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Anticonvulsant Agents

Simple Partial other name? Focal Epilepsy.
Simple Partial characteristic No impairment of consciousness - Awake and aware Jerking arm, leg, face then next steps (Jacksonian March) Unexplained fear, sadness, anger, joy Nausea, odd smells, funny feeling stomach
Complex Partial other name? Teporal Lope or Psychomotor
Complex Partial characteristic Impairment Consciousness - Unaware surrounding Unresponsive w actions that are clumsy not direct: Picking cloths, take off cloths ... May experienced structured hallucinations
Gerneralized Tonic - Clonic other name Grand Mal
Tonic - Clonic characteristics Loss of consciousness Suddend cry, fall --> muscle jerks --> Suspend breathing, loss of bladder control (temporary) Only few minutes then normal breathing Tense - Clicking
Absence other name? Petit Mal
Absence characteristics BRIEFLY impairment or loss of consciousness in children (50% out grow) Blank stare for a few second May have rapid blinking, chewing movement Return after seizures
Atonic other names Drop attacks
Atonic Characteristics Sudden collapse to floor (10s - 1m) Difficult to treat
Myoclonic SUDDEN, BRIEF, massive muscle jerks involves whole body Spill what they are holding or fall off chair
Infantile Spasm other name? West's Syndrome
Infantile Characteristics Children 3 months - 2 years old Sitting - Head forward, arm forward Lying down, kees drawn up, arm, head forward
Partial Seizure treatment Carbamazepin Oxcarbamazepin Lamotrigine = DOC Levetiracetam
Tonic Clonic treatment Valproic Acid Levetiracetam Lamotrigine
Absence treatment Ethosuximide Valproic Acid
Myoclonic treatment Valproic Acid / Lamotrigine - Use in children / Adj: Levetiracetam /
Infantile treatment Phenobarbital (also used to Febrile but now Diazepam) Vigabatrin (mono therapy)
Agents are Gaba - T enzyme inhibitor Vigabatrin, Valproic Acid
Agents are Gaba reuptake inhibitor Tiagabine
Agents enhance Glutamic acid decarboxylase Vaproic Acid, Gabapentrin
Agents are Votage-gated Na+ channel Inhibitor Phenytoin Felbamate Carbamazepine Vaproic Acid Oxycarbazepine Lamotrigine Topipramate Zonisamide - Rufinamide
Agents are T-Type Ca2+ inhibitor Zonisamide / Ethosuximdi/ Lamotrigin / Valproic acid
Agents are N-Type Ca2+ inhibitor (a2d) Gabapentin, Pregabalin
Glutamate AMPA receptor antagonist Phenobarpital Topiramate
Glutamate NMDA receptor blockage Glycine binding site Felbamate
Do not use Absence --> Worsens Phenytoin Carbamazepine
Do not use Myoclonic Carbamazepine
Phenytoin ADRs dose related Sedation, Ataxia, Nystagmus, Diplopia (SAND)
Phenytoin ADRs Non-dose related Acne Coarseing of facial fetures Gingival Hyperplasia Hirsutism RASH - Stop immediately Purple Glove Syndrome(IV) CYP 450 inducer Osteomalacia - Vit D Hemorrhage - Vit K Megaloblastic Anemia - Folic Acid Intellectual impair
Phenytoin indication Oldest non-sedative agent (low dose) 2nd Partial - Tonic-Clonic Sustained control Status Epilepticus
Lennox-Gastaut 2-6 years of age Seizure everyday Multiple Seizure
Fosphenytoin Injectable prodrug of Phenytoin - DOES not appear Purple Glove Syndrome
Agents associated with Rash Phenytoin, Carbamazepin, Lamotrigine
Phenytoin interaction? Valproic Acid --> Displace Phenytoin from albumin and inhibit its metabolism
Rufinamide MOA Prolong inactive state Na+ channel
Rufinamide Indication Adj Lennnox Gastatut Syndrome in patient > 4 YEARS Take with Food --> Bioavailability
Rufinamide ADRs Sonolence, Headache, Abormal Vision, Nause Can shorten QT (Avoid Digoxin or Magnesium - shorten PT)
Carbamazepine MOA Inhibits voltage gate Na+ channel
Carbamazepine indication Partial Seizure - DOC / Trigeminal Neuralgia / Bibolar Disorder (patient non responsive Lithium)
Carbamazepine contraindication? Absence and Myoclonic
Carbamazepin ADRs # Phenytoin - (S)AND Leukopenia (10%) ADH release - HYPONATREMIA Inducer own metabolism --> Increase dose 1st month RAsh APLASTIC ANEMIA (1:20.000) COGNITIVE IMPAIRMENT (Less Phenytoin but STILL moderate)
Oxcarbazepine Prodrug --> MDH active form / Na+ channel HYPONATREMIA more that Carbamazepine LESS CYP450 induction, less drug interaction than Carbamazepine
Phenobarbital MOA 1. Bind GABA receptor Enhance GABA 2. Block AMPA
Phenobarbital Indication DOC of Infantile and Febrile (but now Diazepin preferred for Febrile)
Phenobarbital ADRs SEDATION (than Phenytoin, Carbamazepin) PARADOXICAL HYPERACTIVTY, behavior changes in children INDUCE CYP 450 - Power Associated Vi K - Hemorrhage
