Key points, ADRs, review for Naplex/CPJE 2016
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| Cause kidney stones | topiramate (Topamax)
zonisamide (Zonegran)
* drink plenty of water to reduce risk
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| sulfonamide anti-convulsant | zonisamide (Zonegran) and topiramate (topamax)
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| Dose conversion between fosphenytoin and phenytoin | Fosphenytoin 125-150mg = phenytoin 100mg
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| Free phenytoin level calculation for albumin < 4 | measured conc / [(0.2 x albumin) + 0.1]
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| Free phenytoin level calculation for CrCl < 10 | measured conc / [(0.2 x albumin) + 0.1]
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| Phenytoin therapeutic range | 10-20mcg/mL
> 20 mcg/mL = lateral nystagmus, > 30 ataxia, > 40 decreased mentation, > 100 death
Free phenytoin level: 1-2.5
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| Phenytoin ADRs | P-450 inducer
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenecity
Osteomalacia
Interference with B12 metabolism (hence anemia)
Neuropathies (verigo, ataxia, headache)
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| Autoinduction | Carbamazepine (~ 21 days)
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| BBW of VPA | hepatoxicity especially in children < 2 yo
pancreatitis
teratogenecity
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| BBW carbamazepine | blood dyscrasias
SJS (esp in asians + for HLA-B*1502)
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| Schedule of Fycompa (perampanel) | C-III
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| Schedule of Phenobarb | C-IV
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| Schedule of clobazam (Onfi) | C-IV
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| Schedule of pregablin (Lyrica) | C-V
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| Schedule of Lincosamide (Vimpat) | C-V
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| Schedule of ezogabine (Potiga) | C-V
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| Severe life-threatening rash esp when co-administered with VPA | lamotrigine (Lamictal)
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| DOC for absence seizures | ethosuximide (Zarontin)
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| Max IV rate for phenytoin | 50mg/min
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| Phenytoin IV solution | NS only due to propylene glycol
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| Oligohidrosis | Zonisamide
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| Treatment of febrile seizures | diazepam or lorazepam
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| Dose of Phenytoin for status epilepticus | 15-20mg/kg LD
5-6 mg/kg/d divided TID (~300mg/d)
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