Seizure Meds
Terms
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- Partial seizure DOC (drug of choice)
- Carbamazepine, also phenytoin & phenobarbital
- Absence seizure/petit mal DOC
- ethosuximide (Zarontin), also clonazepam
- Grand mal seizure/tonic-clonic DOC
- Carbamazepina (tegretol) phenytoin, phenobarbital, also valproic acid, topiramate (topamax), adjunt Lamotrigine (lamictal). Extreme cases Felbamate
- Atonic seizure DOC
- Valproic Acid, also Clonazepam, Lamotrigine (adjunt)
- Lenox-gastuat syndrome DOC
- Valproic Acid, Clonazepam
- Lenooux-gastuat syndrome > 30 minutes TTO
- inminent CNS damage. 100 mg thiamine complex, 25 g glucosa (50 ml 50%) Diazepam IV 10-20 mg 2-5 min, Phenytoin 18 mg/kg to reach therapeutic levels, but less than 50 mg/min or cadiac risk (propylen glycol)
- Seizures drugs discontinuation
- Slow over 6 weeks to 3 month, or risk of status epilepticus
- Drugs that may cause seizures
- wellbutrim (bupropion)alcohol, cocaine, theophylline in high doses, lidocaine, meperidine(demerol), diazepam, tramadol, meropenem carbopenem, meropenem, ganziclovir, penicillin, ROH and barbituric withdrawal
- Phenytoin (Dilantin)IM?
- No, slow, erratic absortion, painful local reaction. Use cerebyx instead IM, IV.
- Cerebryx drug, via of administration, storage and type of drug
- Fosphenytoin, IV, IM, REFRIGERATE and prodrug
- Patient counceling with phenytoin and fosphenytoin
- Take it with food or milk to avoid GI symptoms, good dental care (gingival hyperplasia), do not take a discolored capsule
- DOC to prevent seizure
- Phenytoin
- Phenytoin dose, loading dose, therapeutic range, IV caution. Pharmacology
- 4-6 mg/kg/day TID or Kapseals QD, 18 mk/kg, 10 - 20 mg/liter. no more that 50mg/min, only with normal saline use filter. Dose dependent First order kinetic first order to 0 order (dose dependent)
- Funnytoin Adverse effects
- gingival hyperplasia, NAGS (nistagmis, ataxia, GI, sedation, osteomalacia(vitamin D deficiency)
- Phenytoin drug interaction
- Fluconazole, omeprazole, cimetidine increase phenytoin toxicity. Disulfiram increase phenytoin effect. Phenytoin decrese contraceptive and corticosteroid (dexamethasone)effects
- Valproic Acid drug, brand name, indication
- depakene, tto absence and complex partial seizure
- Divalproex sodium brand name, indication
- Depakote EC (enteric coat), FDA approved for Mania (bipolar, and Migrain)
- Valproic Acid, Divalproex sodium side effects
- Hepatotoxicity, pancreatis,bone marrow problems(trombocitopenia, anemia, neutropenia) hair loss, weight gain
- Seizure drugs with possible hepatic complication
- valproic acid, carbamazepina, phenytoin
- Seizure drugs with possible renal complication
- Neurontin (gabapentin), Topamax (topiramate) Keppra (levetiracetam)
- drugs that will decrece valproic acid (substrate) levels
- carbamazepine, phenobarbital, phenytoin
- Depakote EC drug interactions
- Antiacids will increase stomach pH and will disolve the enteric coat faster
- Valproic acid: substrate or inducer?
- Substrate
- Carbamazepine brand name, dose & pharmacology
- Tegretol, 100 -200 mg QPm blood levels fall in 2-4 weeks (autoinducer)
- Carbamazepine adverse effects
- AAAA: aplastic anemia, agranulocitosis, antiarrithmic, anticholinergic. NAGS:Nistagmis, ataxia, GI, sedation.
- Carbamazepine drug interaction
- Drugs that will increase CBZ(carbamazepine):erythromycin, clarithromycin, ketoconazole, itraconazole, diltiazem, verapamil, norvir (ritonavir). Reduce effects of contraceptives
- Seizure medication that may cause kidney stones
- Zonisamide (Zonegran) and Topiramate (Topamax)
- Seizure medication that may cause weight loss
- Topiramate (topamax)
- Seizure medication that may cause weight gain
- All but topiramate (topamax)
- Seizure medication that goes thru the liver
- All but gabapentin and levetiracetam (keppra)
- Seizure medication that goes thru kidneys
- Levetirocetam (keppra) and Gabapentin (neurotin). Renal Failure
- Felbamate indications
- ONLY ON PATIENT WITH NO RESPONSE TO OTHER THERAPIES. LIVER
- Felbamate Side effects
- Aplasic anemia and Hepatoxicity, liver failure
- Gabapentin loading dose and dose. Indication
- start with 100 mg TID increase until effects reached. 900 - 4800 mg daily. Partial seizures adjunt. RENAL
- Lamotrigine brand name and side effects
- Lamictal, rash and photosensitivity
- Lamotrigine and valproic acid
- Valproic acid is an inducer of lamotrigine, so we have to lower the dose to a 100 -200 mg qh when administer with valproic acid. LIVER
- Levetiracetam brand name, side effects
- Keppra, somnolence and psychiatric symptoms
- topiramate brand name, side effects, counceling
- Topamax, Nephrolithiasis (kidney stones), weight loss (anorexia). don't brake pill (bitter taste) drink lots of water (kidney stones)
- Carbamazepine & tricyclics antidepressants
- They are related in terms of structure, so patients allergics to tricyclics antidepressants may be allergic to carbamazepine
- If a pregnant woman in epileptic and is taking valproic , what should she use to avoid congenital malformations on her baby
- Folic acid, because anticonvulsivants normally reduces folic acid, and this is a major cause of spina bifida
- Topiramate & weight
- Topamax (topiramate) can cause significant weight loss (anorexia)
- Valproic acid & weight
- Depakene can cause significant weight gain
- Rash and Seizure medications
- All of the anticonvulsivants are assoicated with life threatening rash.
- Carbamazepine drug interactions
- Because it is an inducer it has a lot of drug-drug interactions
- Anti-seizure medications with black box warning
- carbamazepine and felbamate (aplastic anemia and hepatic failure)
- absence seizure medication for a 1 year old baby
- Ethosuximide (zarontin)
- Complex febrile seizures duration and complications
- Last for >15 min recurrent in 24 hours and do not have any consecuenses like epilepsy
- Meperidine & renal failure
- Meperidine accumulates in patients with renal failure and causes seizures
- Wich drug has Michaelis-Menten parmacokinetics
- Phenytoin, because of its dose, goes from first order kinetis to 0 order kinetics
- Drugs that decreaces phenytoin
- Antiacids, cisplatin, ritonavir(norvir), zodovudine, kava kava and valerian
- Drugs that increases phenytoin
- alcohol abuses, diaepam, estrogens, salicilates, sulfas, warfarin.
- Phenytoin and weight
- Phenytoin do not have a effect on patients weight
- Primidone is a metabolite of...?
- Phenobarbital