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AED+ & Tx

1

QuestionAnswer
Carbamazepine *Partial (Simple and Complex) *Mood Stabilizer *Pain *HA Also: ~Generalized (TC) & mixed ~BRE when decision to tx. ~Safest and most effective for these sz types. (May exacerbate Absence)
Clonazepam *Generalized Epilepsies *Sedation Also: ~Initial or adjunctive therapy for ~ LGS, ~Atypical Absence, ~Atonic ~Myoclonic szs. ~Can control myoclonic jerks in JME but not useful in generalized TC. ~Third choice drug for Absence sz d
Lamotrigine *JME *Mood Stablizer *Generalized Myoclonic Epilepsy Also: ~Some Partial ~Some Absence ~Atonic ~Tonic ~Myoclonic ~TC ~FDA approved for LGS. ~Minimal dose dependency toxicity and no lab monitoring needed.
Lacosamide *Partial Epilepsies Also: ~Generalized ~Newer AED (2009)
Levetiracetam *Generalized Epilepsies *Motor Tics Also: ~Adjunctive mostly for Partial, Generalized (TC) ~Myoclonic, sometimes Focal, sometimes Photic ~(2000)
Lorazepam *Mostly TC Status, but used in other Status as well. *Stops a Sz *Anxiety *Spasticity
Oxcarbazepine *Partial szs (Simple, Complex, or Secondarily Generalized) in adults and children including newly dx pts. (Mono or Adjunct therapy) *Mood Stablizer
Phenobarbital *Generalized Epilepsies *Neonatal Also: ~Status (Intervenious) ~Febrile ~Secondary for Partial & Simple Partial Szs & SP & P Status w/o Diazepam. ~Inexpensive & only needed od (once daily).
Phenytoin *Generalized Epilepsies (DOC) *Partial Epilepsies (DOC) *Kineseogenic Movement Disorders *Status Epilepticus (Adj w/o Diazepam) Also: ~Neonatal ~Safer, more effective than others. ~Ineffective in Absence, myoclonic, and Atonic Sz
Topiramate *Partial Epilepsies *Migraine Prophylaxis (preventative) Also: ~Suppresses Spike and Wave activity. ~An adjunctive therapy for Partial szs and for PGE TC szs in adults and pediatrics ages 2-16. ~Few drug interactions. BID.
Valproic Acid *Generalized Epilepsies *Partial Epilepsies *Migraine Prophylaxis *Mood Stabilizer *Infantile Spasms Also: ~Absence (Atypical) ~JME ~Tonic ~Uncontrolled Typical ~Adjunctive in multiple sz types. ~Absence Status (second tx) ~Post-trauma S
Vigabatrin *Infantile Spasms (New) *Partial Epilepsies
Zonisamide *Generalized Epilepsies Also: ~Adjunctive therapy for Partial szs in pts 12 yrs + that are not controlled by DOC. ~Low interactive risk. High side effects. BID.
Diazepam Rectal Gel *Status *Prolonged Sz *Persistent Febrile sz ~Intended to assist in management with other AEDs that are stable with bouts of increased sz activity.
Ethosuximide *Typical Absence (unaccompanied by any other sz type). Also: ~Only Typical Absence Status. ~Ineffective against TC and Myoclonic szs, which sometimes accompany Atypical Absence szs. If these develop, switch over to a suited AED.
Felbamate *Generalized Epilepsies *Partial Epilepsies *LGS *No longer used. *Linked to deaths due to Aplastic Anemia and Hepatotoxicity. ~Reserved only severe epilepsy refractory to other therapies.
Primidone *Generalized Epilepsies Also: ~Adjunctive therapy for Simple Partial, Complex Partial and TC. ~ Broken down to Mysoline and Phenobarbital. ~TID (Side Effect Notice: Increased incidence of intolerable toxicity).
Diazepam *Status Epilepsies *Spasticity ~High drug serum level
Clorazepate ~Sz ~Spasticity ~Anxiety
Fosphenytoin *Generalized Epilepsies *Status Epilepsies ~A Phenytoin precursor. Developed to overcome many of the complications associated with parenteral Phenytoin administration and was intended to replace Dilantin. ~Used for Sz (see Phenytoin)
Adrenocorticotropic Hormone (ACTH) Infantile Spasms (Old)
Clobazam *Generalized Refractory Szs Also: ~LGS
Ganaxolone An anesthetic related to the steroid allopregnanolone that has sedative, anxiolytic, and anticonvulsant effects. ~A steroid being studied for epilepsy. ~Still experimental.
