Antiepileptics
Terms
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- AEDs that block repetitive firing of Na action potentials
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Phenytoin
Carbamazepine
Lamotrigine - AEDs that block sustained depolarization
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Topiramate
Levetiracetam
Tiagabine
Gabapentin - AED's for generalized seizures
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Ethosuximide
Valproic acid
Lamotrigine - Phenytoin
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Dilantin (controlled release)
Blocks repeat AP's for focal seizures
Tough to administer
Non-linear kinetics
Metabolized be P450 in liver
Dose changes must be monitored and patient educated to signs of OD - Toxicity of phenytoin
- ataxia, nystagmus and lethargy
- Idiosyncratic side effects of phenytoin
- Rashes, Steven Johnson sndrome and hepatitis
- side effects of chronic phenytoin administration
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gingivival hyperplasion
coarsening of facial features
hirsuitism
not used for kids - caused coarsening of facial feature and hirsuitism limiting its use in children
- phenytoin
- pregnancy and phenytoin
- can cause any number of birth defects. women of child bearing potential need to be on folate and drug stopped if pregnant
- carbamazepine
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like phenytoin
needs to be dosed over long period b/c it induces its own metabolism
safe for kids - drug of choic for partial seizures, especially in kids
- carbamazepine
- unique, dangerous side effects of carbamazepine
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leukopenia
aplastic anemia - AED that may cause leukopenia or aplastic anemia
- carbamazepine
- Its metabolism is inhibited by valproic acid and this interaction may produce rash and Steven's Johnson Syndrome
- Lamotrigine
- Lamotrigine
- like phenytoin with addition action on potassium channels
- Used for partial seizures and seizures of Lennox-Gastaut syndrome
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Lamotrigine
Tompiramate - Good drug for patients refractory to AED's or with liver dysfunction
- Levetiracetam
- Absences seizures
- Ethosuximide
- Ethosuximide
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Very safe drug for absence seizures that blocks Ca channels, not Na or GABA
Long half live, metabolized in the liver - Valporic acid
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Does it all for men
Side effects for women and a teratogen
Acts on all receptors
Dose dependent thrombocytopenia and elevation of liver enzymes - Causes does dependent elevation of liver enzymes and thrombocytopenia
- Valproic acid
- Can cause idiosyncratic fulminating hepatitis
- Valproic acid
- Tx for status epilepticus
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Start with Lorazepam immediately
Try fophenytoin
If not, phenobarbital
if not, midazolam, propofol, or pentobarbital