Therapeutics - Epilepsy 1

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Author:
kyleannkelsey
ID:
298796
Filename:
Therapeutics - Epilepsy 1
Updated:
2015-03-20 17:35:31
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Therapeutics Epilepsy
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Therapeutics - Epilepsy
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Therapeutics - Epilepsy
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  1. Carbamazepine Primary Mechanism:
    Inhibition of Na+ channels
  2. Carbamazepine FDA approved Indications:
    • Partial,
    • 1ยบ Generalized Tonic-clonic , not absence, not myoclonic
  3. Carbamazepine Adverse effects:
    • Common: CNS, rash
    • Rare: leukopenia,
    • thrombocytopenia, aplastic anemia, SJS (caution in those of Asian descent)
  4. Carbamazepine Monitoring:
    Platelets, white cells, drug level, HLA-B*1502 (if applicable)
  5. Carbamazepine Inducer/Inhibitor:
    Inducer
  6. Carbamazepine Considerations:
    Not for myoclonic or absence seizures (may worsen). Autoinducer. DC if WBC<2500/mm3, ANC<1000/mm3.
  7. Eslicarbazepine Acetate Primary Mechanism:
    Enhances slow inactivation of Na+ channels
  8. Eslicarbazepine Acetate FDA approved Indications:
    Partial (adjunct)
  9. Eslicarbazepine Acetate Adverse effects:
    Common: dizziness, somnolence, headache
  10. Eslicarbazepine Acetate Monitoring:
    Platelets, drug level
  11. Eslicarbazepine Acetate Inducer/Inhibitor:
    None
  12. What is the difference between a seizure and a convulsion?
    • Seizure: Brief, episodic neuronal discharge, causes disturbances of consciousness, movement, senses, behavior, or any combination thereof
    • Convulsion: Series of muscle contractions, Violent
  13. Which neurotransmitters inhibit seizures? Which propagate them?
    • Inhibitor: GABA
    • Propagator: Glutamate and Aspartate
  14. What are the potential consequences of not controlling seizures adequately?
    • Development of:
    • Increase in frequency
    • New seizure types
  15. How are focal seizures categorized?
    With or without impairment
  16. Briefly describe the characteristics of the generalized seizures.
    • Tonic-Clonic
    • Absence (Usually childhood onset) = Looks like daydreaming, or staring
    • Atonic (Rare and usually confined to childhood)
    • Drop seizure = patient goes limp (fully or partially)
    • Myoclonic (Typically childhood onset and in combination with other seizure types)
  17. When should chronic therapy begin?
    Defiantly after a second seizure, but may be started after 1st as well
  18. Eslicarbazepine Acetate Considerations:
    Long t1/2 so can be dosed qd. Adjust for renal dysfunction. Possible cross allergy with oxcarbazepine.
  19. Ethosuximide Primary Mechanism:
    Believed to inhibit T-type Ca++ channels
  20. Ethosuximide FDA approved Indications:
    Absence
  21. Ethosuximide Adverse effects:
    • Common: N/V (usually transient), CNS
    • Rare: SJS, blood dyscrasias, Lupus-like syndrome
  22. Ethosuximide Monitoring:
    Platelets, drug level
  23. Ethosuximide Inducer/Inhibitor:
    None
  24. Ethosuximide Considerations:
    Long t1/2 so can dose qd (if tolerated). Therapeutic range 40-80mcg/ml.
  25. Ezogabine Primary Mechanism:
    Modulates K+ channel
  26. Ezogabine FDA approved Indications:
    Partial (adjunct, refractory)
  27. Ezogabine Adverse effects:
    • Common: CNS, urinary retention (REMS), QT prolongation
    • Rare:Psychosis, suicidal ideation, blue discoloration, retinal toxicity
  28. Ezogabine Monitoring:
    SCr and LFTs, urinary fxn, ophthalmologic exams
  29. Ezogabine Inducer/Inhibitor:
    None

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