How do you tx Partial Szs secondarily Generalized? Tx Partial Sz.
How do you tx Sensory or Reflex Szs? Tx Sz Type.
What is the best way to tx LGS with multiple and diverse sz types? With Monotherapy.
Typical Absence ~Ethosuximide - (DOC) (fewest side effects) ~Lamotrigine (secondary choice) ~Clonazepam (third choice due to side effects)
Absence Mixed or Atypical ~Valproic Acid - (DOC) ~Clonazepam ~Lamotrigine (only sometimes) Absence w/ TC, Valproic Acid & Lamotrigine.
Myoclonic ~Valproic Acid ~Clonazepam ~Benzodiazephines ~Lamotrigine ~Sometimes Topiramate, Levetiracetam or Zonisamide
LKS ~Valproic Acid ~Lamotrigine
Febrile ~Oral Diazepam ~Diazepam Rectal Gel ~Phenobarbital
Recreational Drug Induced ~Lorazepam ~Diazepam ~Status = Loading dose of Phenobarbital or Phenytonin
PGE ~Carbamazepine (DOC) (not Absence) ~Phenobarbital (DOC) (initial therapy) (not Absence) ~Primidone ~Topiramate (adjunctive therapy) ~Valproic Acid for Absence and Myoclonic or both combined ~Felbamate (sometimes)
SGE ~Lamotrigine ~Levetiracetam ~Oxcarbazepine ~Tiagabine ~Topiramate ~Zonisamide ~Carbamazepine ~Phenobarbital ~Phenytonin ~Primidone (inferior to other drugs - see side effect)
TC ~Phenobarbital (DOC) ~Phenytoin (DOC) ~Carbamazepine (DOC) ~Topiramate (DOC) ~Primidone ~Lamotrigine ~Levetiracetam ~Valproic Acid ~Benzodiazephines
CP (Psychomotor / Temporal Lobe Sz) ~Phenobarbital ~Carbamazepine ~Phenytoin ~VA ~Oxcarbazepine (mono or adj) ~Primidone (adjunctive - inferior to others - side effects) ~Zonisamide (adj) ~Tiagabine Hydrochloride (adj) ~Topiramate (adj) ~Levetiracetam (sometimes) ~Felbamate
Neonatal ~Brief Sz = Benzodiazephine (short acting) ~PGE = Phenobarbital or Phenytoin ~Uncontrolled = vigorous tx followed by loading of phenobarbital ~Tonic and Atonic = Valproic Acid, Lamotrigine, Benzodiazephines, and Felbamate
Infantile Spasms (IS) ~ACTH (Old) ~Vigabatrin (New) ~Lamotrigine ~Topiramate ~Felbamate ~Valproic Acid (adjunctive therapy) ~Tiagabine (adjunctive therapy)
BRE ~Monotherapy for Partial Sz ~Phenobarbital ~Phenytoin ~Carbamazepine ~Valproic Acid
LGS ~Valproic Acid (advantage = covers most broad spectrum types in this syndrome) ~Also Lamotrigine (FDA approved) & Topiramate ~Clobazam ~Rufinamide
Atonic ~Clonazepam ~Lamotrigine
Partial ~Carbamazepine ~Phenytoin ~Valproic Acid ~Oxcarbazepine (mono or adjunctive) ~Phenobarbital (secondary) ~Lamotrigine (adjunctive therapy) ~Topiramate (adjunctive) ~Zonisamide (adjunctive) ~Levetiracetam (adjunctive)
JME ~Lamotrigine ~Valproic Acid
Tonic Lamotrigine
Generalized Barbituates: Phenobarbital, Primidone (Used Primarily) Others: Tiagabine, Vigabatrin. ~ Phenytoin ~ Lacosamide ~ Carbamazepine ~ Oxcarbazepine ~ Levetiracetam ~ Topiramate ~ Clobazam ~ Rufinamide ~ Lamotrigine (sometimes)
Photic Levetiracetam (sometimes)
Status Benzodiazephines: ~ Lorazepam ~ Diazepam ~ Loading dose of Phenobarbital or Phenytoin (secondary)
TC due to sudden stop of AED Use AED for Pt sz type.
