What are the AED safe for pragnancy?
- Lamotrigine (can be used a monotherapy)
- Oxcarbazepine
- Topiramate
- Gabapentin
- Levetiracetam
AED that are hepatic enzyme inducers:
- Phenytoin
- Carbamazepine ( autoinduction)
- Barbiturates
- Oxcarbazepine
- Topiramate (weak)
AED that mainly renal excreted:
- Gabapentin
- Levetiracetam
AED should be avoided in young women:
- Valproate (higher teratogenic risk)
- Phenytoin (cosmatic effects, hirutism)
When to check AED drug level?
- Assessment of compliance to drug treatment for or with refractory epilepsy
- Pt with symptoms suspected for AED toxicity (e.g. cerebellar signs)
- Titration of phenytoin level
What are the AED that block the neuronal inactive form sodium channels, to decrease seizure activities?
- Phenytoin
- Carbamazepine
What are the AED with Action of increasing GABAergic inhition (by inhibiting the breakdown of GABA)?
- Phenobarbital
- Valproate
- Vigabatrin
What is the MOA of keppra?
Levetiracetam binds to the symaptic protein SV2A , altering neurotransmitter release (e.g. decrease glutamate release), in the presynaptic boutons of neurons
AEDs are the glutamate blockers
- NMDA inhibitor: felbamate, levetiracetam
- AMPA/KAINATE inhitor: tropiramate
What are the GABA enhancer:
- GABA A Agonist ( barbuturates, benzodiazepines, progestorone and ganaloxone)
- Block GABA update ( tiagabine)
- Inhibit the metabolism ofnGABA by GABA transminase ( Vigabatrine)
- Prodrug: (progabide)
S.e. of phenytoin:
- LOA, nausea
- Poor coordination, drowsiness
- Increased hair growth and enlargement of the gums
- Liver toxicity
- Bone marrow suppression
- Hypotension
- TEN
- Teratogenic
- Osteoproesisis
S.e of carbamazepine:
- Nausea/vomiting
- Constipation
- Poor coordination, drowsiness
- Headache and migraine
- Leukopenia and thrombocytopenia
- Hyponatremia (SIADH, INCREASE production of ADH)
- TENS ( HLA-B 1502, higher risk for SJS)
- teratogenic
Carbamazepine with variable T1/2 due to:
Autoinduction
Properies of carbamazepine:
- Oral form ( CR is available) No IV form
- Well obsorpted after oral admistration
- It is a strong hepatic inducer and autoinduction
- With variable T1/2
- T1/2 shorten to 15hr when it given repeatedly
DDR: carbamazapine PDC will increase if is is given with:
- Erythromycin
- Cimetidine
- CCB
What drug might increase phenytoin toxity?
- Warfarin
- Trimethoprim
S.e of valproate
- N/V, constipation
- Poor coordination, drowsiness
- Hepatotoxity
- Thrombocytopenia, leukopenia
- Pancreatitis
- Suicidal behaviours and thoughts
- Teratogenic
