Therapeutics - Epilepsy 3

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Therapeutics - Epilepsy 3
2015-03-20 17:37:50
Therapeutics Epilepsy
Therapeutics - Epilepsy
Therapeutics - Epilepsy
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  1. Levetiracetam Primary Mechanism:
    Unknown-binds to synaptic vesicle protein (SV2A)
  2. Levetiracetam FDA approved Indications:
    • Partial (adjunct),
    • 1º generalized tonic-clonic (adjunct), myoclonic (adjunct)
  3. Levetiracetam Adverse effects:
    Common: Somnolence or asthenia, psychotic symptoms
  4. Levetiracetam Monitoring:
  5. Levetiracetam Inducer/Inhibitor:
  6. Levetiracetam Considerations:
    Not protein bound, so no binding interactions. Dose adjustment for renal dysfunction.
  7. Oxcarbazepine Primary Mechanism:
    Inhibition of Na+ channels
  8. Oxcarbazepine FDA approved Indications:
    • Partial ,
    • not absence
  9. Oxcarbazepine Adverse effects:
    Common: CNS, GI, hyponatremia
  10. Oxcarbazepine Monitoring:
  11. Oxcarbazepine Inducer/Inhibitor:
  12. Oxcarbazepine Considerations:
    Not autoinducer. CBZ Cross allergy possible. Pro-drug.
  13. Perampamel Primary Mechanism:
    Non-competitive AMPA receptor antagonist
  14. Perampamel FDA approved Indications:
    Partial (adjunct)
  15. Which drug is an auto-inducer?
    • Carbamazepine
    • Auto-induction begins within 3-5 days – seizure activity breaks through
    • Completse at 4 weeks
  16. What is the therapeutic range for Carbemazapine?
    4-14mcg/ml (dosed to effect)
  17. What labs must be monitored for patients taking carbamazepine? When must the drug be stopped? What is the risk associated with the side-effect in question?
    • Check WBC early in therapy
    • Blood dyscrasias Black box warning: Aplastic Anemia, Thrombocytopenia and Leukopenia
    • Stop therapy if WBC<2500/mm3 or ANC<1000/mm3
  18. What ethnic group is most at risk for SJS with carbamazepine use? How is this determined?
    • Asian
    • HLA-B*1502 antigen presence
  19. What is the drug of choice for patients with absence seizures alone?
    Ethosuximide (Zarontin)
  20. Why is felbamate reserved for patients with refractory seizures?
    • Due to its toxicity profile: Aplastic Anemia (1:3000) and Acute liver failure (1:10,000)
    • Get LFTs and CBCs while using
  21. Why must gabapentin be dosed three times a day?
    • Saturable carrier protein mediated absorption limits dose
    • half-life is only 8 hours
  22. Perampamel Adverse effects:
    • Common: CNS, weight gain
    • Rare: Psychiatric effects (suicidal/
    • homicidal ideation, aggression)
  23. Perampamel Monitoring:
  24. Perampamel Inducer/Inhibitor:
  25. Perampamel Considerations:
    Average t1/2=105 hours, dose adjust if hepatic impairment (do not use if severe).
  26. Phenobarbital- Primidone Primary Mechanism:
    GABA rcptr agonist, glutamate inhibition, Na+, Ca++ and K+ modulation
  27. Phenobarbital- Primidone FDA approved Indications:
    • Partial,
    • 1º generalized tonic-clonic
  28. Phenobarbital- Primidone Adverse effects:
    Common: Cognitive and behavioral, sedation, nystagmus
  29. Phenobarbital- Primidone Monitoring:
    Drug level
  30. Phenobarbital- Primidone Inducer/Inhibitor:
  31. Phenobarbital- Primidone Considerations:
    Not primary for any adult seizures. Primidone is pro-drug of Phenobarb.
  32. Phenytoin Primary Mechanism:
    Inhibition of Na+ channels