Sedative or Hypnotic Drug Withdrawal Phenobarbital intramuscularly. (Absence of sedation after 1 hour confirms tolerance and then gradually wean.)
SP (Focal) ~Carbamazepine (Doc) ~Phenytoin ~Valproic Acid ~Oxcarbazepine (mono or adjunctive) ~Primidone (adjunctive - inferior to other 4 drugs - see side effect) ~Topiramate (adjunctive) ~Zonisamide (adjunctive) ~Levetiracetam, Felbamate (sometimes)
LGS Monotherapy even with multiple sz types.
Lorazepam Mostly TC Status, but used in other Status as well.
Alprazolam Psychiatric (Non-AED)
Risperidone Non-AED. An atypical antipsychotic drug that is used for treating schizophrenia, bipolar mania and autism. New antipsychotic that is supposed to reduce movement disorders.
Aripiprazole Anti-psychotic drug for treating psychoses. Also tx bipolar mania and mixed manic/depressive episodes (as sole or adjunctive therapy) and as adjunctive therapy for major depressive disorder.
Tiagabine ~Adjunctive for Partial, Some Generalized ~Can produce Status Absence. ~Increases GABA NT to control szs. ~May exacerbate 3/s s/w activity (status reported). ~No effect on focal activity. ~Toxic doses diffuse slowing.
Adjunctive therapy for Absence Sz. Methsuximide, Paramethadione, Trimethadione.
Carbamazepine All Partial, Generalized, TC. No Absence.
Valproic Acid All Szs except for Typical Absence.
Tolbutamide Causes relative hypoglycemia and has been used to 'activate' EEG abnormalities (like HV does). Used for tx of type 2 diabetes (non-insulin dependent).
Almost all AEDs can handle what sz types? Simple and Complex Partial.
What type of sz drug should you not use for Absence? Focal such as Phenytonin or Carbamazepine.
What is DOC for JME? Lamotrigine and Topiramate, indefinitely.
What criteria is used when determining whether to d/c AEDs? S/f lesions, duration of epilepsy, neurological findings, age. Decision for children is usually based on EEG findings. Adults, situation.
Guanfacine ADHD and High Blood Pressure tx.
Which AEDs have little effect on the EEG background? VA, Gabapentin, and Lamotrigine.
Which drugs are Anti-Spike/Wave? VA, Topiramate, and Lamotrigine.
Which Anti Spike/Wave drugs are best for women of child bearing age? Toprimate and Lamotrigine.
What is the DOC for a focus of temporal spikes in Absence? Focal agents such as the newer drugs or Carbamazepine or Phenytonin, or a mix of VA, Lamotrigine or Toprimate.
Overt GCSE Immediate & IV. Should include continuous monitor. Cap Ok. Lorazepam is recommended, followed by loading dose of fosphenytonin. Must eliminate all clinical and EEG sz activity for success. Phenobarbital FDOC, GA is TDOC (Propofol).
Subtle GCSE Therapeutic challenge b/c it can only be tx w/ EEG monitoring. No clinical symptoms. Mostly Ictus. Lorazepam recommended followed by loading of fosphenytonin. Phenobarbital debated, GA also good. Benzos good but sedating and can cause hypotension.
NCSE Mildly less urgency than others. If underlying cause, urgency could increase and tx may worsen this because it effects the system that controls the epilepsy.
Absence NCSE Easy tx, excellent result. Use EEG and intervenious Benzos, preferably Lorazepam (longer duration). Titrate. Always adjust lower for younger children & f/u w/ 2mg if needed. Intervenious VA can be used and continued orally if pt is already taking.
CP NCSE No agreed upon tx. Must use EEG. Lorazepam is usually effective, but more in AED withdrawal status. VA good in synchronous epilepsies. IV Phenytonin/fosphenytonin is best b/c status has no focal onset. Trick: Suppress discharges w/o putting pt to sleep.
How should you tx elderly pts with AEDs? It is important to go slower and incrementally. They have a different metabolism than younger adults and dose should be between children and adults for the most part.
Fioricet A combination of acetaminophen, butalbital, and caffeine for tx of Migraines.
