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IOS8

Exam1 (seizure/pain meds)

QuestionAnswer
MOA of vigabatrin Enhance GABA levels by inhibiting GABA transaminase
MOA of Tiagabine Blocks the reuptake of GABA
MOA of gabapentin Accumulation & enhancement of GABA release; binds to alpha-2-delta subunit of voltage-sensitive L-type Ca channels to reduce inward Ca current
MOA of pregabalin Accumulation & enhancement of GABA release; binds alpha-2-delta subunit of voltage-gated Ca channel, modulating the release of glutamate, NE, and substance P
MOA of Barbiturates Enhance Cl conductance through GABA-A, thereby enhancing GABA
MOA of Benzodiazepines Enhance Cl conductance through GABA-A, thereby enhancing GABA
MOA of topiramate Enhance GABA; block Na channels; block L-type Ca channels; blocks Kainate glutamate receptors, weak carbonic anhydrase inhibitor
MOA of Felbamate Enhance GABA; blocks NMDA receptors
MOA of Valproate Enhance GABA; blocks Na channels; blocks T-type Ca channels in thalamus (absence)
MOA of phenytoin blocks Na channels
MOA of Carbamazepine blocks Na channels
MOA of lamotrigine blocks Na channels; blocks glutamate release
MOA of Primidone enhances GABA (like 3 drugs wrapped into one with phenobarbital being the most active)
MOA of oxcarbazepine blocks Na channels
MOA of zonisamide blocks Na channels; blocks T-type Ca channels in thalamus (absence), carbonic anhydrase inhibitor
MOA of lacosamide Selective enhancement of Na channel; slow inactivation. Binds to CRMP-2.
MOA of levetiracetam Enhances the function of SV2A that inhibits abnormal bursting in epileptic circuits.
Enzyme Induction Phenobarbital, phenytoin, primidone, carbamazepine (autoinduction), felbamate, topiramate (above 200mg/day), oxcarbazepine (higher doses), vigabatrin
Enzyme inhibition Valproic acid, felbamate, oxcarbazepine (mild), topiramate (mild), vigabatrin
AEDs with aromatic rings that can show cross-reactivity Phenytoin, carbamazepine, phenobarbital, oxcarbazepine, lamotrigine (metabolite)
Causes of breakthrough seizures Nonadherence, insomnia, emotional/physical stress
Monitoring AED therapy LFTs, CBC, platelets, Chem 8, neurological exam and patient report, serum level (trough if short t1/2)
MOA of ethosuximide Blocks T-type Ca channels in thalamus (absence)
MOA of phenobarbital enhances GABA
Indications of Phenobarbital GTCS, PS, SE
Indications of phenytoin GTCS, PS, SE
Side Effects of Phenytoin gingival hyperplasia, hirsutism
Indications of Primidone GTCS, PS
Side effects of ethosuximide hiccups, aggression, nightmares, GI upset
Indications of valproate Broad spectrum, PS, GTCS, pain, migraine prophylaxis, bipolar, absence
Side effects of valproate tremor, weight gain, hair thinning (less with ER), hepatotoxicity Increases conc. of lamotrigine (reduce dose by 50%)
Indications of carbamazepine PS, GTCS, bipolar, pain, (can make absence worse)
Side effects of carbamazepine visual distortion, SIADH, cardiac arrhythmias
Indications of felbamate LGS, GTCS, PS Use only in patients that are unresponsive to other AEDs
Side effects of felbamate insomnia, weight loss, aplastic anemia, liver failure, rash (SJS)
Indications of lamotrigine LGS, GTS, PS, absence, myoclonic, bipolar Metabolized by the liver (glucuronidation)
Side effects of lamotrigine visual distortion, weight neutral, Rash (titrate dose slowly to prevent SJS or TEN) Reduce dose by 50% with valproate Double dose with carbamazepine
Indications of gabapentin PS (add-on), pain, post herpatic neuralgia
Side effects of gabapentin edema, weight gain, thinking problems Renal elimination
Indications of topiramate LGS, PS, GTCS, myoclonus, bipolar, migraine
Side effects of topiramate paresthesias, weight loss (dose dependent), kidney stones (drink water), decreased cognition, acute myopia, and secondary glaucoma
Side effects of levetiracetam somnolence, fatigue, incoordination, behavioral changes (monitor psychosis), dizziness
Clinical pearls of oxcarbazepine Measure MHD plasma levels, monitor Na, dose at 1.2-1.5 times daily dose of CBZ
Metabolism of zonisamide glucuronidation, kidney elimination, sulfonamide derivative
Side effects of zonisamide kidney stones, weight loss, parasthesias
MOA of rufinamide Prolongation of the inactive state of Na channels
Created by: 1297689939
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