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RxPrep
Epilepsy (70)
| Question | Answer |
|---|---|
| General first-line concept for chronic seizure management? | Start with 1 ASM and titrate; add/switch if needed |
| What is a common last-line/add-on approach for severe refractory epilepsy? | Biologics/cannabinoid/ketogenic diet/adjuvant therapy |
| What major counseling point applies to all ASMs? | Suicidal thoughts/behaviors can occur |
| What should all ASM patients usually take for bone health? | Calcium + vitamin D |
| Which ASMs are enzyme inducers that lower concentrations of many drugs? | Carbamazepine, oxcarbazepine, phenytoin/fosphenytoin, phenobarbital, primidone |
| Which ASM is a “common broad-spectrum” and is very commonly used? | Lamotrigine |
| Which oral ASM is commonly used because of broad utility and fewer interactions? | Keppra |
| Which ASM is reserved only for seizures associated with Dravet syndrome? | Stiripentol (Diacomit) |
| Which ASM is approved only for absence seizures in the common narrow-spectrum list? | Ethosuximide (Zarontin) |
| Which agent is specifically noted for status epilepticus rescue as rectal gel? | Diazepam rectal gel/spray (Valtoco is nasal diazepam; rectal gel) |
| Which ASM is an add-on for severe epilepsy syndromes like Lennox-Gastaut? | Clobazam / cannabidiol |
| Cenobamate brand name? | Xcopri |
| Ethosuximide brand name? | Zarontin |
| Lacosamide brand name? | Vimpat |
| Levetiracetam other brand names? | Elepsia XR, Spritam |
| Lamotrigine brand name(s)? | Lamictal (tablets) and Subvenite (oral suspension) |
| Topiramate brand names? | Topamax, Trokendi |
| Phenytoin brand names? | Dilantin, Phenytek |
| Fosphenytoin brand name? | Cerebyx |
| Gabapentin brand names? | Neurontin or gralise (XR form) |
| Phenobarbitol brand names? | Solfoton and Sezaby |
| Zonisamide brand names? | Zonegram |
| Tiagabine brand names? | Gabitril |
| Vigabatrin brand names? | Sabril, Vigadrone |
| Clobazam brand name | Onfi, Sympazan |
| Cannabidiol brand name? | Epidiolex |
| Box warnings for lamotrigine? | SJS/TEN, esp with rapid titration or with VPA |
| Which ASMs can cause alopecia? | Lamotrigine and valproic acid (supplement biotin, zinc, and/or selenium) |
| Warnings (not box warnings) for lamotrigine? | Multi-organ hypersensitivity reactions (DRESS), aseptic meningitis, hemophagocytoic (HLH), and arrhythmias |
| How often do we titrate up on lamotrigine? | Every 2 weeks for the first 4 weeks on the medication, then every 1-2 weeks after 50mg. |
| Which color kit is the lower dose for lamotrigine? | Blue, 25mg every other day, for patients on inhibitors (VPA) |
| Which color is the higher dosing kit for lamotrigine? | Green, 50mg daily to start, for patients on COPPP |
| What supplement should all women of childbearing age on ASMs receive? | Folic acid supplementation |
| What are the 4 major ASMs that are teratogenic? | VPA, topiramate, phenytoin, carbamazeapine (think TV-PC) **oxcarbazepine might be teratogenic, avoid if possible** |
| Why should females of childbearing age on ASMs avoid estrogen OCs with some drugs? | Some ASMs induce metabolism of contraceptives and may lower efficacy |
| Which drug can cause hyperthermia/oligohydrosis in patients, esp kids? | Topiramate and also zonisamide |
| Which drugs can lower efficacy of hormonal birth control? | Carbamazepine, phenytoin/fosphenytoin, phenobarbital, primidone, oxcarbazepine (think COPPP) + topiramate at higher doses |
| Recommended birth control with carbamazepine? | Non-hormonal contraception |
| What contraception is recommended with oxcarbazepine? | Non-hormonal contraception |
| At what point dose topiramate start to affect hormonal birth control? | Can decrease effectiveness of oral contraceptives at doses ≥ 200 mg/day |
| Which ASM(s) efficacy can be lowered by estrogen containing birth controls? | Lamotrigine |
| Which ASM is a strong inducer of CYP3A4 and P-gp and also induces CYP1A2, 2B6, 2C19? | Carbamazepine |
