Seizures 2
Terms
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- Complex partial seizures Drug therapy New Onset
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Monotherapy: Carbamazepine is Drug of Choice
Phenytoin, valproic acid, gabapentin, lamotrigine, topiramate, phenobarb - Absence Seizures Drug therapy
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Ethosuximide: Drug of choice
If both absence and generalized:valproic acid - Tonic clonic seizures drugs of choice
- Phenytoin, carbamazepine, topiramate, valproic acid
- Second-line
- Lamotrigine, phenobarb, primidone
- Drug for women that may have children to take if on anticonvulsants
- 1 mg of Folic acid per day
- Phenobarb Side effects
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Drosiness,, folate deficiency, hepatic failure, teratogenic
Decreases effective ness of birth control pills - Phenytoin Indications
- All seizures except absence and febrile
- Phenytoin Side effects
- N/V, Osteomalacia, peripheral nuropathy, hepatic failure, teratogenic
- Phenytoin counseling
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Do not break, crush, chew
May alter your gums. Brush and floss daily - Carbamazapine Indications
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Most widely used anticonvulsant
DOC for complex partial
Effective in most generalized seizures
Ineffective in absence and febrile
Carbamazepine is metabolized to its effetive drug - Carbamazepine Side effects
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N/V, neutropenia, reversible rash
SIADH (Hyponatremia and water retention), osteomalacia, folate deficiency
Direct hepatotoxicity, Aplastic anemia
Teratogenic
Do not use with MAOIs - Valproic acid Indications
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DOC for absence seizures along with ethosuximide
All types of generalized and partial seizures
Not used <2 years old - Valproic acid side effects
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Fatal hepatotoxicity
GI upset
Avoid use in pregnancy
Teratogenic - Gabapentin Indications
- Partial seizures: used most often for peripheral neuropathies
- Topiramate counseling
- Drink plenty of water to avoid renal caliculi (Kidney stones)
- Status epilepticus Drug of choice
- Benzodiazepenes: Lorazepam preferred over diazepam
- Bipolar Terapies
- Lithium, Divalproex sodium, carbamazepine
- Lithium Brand
- Lithobid, Eskalith generic
- Divalproex sodium Brand
- Depakote generic
- Carbamazepine Brand
- Tegretol generic
- Lithium contraindications
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Renal disease, Cardiovascular disease
Use in caution with thyroid disease, sodium depletion, diuretics - Lithium monitoring
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Thyroid panel - may cause hypothyroidism
SCr/BUN - Renally eliminated
CBC w/diff-may cause leukocytosis
Electrolytes-hyponatremia=lithium toxicity - Depakote indication
- first line in treating acute manic episodes, off label use for prophylaxis
- Depakote contraindications
- hepatic sysfunction, pregnancy, <2 years old
- Depakote monitoring
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Valproic acid levels
LFTs every month for 6 then every 6 months - Carbamazepine Indication
- Second-line for acute and prophylactic bipolar treament
- Clozapin/Clozaril drug class
- Atypical Antipsychotic
- Risperdal drug class
- Atypical Antipsychotics
- Zyprexa generic
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Olanzapine brand
Atypical antipsychotic - Seroquel generic
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Quetiapine brand
Atypical antipsychotic - Ziprasidone brand
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Geodon Generic
Atypical antipsychotic - Abilify generic
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Aripiprazole brand
Atypical antipsychotic - TCAs MOA
- Increase the synaptic concentration of 5-HT and/or norepinephirne in the CNS
- TCA Adverse effects
- Orthostatic hypotension, tachy, sedation, anitcholinergic, weight gain, sexual dysfunction
- TCA contraindications
- MAOI, pregnany, lactation, glaucoma
- Amitriptyline brand
- Elavil generic
- Nortriptyline brand
- Pamelor generic
- Imipramine brand
- tofranil generic
- Doxepin Brand
- Sinequan generic
- Clomipramine brand
- Anafranil generic
- Desipramine brand
- Norpramin generic
- Doxepin drug class
- TCA
- MAOIs MOA
- Increase synaptic concentration of NE,5-HT, and DA by inhibiting enzyme MAO
- MAOI adverse effects
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ortho hypotension
Weight gain
Sexual dysfunction
anticholinergics effects - MAOI contraindications
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Renal or hepatic dysfunction
CVD
Not within 5 weeks of fluoxetine or 2 weeks of other SSRIs - MAOI drug food interactions
- Tyramine containing foods: red wine, aged cheese, and marmite
- Phenelzine brand
- Nardil Generic
- Phenelzine drug class
- MAOI
- Tranylcypromine brand
- Parnate generic
- Tranylcypromine drug class
- MAOI
- SSRI MOA
- Inhibit reuptake of 5-HT, Taper on disconinuation except fluoxetine
- SSRI Adverse effects
- GI, nervousness, insomnia, HA, fatigue, sexual dysfuntion
- Lexapro generic
- Escitalopram brand
- Fluvoxamine brand
- Luvox generic
- Fluvoaxamine drug class
- SSRI
- Venlafaxine brand
- Effexor generic
- Effexor MOA
- Inhibits reuptake of 5-HT and NE
- Effexor indication
- Generalized anxiety disorder and major depression
- Effexor Adverse effects
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GI, anxiety, insomnia
Elevation in BP
Same as SSRIs - Cymbalta generic
- Duloxetine brand
- Cymbalta indications
- Major depression and diabetic peripheral neurpathic pain
- Nefazodone brand
- Serzone generic
- Nefazodone MOA
- inhibits 5-HT and NE uptake
- Mirtazapine brand
- Remeron Generic
- Remeron MOA
- Increases 5-HT and NE in synapses
- Benzodiazepine MOA
- potentiate actions of GABA by increasing influx of chloride into neurons, reducing neruonal firing
- Benzo Adverse effects
- Sedation, dizziness