Epilepsy- nueropsych drugs

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Epilepsy- nueropsych drugs
2013-11-04 17:08:36
epilepsy drugs AE

adverse effect and drug
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  1. Carbamazepine 

    brand name? 
    Active metabolite? (enzyme? effect?)
    Labeled use and off label use?

    • CI: MAO inhiitor use within last 14 days or w/ use. 
    • concomitant nafazodone, hx of BM depression, hypersensitivites to TCA** 
    • concomitant delarirdine or NNRTIs
    • 10,11 epoxide are active metabolites and metabolized by epoxide hydrolase -> can get serum concentration
    • carbamazepine metabolized by Cyp 3A4
    • to its metabolites

    can exacerbate absence seizure and primary GTC

    • Equetro: acute mania, mixed episodes w/ bipolar 1 disorder
    • Carbatrol, tegretol and tegretal XR : mixed seizure patterns, trigeminal neuralgia, glossopharyngeal neuralgia

    • Off label use: restless leg syndrome, PTSD
    • 200mg BID
  2. Carbamazepine Acute, idiosyncratic, chronic 
    acute: CNS effects (diplopia, dizziness, ataxia, drowsiness, lethargy )

    • idiosyncratic: Blood dycrasis ** (BBW)
    • leukopenia - dc if WBC <2500 &ANC <1000

    Rash (BBW)- asian, 1502 allele (TEN/SJS)

    • Chronic: hyponatremia ( elderly, thiazide diuretic users at risk)
    • osteopathy
  3. Ethosuximide 
    • 1st line in absence. & only for absence
    • brand: zarontin

    • acute: ataxia
    • GI upset N/V (alleviate w/ lower dose commonly)
    • hiccups 

    • idiosyncratic : blood dyscrasias, rash
    • chronic behavioral changes, HA
  4. Felbamate
    CI ?
    • felbatol
    • patient should sign a consent form to use
    • CI in hepatic disease and hx of blood dyscrasis
    • acute: anorexia n/v insomnia
    • Idiosyncratic: Aplastic anemia (BBW) 
    • Acute hepatic failure (BBW) 
    • chronic : osteopathy
  5. Ezogabine
    • potiga
    • 1st in class 
    • MOA: K channel opener
    • active metabolite- NAMR
    • schedule 5 

    • Acute: confsional state, psychotic symptoms 
    • hallucinations (all 3 concentration dependent )

    somnolence, dizziness, vertigo, abnl coordination attention disturbance, memory impair 

    • idiosyncratic: QT prolongation 
    • Chronic: urinary retention(if w/ anticholinergic drug, worry)
    •  blue skin, retinal abnormalities (if turning blue, stop. not sure if reversible )
  6. gabapentin
    • enurontin
    • (never mono or 1st line) not effective 
    • off label: neuropathic pain, diabetic peripheral neuropathy , fibromyalgia, postoperative pain, restless leg syndrome, vasomotor symptoms

    acute: dizziness, fatigue, ataxia, aggressive behavior in children 

    • idiosyncratic: peripheral edema 
    • chronic: wt gain, abrupt discontinuation cause w/d syndrome (anxiety, insomnia, sweating)
  7. lacosamide
    vimpat, schedule v

    acute: dizziness, HA, N/V, ataxia,  QT prolongation (EKG prior, if cardiac issue, not CI but cautious)
  8. Lamotrigine 
    brnad? use? 
    • other label: maintenance tx bipolar 1 disorder
    • dose 25mg daily,
    • 25mg every other day w/ VPA, 50mg  w/ inducers 
    • all for 1-2 wks and specific guideline after. 

    • acute : ataxia, dizziness, diplopia, HA 
    • idiosyncratic: Rash (BBW), aseptic miningitis

  9. Levetriacetam
    • Keppra, 
    • FDA approved adjunctive, but always mono therapy especially for hepatic dysfunction 

    • acute: dizzy, drowsiness, 
    • idiosyncratic: behavioral disturbances/psychosis (if become agressive, take off!)
  10. Clobazam
    • onfil
    • schedule 4
    • active metabolite:
    • n- desmethylclobazam. 
    • can be used for pron in refractory patients. 
    • all benzos are antiseizure but not used for out pts as scheduled meds.

    • Actue: CNS depression, somnolence, lethargy
    • ataxia, drooling constipation

    idiosyncratic: anterograde amnesia

    chronic: physical and psychological dependence w/d symptoms (seizure, psychosis, hallucination,, etc) 
  11. Phenytoin
    dose, formulation 
    brand name (AE for other slide)
    • IV in NS 
    • 40% propylene glycol - hypotension and cardiac arrhythmias 
    • iv : phlebitis, extravasation of tissue
    • contraindication: delavirdine, other NNRTIS,
    • IV phenytoin: sinus bradycardia, sinoatrial block , adams strokes syndrome

    • dose: loading: 15-20mg/kg  followed by maintenance dose 100mg TID (q8h)
    • IV max : 50mg/min
    • ER capsules used for once a day (this is the formulation typically used)
    • IR IV: given TID
    • suspension: interact w/ tube feeding