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anti-convulsants

Key points, ADRs, review for Naplex/CPJE 2016

QuestionAnswer
Cause kidney stones topiramate (Topamax) zonisamide (Zonegran) * drink plenty of water to reduce risk
sulfonamide anti-convulsant zonisamide (Zonegran) and topiramate (topamax)
Dose conversion between fosphenytoin and phenytoin Fosphenytoin 125-150mg = phenytoin 100mg
Free phenytoin level calculation for albumin < 4 measured conc / [(0.2 x albumin) + 0.1]
Free phenytoin level calculation for CrCl < 10 measured conc / [(0.2 x albumin) + 0.1]
Phenytoin therapeutic range 10-20mcg/mL > 20 mcg/mL = lateral nystagmus, > 30 ataxia, > 40 decreased mentation, > 100 death Free phenytoin level: 1-2.5
Phenytoin ADRs P-450 inducer Hirsutism Enlarged gums Nystagmus Yellow-browning of skin Teratogenecity Osteomalacia Interference with B12 metabolism (hence anemia) Neuropathies (verigo, ataxia, headache)
Autoinduction Carbamazepine (~ 21 days)
BBW of VPA hepatoxicity especially in children < 2 yo pancreatitis teratogenecity
BBW carbamazepine blood dyscrasias SJS (esp in asians + for HLA-B*1502)
Schedule of Fycompa (perampanel) C-III
Schedule of Phenobarb C-IV
Schedule of clobazam (Onfi) C-IV
Schedule of pregablin (Lyrica) C-V
Schedule of Lincosamide (Vimpat) C-V
Schedule of ezogabine (Potiga) C-V
Severe life-threatening rash esp when co-administered with VPA lamotrigine (Lamictal)
DOC for absence seizures ethosuximide (Zarontin)
Max IV rate for phenytoin 50mg/min
Phenytoin IV solution NS only due to propylene glycol
Oligohidrosis Zonisamide
Treatment of febrile seizures diazepam or lorazepam
Dose of Phenytoin for status epilepticus 15-20mg/kg LD 5-6 mg/kg/d divided TID (~300mg/d)
Created by: lukaszewiczj
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