Anti-Epileptics / Anti-Convulsatns Suppresses Sz activity or convulsions by making neurons more difficult to stimulate by changing the permeability of the cell. These drugs are useful in tx Epilepsy and Trigeminal Neural Glia.
Which two AEDs are similar in action mechanisms by inhibiting rapid firing of use-dependent sodium channels? Carbamazepine and Phenytonin.
What are the best DOC AEDs for Partial szs in order? Carbamazepine, Phenytonin, Primidone, Phenobarbital.
What 'pro-drug' has replaced Dilantin and can be given in IV or IM for partial loading? Fosphenytonin (Cerebyx), a derivative of the drug.
What was the first effective drug for tx of epileptic szs (1950 Breakthrough)? Bromide.
Which drug is very water insolulable and has a mixture of 40% propylene glycol (antifreeze), 10% alcohol, and adjusted to a pH of 12 with sodium hydrate (Drano) to make it soluble? Phenytonin.
What is the best tx for Status Epilepticus? Protocol A: Lorazepam 4mg IV followed by fosphenytonin 20mg/kg. Protocol B: Fosphenytonin 20mg/kg, using small doses of Lorazepam or Diazepam PRN.
What is the recommended dose for Chloral Hydrate? 50 - 100 mg/kg. 1 kg = 2.2 lb. Start with lowest dose.
How do you calculate for Chloral Hydrate? Ex: 50 lbs = 22 kg. -> 50 mg x 22kg = 1100 mg.
What is the max dose of Chloral Hydrate? 1,000 mg/child. 2,000/adult.
CH has no... Analgesic (pain relieving) properties.
Paramethadione An anticonvulsant in the oxazolidinedione class. It is associated with Fetal Trimethadione Syndrome, which is also known as a syndrome of this drug name.
Trimethadione An oxazolidinedione anticonvulsant. It is most commonly used to treat epileptic conditions that are resistant to other treatments.
Methsuximide Treats Absence Seizures (also called Petit Mal Seizures) after other medicines have been tried, but are unable to control the seizures. This medicine is an anticonvulsant.
Rufinamide Generalized Sz. ~Lennox-Gastaut Syndrome (LGS). (2008)
How many kilograms is 1 pound? .45
How many pounds are in 1 kilogram? 2.2
Gabapentin *Used for Pain (Neuropathy). ~Originally designed for tx of Epilepsy but not effective enough.
Pregabalin An anticonvulsant drug used for neuropathic pain and as an adjunct therapy for partial seizures with or without secondary generalization in adults. First medication approved in the U.S. to tx Fibromyalgia.
Remacemide Used for Pain (non-AED)
Pimozide *Tic Disorders ~Treats symptoms of Tourette syndrome such as uncontrolled body movements or vocal sounds. It is used when these symptoms are severe.
Guanfacine *Behavior *Motor Tics ~An alternative to stimulants for tx of ADHD. Works best in decreasing hyperactivity, but not always distractibility (as stimulants do). Benefits are with children who have ADHD and conduct problems. *Intuniv is ER, Tenex is SA.
Aripiprazole Treats schizophrenia, bipolar disorder, and depression. Also treats irritability associated with autism.
Midazolam *Status Epilepsies *Short Acting Sedation for children before medical procedures or before anesthesia for surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. Also: May treat: Anxiety disorder, Agitation.
Clorazepate *Generalized Epilepsies Also: Treats anxiety, trouble sleeping, symptoms of alcohol withdrawal, and certain types of epilepsy (seizures).
Methylphenidate *ADHD
Amphetamine *ADHD
Clonidine *Hyperkineses *Insomnia *Motor Tics *Spasticity
Risperidone *Psychosis *Behavior *OCD *Tic Disorders
Butalbital *HA Abortive Therapy
Compazine *Nausea Emesis
Acetazolamide *Increased ICP *HA Related to Increased ICP Also: ~Catamenial Epilepsy (when szs are aligned with menses cycle), glaucoma, szs, hypertension, cystinuria, periodic paralysis, central sleep apnea and dural ectasia. ~(2012)
Imipramine *Nocturnal Enuresis *Depression
Fioricet Treats tension (or muscle contraction) headaches.
Cyproheptadine Allergy, nightmares, PTSD, Migraine.
Created by: kmburg5840