Question | Answer |
first choice drugs for focal/partial seizures | VPA, CBZ and PHT |
First choice drugs for tonic clonic seizures | VPA, CBZ and PHT |
First choice drugs for myoclonic seizures | VPA |
First choice drugs for absence seizures | ethosuximide and VPA |
alternative choices for focal partial seizures | keppra, lamictal, zonisamide, topiramate, oxcarbazepine, gabapentin, phenobarbital, lacosamide, tiagabine |
alternative choices for tonic clonic seizures | lamotrigine, topiramate, zonisamide, levetiracetam |
alternative choices for myoclonic seizures | topiramate, zonisamide and levetriacetam |
alternative choices for absence seizures | lamotrigine, zonisamide and levetiracetam |
first choice drugs for Lennox Gastaut syndrome | VPA, topiramate and lamotrigine |
alternative choices for Lennox Gastaut syndrome | rufinamide, clobazam, felbamate, zonisamide |
first choice drugs for infantile seizures | ACTH - $$$$$$$$$$$$$ |
Alternative choices for infantile seizures | vigabatrin, lamotrigine, tiagabine, topiramate, VPA, zonisamide |
seizure meds that tend to decrease efficacy of oral contraceptives | CBZ and phenytoin, and phenobarbital |
seizure meds that tend to have increased clearance in pediatric patients | keppra, oxcarbazepine, tiagabine, topiramate, gabapentin |
seizure meds that have hyponatremia associated with them and do they have more or less affect in peds or adults | oxcarbazepine (greater in adults) carbamazepine (similar affect in adults and kids but less than in oxcarb in general) |
drug classes used to treat ADHD | stimulants such as amphetamines and methylphenidate containing drugs, norepinephrine reuptake inhibitors such as straterra, alpha agonists such as guanfacine and clonidine, and antidepressants [typically wellbutrin, or tricyclics in particular] |
what drugs should be avoided in patients taking methylphenidate | MAOIs |
what ADEs are more common with Daytrana patch over other methylphenidate dosage forms | tics, anorexia and insomnia. also as can be expected skin reactions |
What mortality issues are associated with amphetamine products | sudden cardiac death - pts should not take if they have known structural heart defects. OF NOTE: no causal relationship has been established. NOT RECOMMENDED TO WITHHOLD TREATMENT routinely |
What new labeling is included with Straterra | Severe liver injury though routine hepatic monitoring not recommended. Also black box warning for suicidal ideation. |
What is the contraindication for Wellbutrin in the treatment of ADHD | seizure disorder. buproprion lowers seizure threshold. |
Which tricyclic antidepressant is typically not used for ADHD treatment and why | Desipramine due to reports of sudden death |
Describe the delivery system of methylphenidate OROS (Concerta) | an outer capsule contains 22% of the drug while the remainder of the drug is in the tablet core which is released over 10 hours to minimize peaks and troughs |
What is the advantage of Concerta over Focalin XR | Focalin XR delivers bimodal peak serum concentrations at 1.5 and 6.5 hours but has a shorter duration of action than Concerta so may be problematic for afternoon symptom management. |
The advantage of Lisdexamphetamine over amphetamine salts | less abuse potential as it is designed as a prodrug. no therapeutic advantage over other amphetamine products |
Advantages of straterra over amphetamine and methylphenidate | no abuse potential as is not a stimulant and does not exacerbate tics or anxiety. |
What cyp enzyme is associated with Strattera | 2D6 |
advantage of guanfacine over clonidine in treatment of ADHD | less sedating. |
when should you hold vaccines when a patient is getting steroids. | never unless it is a live vaccine and in that case ONLY if high dose; then give at the end of treatment or if >14 days give after a month. |