Term
| Phenytoin (Dilantin, Diphenylan) |
|
Definition
Use: Monotherapy, t-c and partial sz
MOA: prolong rate of recovery of Na channels
90% bound albumin, [drug] increases disprop. as dosage increases.
Side Effects: CYP2C9/10/19 - Warfin interactions,
CYP3A4 induction increases met. (Oral conc.)
-SJS |
|
|
Term
|
Definition
Use: monotherapy, T-C, partial sz (and manic depressive pts)
MOA: Prolonged Na channel recovery
PharmK: induces itself, 3 weeks for consistant plasma conc to be reached. Phenobarb, phenytoin, valproic acid all increase metab of carbamazepine
Side effects: acute: stupor, coma, hyperirritability convulsions
Chronic: drowsiness, vertigo, ataxia, blurred vision
CYP3A4 induction (oral contraceptives) |
|
|
Term
|
Definition
Monotherapy, abscense Sz
MOA: Inhibits T-Type Ca channels
-No plasma protein, few D-D interactions
Side Effects: Nausea, vomiting, anorexia...CNS drowsiness, lethargy euphoria, SJS, aplastic anemia |
|
|
Term
|
Definition
Only drug to treat all Sz (mono, abscense, myoclonic, partial and t/c sz)
MOA: Inhibit T-type Ca channels, prolong inactivation of NA, increase GABA synth (in vitro)
Side effects: GI nausea, anorexia, sedation ataxia tremor
-Hepatic toxicity in pts <2 with multiple AEDs.
Inhibits CYP2C9 |
|
|
Term
| Trad. antiepileptic drugs |
|
Definition
| Phenytoin, carbamazepine, ethosuximide, valproic acid, benzodiazepines (clonazepam and clorazepate), Fosphenytoin |
|
|
Term
| Newer Antiepileptic Drugs |
|
Definition
| Gabapentin, oxcarbazepine, lamotrigine, levetiracetam |
|
|
Term
| Benzodiazepines - Clonazepam and Clorazepate |
|
Definition
Use: Adjunctive tx abscence and juvenile myoclonic sz
MOA: potentiation of synaptic inhibition via GABA receptor
-Good oral absorbtion, fast acting on CNS for clonazepam
Side effect: Drowsiness, lethargy, aggression and hyperactiving and irritability in children, prolonged episodes of multiple sz if withdrawn too quickly |
|
|
Term
|
Definition
Use: adjunctive tx patial w/ and w/o generalized secondary sz. Mostly for neuropathic pain
MOA: not known, L-type Ca channels but there is no change in CA conductance?
Not metabolized, excreted unchanged in urine, Renal fxn must be determined prior to dosing!
-Side effects are fatigue and ataxia |
|
|
Term
|
Definition
Black box warning
Use: monotherapy and adjunctive tx for Lennox-Gustaut Syndrome (LGS), partial generalized sz in adult
MOA: inhibit Ca, Na channels, plus NMDA and AMPA-Kainate receptors
Side effects: Gi upset anorexia, insomia, aplastic anemia (Rare), hepatotoxicity
Drug of last resort due to bad side effects |
|
|
Term
|
Definition
Use: Monotherapy and adjunctive tx partian and generalized T/C sz...LGS
MOA: prolong Na channel recover, inhibit Ca to a lesser extent.
Side effect: Dizziness, ataxia, blurred vision, nausea, rash and SJS when in addition to other AEDs |
|
|
Term
|
Definition
Use: Adjunctive tx for partial sz in adults
MOA: ???
- 65% excreted unchagned in urine, highest safety margin in animal studies, rapid dose titration
Side effects: somnolence, dizziness, asthenia, no drug drug interactions |
|
|
Term
| Drugs of choice for Partial, secondarily generalized szs (and alternatives) |
|
Definition
| Carbamazepine for partial. Phenytoin for 2ndarily generalized. Lamotrigine and valproic acid are good alternatives. |
|
|
Term
| Drug of choice for abscence sz. and alternative |
|
Definition
| Ethosuximide and valproic acid are first line and are the only options. Clonazepam in addition to one of other 2 but isn' t a replacement. |
|
|
Term
| Drug of choice for t-c sz and alternatives |
|
Definition
| carbamazepine, phenytoin, valproic acid are first line. Lamotrigine are alternatives |
|
|
Term
| Ergot alkaloids and drugs that act at 5-HT receptors |
|
Definition
| ergotamine tartate, dihydroergotamine, methysergide maleate and specific 5-HT1b/1d agonists are sumatriptan and zolmitriptan |
|
|
Term
| Dopamine antagonists - Antiemetics |
|
Definition
| Metoclopramide, prochlorperazine |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Beta blockers (propanolol, timolol, atenolol, metropolol, nadolol), Antidepressants (amitriptyline), Antiseizure drugs (valproate, topiramate, gabapentin) |
|
|
Term
|
Definition
Acute treatment
As effective as oral ergotamine tartrate in some pts with fewer side effects...
Isometheptene, dichloralphenazone, acetaminophen.
Isometh is a synthetic sympathomimetic with alpha and beta adrenergic activity --Vasoconstrictor activity
Contraindicated in glaucoma, renal disease, hypertension, heart and liver disease, use with MAOIs |
|
|
Term
|
Definition
Oral, subL, suppository forms.
-Max should never exceed 6mg/attack or 10mg/week
Caffeine is added to some ergotamine products for vasoconstriction and improve intestinal absorption
-Interacts with serotonin, dopamine and adrenergic receptors, activates 5-HT1B receptors and vasoconstriction, reduce neurogenic inflammation
and more side effects |
|
|
