Therapeutics - Epilepsy 4

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Therapeutics - Epilepsy 4
2015-03-20 17:40:13
Therapeutics Epilepsy
Therapeutics - Epilepsy
Therapeutics - Epilepsy
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  1. Valproic Acid/Divalproex Na+ Primary Mechanism:
    Increases GABA concentration, probable inhibition of Na+ and Ca++ channels
  2. Valproic Acid/Divalproex Na+ FDA approved Indications:
    • Absence,
    • Partial
  3. Valproic Acid/Divalproex Na+ Adverse effects:
    • Common: GI upset, tremor, alopecia, weight gain or anorexia, drowsiness
    • Rare: hepatotoxicity, thrombocytopenia
  4. Valproic Acid/Divalproex Na+ Monitoring:
    Platelets, LFT’s, drug level
  5. Valproic Acid/Divalproex Na+ Inducer/Inhibitor:
  6. Valproic Acid/Divalproex Na+ Considerations:
    Effective for all seizure types. Formulations interchangeable, but not dose/dose. Pregnancy category X.
  7. Zonisamide Primary Mechanism:
    Inhibition of Na+ and Ca++ channels, may enhance GABA release
  8. Zonisamide FDA approved Indications:
    Partial (adjunct)
  9. Zonisamide Adverse effects:
    • Common: CNS, anorexia, psychosis (2%)
    • Rare: SJS, TEN
  10. Zonisamide Monitoring:
  11. Zonisamide Inducer/Inhibitor:
  12. Zonisamide Considerations:
    Possible cross allergy with sulfa. Titrate doses at 2 week intervals.
  13. What are the general rules for the initiation of anti-epileptic drug therapy?
    • Goal is to decrease frequency
    • Begin low and go slow
    • Seizure control and side-effects must be in balance
  14. Which drugs are controlled substances?
    • Ezogabine-(V)
    • Lacosamide-(V)
    • Perampamel-(III)
    • Phenobarbital-(IV)
    • Pregabalin-(V)
  15. Which drugs are available in IV form?
    • Lacosamide
    • Phenytoin
    • Valproic acid
  16. What drugs require dose adjustments when switching from one formulation to another? What are the adjustments?
    Valproic acid: Switching from enteric coated form to ER requires 8-20% dose increase
  17. Which patients being considered for lacosamide therapy need to undergo special screening, and which test is indicated?
    • May cause Atrial Fibrillation/Flutter: Caution in DM, autonomic neuropathy and pre-existing CVD
    • Asymptomatic AV Block: Caution in conduction abnormalities (AV block, sick sinus syndrome without pacemaker), heart failure, cardiac ischemia
    • Test: ECG
  18. What is the conversion factor of IV to PO antiepileptic drugs?
  19. How does vigabatrin affect vision?
    Permanent peripheral visual field defects
  20. Which drug is associated with urinary retention, and which patients are at risk?
    • Ezogabine
    • Caution in: Dementia, BPH, high anticholinergic load in the in medications and elderly
  21. Vigabatrin Primary Mechanism:
    Inhibition GABA-T
  22. Vigabatrin FDA approved Indications:
    • Complex Partial (adjunct, refractory)
    • (Also infantile spasms in children)
  23. Vigabatrin Adverse effects:
    • Common: CNS, Peripheral visual field defects
    • Rare: Psychiatric symptoms, neuropathy, edema
  24. Vigabatrin Monitoring:
    Ophthalmologic exams (REMS)
  25. Vigabatrin Inducer/Inhibitor:
  26. Vigabatrin Considerations:
    For severely refractory seizures only in adults, currently only available through select mail order pharmacies via SHARE Program
  27. What is the brand name for Carbamazepine
  28. What is the brand name for Eslicarbazepine Acetate