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Antiepilieptic Drugs

Drugs for epilepsy

What is the etiology of epilepsy? excessive excitability of neurons in the CNS
what is a focus? a group of excitable neurons
what are the 4 mechanisms of action for antiepileptic drugs? (1) suppression of sodium influx (2) calcium influx suppression (3) antagonism of glutamate (4) agonizing GABA
what is needed to diagnose epilepsy? EEG
when organizing drug therapy for a pt with epilepsy, when the first drug doesn't work what does the prescriber do? waht if the second drug doesn't work? if the first doesn't work, stop it and start a second. if the second doesn't work, stop it and start a third OR start a combo
antiepileptic drugs increase your risk for something, what is it? suicide
Serum level: Carbamezepine [Tegretol] 4-12
Serum level: Phenytoin [Dilantin] 10-20
Serum level: valporic acid [Depakote] 40-100
Serum level: Phenobarbital 15-45
Serum level: gabapentin [neurontin] 12-20
Serum level: Lamotrigine [Lamictal] 3-14
Serum level: oxcarbazepine [trileptal] 3-40
Serum level: Levetiracetam [Keppra] 10-40
Serum level: pregabalin [Lyrica] NA
Serum level: Topiramate [Topamax] 5-25
what is the mechanism of action for Dilantin? inhibits sodium channels
what are the dosing intervals for Dilantin? dependent on dose (lower dose=shorter half life)
metabolism of Dilantin minimal metabolism by liver --> HIGH risk for toxicity
what is an alternate use for Dilantin? dysrhythmias
Can you push Dilantin? yes, but only over at least 5 minutes!
Antiepileptic drugs decrease the effects of some drugs, what are they? Birth control, anticoagulants
How should you discontinue Dilantin? gradually!!! to avoid seizures
What are the adverse effects of Dilantin? CNS: Nystagmus GINGIVAL HYPERPLASIA SKIN RASH! - STOP DRUG!! teratogen dysrhythmias, hypotension
What are the drug interactions of Dilantin? decrease effects of BC/anticoagulants/glucocorticoids AVOID CNS depressants
What is the mechanism of action for Tegretol? inhibiting sodium channels
how is Tegretol metabolized? liver. the longer you are on this drug, the shorter the half life
Which drug requires that pts of Asian descent have genetic testing done before going on it? why? Tegretol. because they are at increased risk for a deadly skin rash
What are the 3 uses for Tegretol? Epilepsy Bipolar Trigemiinal and glossopharyngeal neuralgias
What are the adverse effects of Tegretol? CNS: minimal Hematologic: bone marrow suppression -> leukopenia, anemia and thrombocytopenia neural tube defects can inhibit excretion of water skin rash!!
What are the drug interactions of Tegretol? phenytoin & phenobarbital: inductino of metabolism will be greather than with Tegretol alone grapefruit juice: inhibits the metabolism therefore increasing plasma levels.
Which antiepileptic drug is the first line for all seizures? valporic acid
What labs should you monitor when your pt is on valporic acid? ALT, AST, pancreatic amylase and lipase (because it poses threat to liver and pancreatic function
s/s liver failure jaundice, ascites, RUQ pain, dark urine, n/v, steatorrhea
can you take valporic acid during pregnancy? not recommended. teratogenic. category D
what should your female patients be on when taking valporic acid (or any teratogenic drug)? folic acid.
What are the different uses for valporic acid? seizures bipolar migraine
what are the adverse effects of valporic acid? MOST COMMON = GI (n/v, indigestion) hepatotoxicity pancreatitis teratogenic hyperammonemia rash weight gain hair loss tremor blood dyscarasias
what are the s/s of hyperammonemia? n/v/d, lethargy, altered LOC/cognition
?what is the mechanism of action of Phenobarbital? increases GABA effects
what are some advantages to phenobarbital? oral, effective, cheap, 1x per day, oral
what are some side effects of phenobarbital? lethargy, depression, learning impairment, drowsiness, somnolence
what are some drug interactions of phenobarbital? CNS depressant - AVOID others! barbiturate family
Which are better tolerated, newer or older antiepileptic drugs? newer
what is the mechanism of action of Trileptal? blocks sodium channels
T/F: Trileptal is inactive until activated in the liver. true
what are some adverse effects of Trileptal? diplopia, dizziness, nystagmus, headache, ataxia, hyponatremia, SKIN RXN!
What is the mechanism of action for Lamictal? blocks sodium and calcium channels decreases glutamate
route of admin for Lamictal oral
what are some adverse effects of Lamictal? life threatening rashes dizziness diplopia n/v headaches blurred vision
what is the mechanism of action for Lyrica? similar to neurontin
T/F: Lyrica is a controlled substance True: Category V (dt euphoria)
what is the mechanism of action for Topamax? GABA inhancer blocks Sodium, calcium, glutamate
what is the metabolism and excretion of Topamax? excreted by kidneys not metabolized
what is the risk with Topamax? can cause metabolic acidosis because kidneys excrete more bicarbonate causing acidosis
what labs should you monitor when your pt is on Topamax? Bicarbonate levels!
what is the risk of antiepileptic drugs and pregnancy? congenital heart defects most risk during first trimester
What is the medical emergency during Status Epilepticus? Airway mgmt acidosis
what is used to stop a SE seizure? benzodiazapines
what are the major problems associated with SE? massive hypoglycemia (dt energy expenditure) increased HR, BP, temp acidosis
Created by: 1398660434



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