and akinetic and myoclonic seizures
  18. Clorazepate (Tranxene)
    adjunct in complex partial seizures
  19. Lorazepam (Ativan)
    status epilepticus
  20. Zonisamide (Zonegran)
    • partial but has broad spectrum
    • blocks VSSC and T-type Ca channels
    • sulfonamide
    • does not interact with other AED
  21. Vigabatrin (Sabril)
    • partial seizures, infantile spasms
    • irreversible inhibitor of GABA transaminase
    • visual field loss in 1/3 of pts, wt gain
  22. Pregabalin (Lyrica)
    • partial seizures
    • same as gabapentin
    • somnolence, ataxia, dizziness
  23. Lacosamide (Vimpat)
    • add-on with partial seizures
    • slow inactivation of Na channels
    • HA, N, diplopia
  24. Rufinamide (Banzel)
    • Lennox-Gastaut syndrome, difficult to treat syndromes
    • inactivation of Na channels
    • QT shortening, HA, N, somnolence
  25. Ezogabine (Potiga)
    • adjunct in partial seizures
    • facilitator of K channels
    • bladder dysfunction (8-9%), confusion, somnolence, blurred vision
  26. PerAMPAnel (Fycompa)
    • adjunct in partial seizures
    • antagonist of AMPA gluatamate receptor
    • drowsiness, dizziness
    • wt gain, mood changes, N, visual disturbances
  27. Stiripentol (Diacomit)
    • orphan drug in tx of severe myclonic epilepsy in infancy
    • unique GABA-a receptor agonist
  28. Acetazolamide (Diamox)
    • adjunct in petit mal
    • CA inhibitor in the seiure focal area
    • sulfonamide
  29. DOC in Partial, including secondarily generalized seizures
    • Lamotrigine
    • Carbamazepine
    • Levetracetam
    • Oxcarbazepine
  30. DOC in Primary generalized tonic-clonic
    • Valproate
    • Lamotrigine
    • Levetracetam
  31. DOC in Absence
    • Ethosuximide
    • Valproate
  32. DOC atypical seizures
    • Valproate
    • Lamotrigine
    • Levetracetam

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