Name | MOA | USES | AE/BB | Contra/Inter | Monitor/Pearls |
Phenobarbital | GABA-a receptor agonist
Barbituate | 2nd line partial and GTC
1st line febrile seizures children | drowsiness and cognitive slowing | CYP450 (dec lvls of drugs) | serum concentrations, LFTs, CBC |
clonazepan (Klonopin) | GABA-a receptor agonist
BZD | DOC myocloinc | drowsiness/sedation
Preg Cat D | CYP34A inhibitors and inducers | CBC, liver and renal function |
diazepam (valium) | GABA-a receptor agonist
BZD | DOC for Status Epilepticus | too rapid = apnea and cardiac arrest
preg cat D | be aware of dependence | |
lorazepam (ativan) | GABA-a receptor agonist
BZD | DOC for Status Epilepticus | too rapid = apnea and cardiac arrest
preg cat D | | |
tiagabine (gabitril) | inhibits GABA uptake in neurons and glia | "adjunct agent"
combo with older drugs to treat partial seizures | increased risk of suicidal thoughts
Preg cat C | | |
gabapentin (neurontin) | increases release of GABA | all forms of partial seizures | minimal, but can cause ataxia, dizziness | | increase interval in persons with renal insufficiency |
vigabatrin (sabril) | GABA transaminase inhibitor
increases lvls of GABA | partial, secondarily generalized
*west's syndrome* | psychiatric defects
visual field
preg cat C | | used in refractory bc of visual defects |
ethosuximide (zarontin) | blocks T-type Ca channesl | absence seizures | safe | inc by vpa | not effective in adults |
topiramate (topamax) | glutamate blocker | (1) partial onset and secondarily GTC
(2) primary GTC
(3) Lennox Gastaut syndrome | MC ataxia, cognitive sedation
preg cat D | | |
levetiracetam (keppra) | binds to SV2A
impedes neuronal firing | adjunct for partial, juvenile myoclonic, primary GTC | somnolence | | |
zonisamide (zonegran) | blocks Na+ channels
blocks T-type Ca channels | adjunct with older AED for partial | dizziness, anorexia, HA, ataxia
preg cat C | | serum bicarb before and after treatment |
phenytoin (dilantin) | Blocks Na+ channels | first line for partial and GTC seizures | Gingival Hyperplasia
hirsutism
preg cat D | Benzos, PPI, & Itraxonazole INCREASES effects
Carbemazepine & Barbituated DECREASE effects | Non-linear kinetics |
Carbamazepine (tegretol) | Blocks Na+ channels | first line for partial and GTC seizures
DOC trigeminal neuralgia | CNS=sedation, ataxia
Eyes=diplopia
GI=N/V
Metabolic/endo=hyponatremia (SIADH in old)
BB= SJS, agran | CYP450 inducer
and autoinduce | |
Lamotrigine (lamictal) | Blocks Na+ channels | adjucnt for partial | SJS | | MC for prego |
valporic acid (depakote/Depakene) | Inibits Na+ channesl at HIGH concentrations | DOC for generalized myoclonic seizures | GI
Preg cat D | salicylates increase serum VA lvls | LFTs baseline and 1st 6 months |