Agents associated with Cognitive Impairment Phenytoin / Carbamazepine / Phenobarbital - WORST / Topiramate - 2nd/ Tiagabine /
Primidone Prodrug --> PHENOBARBITAL + PEMA Less PARADOXICAL HYPERACTIVITY than Phenobarbital CYP450 inducer
Felbamate MOA 1. GABA active 2. NMDA 3. Na+
Felbamate indication Comlex partial Adjunct in Lennox-Gastaut
Felbamate ADRs Aplastic Anemia Severe Hepatitis (Pull from the market - REstated INFORM CONSENT)
Felbamate Favorable Less cognitive effects
Lamotrigine MOA Inhibit RELEASE GLUTAMATE Ca2+ Na+
Lamotrigine Indication DOC - PARTIAL SEIZURE / Myoclonic on Children (Valproic Acid - DOC) / BIPOLAR DISORDER
Lamotrigine ADRS RASH 10% Interact with Vaproic Acid --> Increase Lamotrigine
Lamotrigine ADRs Advantage Little Cognitive impairment
Topiramate MOA GABA / AMPA / Na+
Topiramate Indication NOT 1st choice for any Seizure / Adj Lennox Gastaut > 2 YEARS / Migraine Prophylaxis / Piopar Disorder
Topiramate ADRs Weight Loss (+ Pheteramine) Nephrolithiasis FLAT EFFECTS (70%) COGNITIVE Worst 2nd
GABAPENTIN MOA PREGABALIN DO NOT bind GABA Bind a2d Voltage Ca2+ Channels (type N)
GABAPENTIN Indication ADJUNCT Parial and Tonic-clonic (not mono)
Gabapentin ADRS Dizziness, Drowsiness, Ataxia, Edema, WEIGHT GAIN
Gabapentin Advantage No drugs interaction (# Levetiractam)
Pregabalin indication Neuropathic Pain, Fibromyalgia
Vigabatrin MOA Inhibit GABA - Transaminase
Vigabatrin Indication Mono therapy for INFANTILE
Vigabatrin ADRs Concentrically Constricted Visual Fields (1/3 patients)
Tiagabine MOA Inhibits GABA reuptake
Tiagabine Indication ADJUNCT partial seizure
Tiagabin ADRs More GABA --> Cognitive impairment
Levetiracetam MOA Bind to SV2A protein on synaptcic Vesicles / Metabolize = Hydrolysis --> Not CYP450 --> no drug interaction
Levetiracetam Indication 1ST for Partial and Tonic-Clonic
Levetiracetam most Favorable Less cognitive effects / NO DRUGS INTERACTION
Ethosuximide MOA Ca2+ T Type
Ethosuximide Indiation DOC Absence (Vaproic also)
Ethosuximide ADRs GASTRIC DISTRESS (40%) - Pain N/V: Slowly increase dose to prevent / Ataxia, Rash, hepatoxicity, lupus - like, Drowsiness
Zonisamide MOA Ca2+ T Type Na+
Zonisamide Indication Absence (Ca2+) Actually Broad Spectrum
Zonisamide ADRs Dizziness, Somlonance / Nephrolithiasis (Topipramate) / weigh loss (Big agent is Topiramate) / RARE OLIGOHYDROSIS , Hyperthermia , Heat Stroke ,
Zonisamide contraindication Sufonamide Hypersensity
Benzodiazepines (Clonazepam) MOA GABA - Frequency
Clonazepam Indication 2nd line Absence, Myoclonic, Atonic
Clonazepam ADR's SEDATION / TACHYPHYLASIS (rapid tolerance 1-6 months) / PARADOXICAL HYPERACTIVITY
Diazepam Indication DOC Febrile STATUS EPILEPTICUS (not chronic treatment)
Why Diazepam could use for status epilepticus (emergency) High Lipophilicy fast to brain
Why Diazepam associated with return seizure High lipophilicy fast to brain then fast redistribute to tissue stuck there --> reduce concentration
How to stop return seizure with Diazepam treatment Combine Phenytoin or Fosphenytoin or Phenobarbital
Lorazepam Sometimes IV instead Diazepam - Action prolong, less Lipophilic --> not quick redistribution
Valproic Acid MOA GABA-Transaminase Na+ + Mildly Ca+ Stimulate Glutamic Acid Decarboxylase
Valproic Acid Indication - 1st Atonic, Myoclonic, Tonic-Clonic - DOC Absences - Migraine prophylaxis - Bipolar Disorder (Broad spectrum)
Valproic Acid ADRs GI DISTRESS (N/V) SEVERE idiosyncratic (individual) HEPATOXIC (high risk for thow , 2 YO) WEIGH GAIN (BIG PROBLEM) Minimal Cognitive (BIG ADVANCE) Teratogenic - Spinal bidifa ALOPECIA; PICOS
Agents have more than 2 MOAs Felbamate Lamotrigine Topiramate Vaproic Acid
Anticonvulsant agents most weigh gain ? VALPROIC ACID Gabapentin
Valproic Acid Big Problem? Weight Gain
Valproic Acid big advance? Less Cognitive
Which agent have ALOPECIA (different hair color) Valproic Acid
Which agent have PCOS (Polycystic Ovary Syndrome) Valproic Acid
Which Agent have pancreatitis Valproic Acid
Which agent have own metabolism Carbamazepin Valproic Acid
Which agent displace phenytoin from plasma Valproic Acid
Which agent inhibits Metabolism of Phenobarbital, Phenytoin (CYP 2C9 subtrates) Valproic Acid
Which agent double plasma concentration of Lamotrigine --> Rash Valproic Acid
Which AEDs have 40% Gastric Distress as side effects? Ethosuximide
Which AEDs caused irreversible concentrically constricted visual fields? Vigabatrin
Which AEDs cause hyponatremia Carbamazepine Oxcarbazepine
which agent inhibit CYP 450 Valproic Acid
Created by: nguyenthientoai



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