| Which ASM is a weak CYP3A4 inducer and CYP2C19 inhibitor? | Oxcarbazepine |
| Which ASM is a broad enzyme inducer affecting CYP2C19, 2C8/9, 3A4, P-gp, UGT1A1? | Phenytoin/fosphenytoin |
| Which ASM is an inhibitor of CYP2C9 and weaker inhibitor of CYP2C19/UGT, and displaces protein-bound drugs? | Valproic acid |
| Which ASM is a major substrate of CYP1A2? | Zonisamide |
| Which ASM is a 2C19 substrate? | Lacosamide |
| Which ASM is a major substrate of 3A4? | Perampanel |
| Which ASM is significantly lowered by a class of antibiotics? | VPA, whose levels are lowered by carbapenems. Avoid these together |
| Which ASM's levels can be significantly increased by a class of antibiotics? | Carbamazepine levels can be increased by carbapenems due to 3A4 inhibition |
| Which ASM cant be used with NNRTIs or nefazodone | Carbamazepine |
| Which ASM lowers levels of multiple different drug classes? | Carbamazepine, lowers levels of ASMs, antipsychotics/warfarin/OCPs due to induction |
| Which ASM increases levels of phenytoin/fosphenytoin? | Oxcarbazepine |
| Topiramate lowers levels of what other ASMs? | Phenytoin, carbamazepine, VPA, and lamotrigine |
| Which ASMs primarily affect GABA? | Phenytoin, Benzos, VPA |
| Which ASM works via SV2a proteins? | Levetiracetam and its cousins |
| Which ASMs primarily work by blocking sodium channels? | Carbamazepine, topiramate, phenytoin, and lamotrigine |
| Which ASMs work by blocking t-type Ca channels? | Ethosuximide |
| Monitoring for carbamazepine | CBC with differential, LFTs, rash, eye exam, thyroid, sodium, renal function, drug levels early on |
| Which drugs require thyroid monitoring? | Carbamazepine and oxcarbazepine |
| Which ASM may require ECG monitoring with some ppl? | lacosamide, ethosuximide, phenytoin |
| Which drugs can affect vision/eyes and requiring monitoring? | Carbamazepine, Cenobemate, and vigabatrin |
| Cenobemate monitoring? | Eye exams, serum K (hyperkalemia possible) |
| Which drug requires monitoring of ammonia? | VPA |
| Box warnings for carbamazepine? | SJS/TEN (and other skin rxns), *HLA-B 1502*, aplastic anemia, agranulocytosis, and pancreatitis |
| CIs for carbamazepine? | Bone marrow suppression, use of MAOIs in 14 days |
| Lacosemide major warning? | PR interval prolongation/AV block/risk of arrhythmias, caution with CCBs/BB/digoxin |
| VPA boxed warnings? | Hepatotoxic, pancreatitis, fetal harm |
| VPA contraindications? | Liver disease, urea cycle disorders, migraine prophylaxis in pregnancy, mitochondrial disorders in infants |
| This ASM is contraindicated when patient has XR metformin? | Topiramate, due to risks of lactic acidosis in both drugs |
| Topiramate warnings? | metabolic acidosis, oligohydrosis/hyperthermia, kidney stones, glaucoma, hyperammonia, fetal harm. |
| Which ASMs should not be used in patients with AV block? | Phenytoin and lacosamide |
| Which drug causes purple glove syndrome? | Phenytoin, causes blue/purple skin and edema |
| Gabapentin ADRs? | Edema, ataxia, diplopia |
| Which ASMs cause weight gain? | VPA and gabapentin |
| Which ASMs can cause weight loss? | Topiramate, ethosuximide, felbamate, and cenobamate |
| Which ASM requires caution in sulfa allergies? | Zonisamide |
| Which ASM can cause partial aphasia/trouble speaking? | Topiramate |
| VPA therapeutic range? | 50-100 mcg/mL |
| What is the IV:PO of keppra? | 1:1 |
| Carbamazepine therapeutic range? | 4-12 mcg/mL |
| Therapeutic range of phenytoin? | 10-20mcg/mL total, 1-2 free |
| Which ASMs have a 1:1 IV-PO ratio? | Phenytoin and Keppra |
| This ASM has a boxed warning for aplastic anemia and liver failure? | Felbamate |
| This ASM has a box warning for Valvular heart disease and pulmonary HTN? | Fenfluramine |
| Which ASMs are controlled? | Brivaracetam, Cenobamate, and all the benzos |
| Aside from Keppra, what other drug has a box warning for psychiatric effects? | Parempanel |
| This ASM is used specifically for Dravet syndrome? | Stiripenol |
| ASM of choice for absence seizures? | Ethosuximide |
Created by:
cdaughtry