Seizures

Question 1

What are the 1st gen anti epileptic drugs?

Answer 1

1. Valproate (Depakote)
2. Carbamazepine (Tegretol)
3. Phenytoin (Dilantin)

Question 2

What are the 2nd gen anti epileptic drugs (AED)?

Answer 2

1. Topiramate (Topamax)
2. Oxcarbazepine (Trileptal)
3. Lamotrigine (Lamictal)

Question 3

What are the different ways that AEDs work?

Answer 3

1. Enhancement of sodium channel inactivation
2. Reducing current through T-type calcium channels
3. Enhancement of GABA activity
4. Antiglutamate activity

Question 4

How do doctors decide what medication a pt gets for seizures?

Answer 4

depends on the type of seizure; may be on one drug, and may be on many
- if a pt is on a drug and have a continued amount of time without seizures, MD may taper off drug and seizures may not return

Question 5

What are the common side effects of AEDs?

Answer 5

1. Drowsiness
2. Dizziness
3. Cognitive Dulling

Question 6

Side Effects:

• Initiation: nausea, vomiting, drowsiness, dizziness
• Chronic: peripheral neuropathy, hydantoin facies, gingival hyperplasia, osteomalacia
• Severe/Life Threatening: hepatic failure, Stevens-Johnson syndrome (skin rash; damage to large portion), Teratogenic

Answer 6

Phenytoin (Dilantin)
- Drug Interactions:
Carbamazepine (AED), Valproate (AED)
Fluoxetine
Warfarin
many others (CNS depressants)

Question 7

Side Effects:

• Initiation: nausea, vomiting, drowsiness, dizziness, neutropenia
• Chronic: osteomalacia, low sodium and water retention
• Severe: Direct Hepatotoxicity- Black Box Warning

Answer 7

Carbamazepine (Tegretol)
- Drug interactions--MANY:
Oral contraceptives
Most other AEDs
Erythromycin
Warfarin

Question 8

Side effects:
Dizziness
Nausea and vomiting
Hyponatremia

Answer 8

Oxcarbazepine (Trileptal)
- Drug interactions:
Potential for contraceptive failure
Phenytoin (AED)

Question 9

Side Effects:

• Initiation: nausea, vomiting
• Chronic: weight gain, alopecia, tremor, thrombocytopenia
• Severe/Life Threatening: Fatal Hepatotoxicity, fatal hemorrhagic pancreatitis

Answer 9

Valproic Acid (depakote)
- Drug Interactions:
Phenytoin (AED)
Carbamazepine (AED)
Lamotrigine (AED)
Many others

Question 10

Used for different reasons, adverse effects are less severe and has less drug interactions than other AEDs
Side Effects:
Peripheral edema, Myalgia, Dizziness, Nystagmus, Somnolence, Mood swing, Fatigue

Answer 10

Gabapentin (neurontin)
- Drug Interations:
Aluminum/magnesium-containing antacids** may decrease the absorption

Question 11

Side Effects:
Rash , Abdominal pain, Indigestion, Nausea, Vomiting, Pain, Ataxia, Dizziness, Headache, Somnolence, Blurred vision, Diplopia
- Severe Life Threatening Side Effect: Skin rash (Black Box Warning)

Answer 11

Lamotrigine (Lamictal)
- Drug Interactions:
Valproic Acid (increased concentration of lamictal)
Carbamazepine (AED)
Phenytoin (AED)
Phenobarbial
Primidone

Question 12

Side Effects:

• Initiation: Drowsiness, dizziness, mood changes, loss of appetite
• Chronic: Metabolic acidosis, Kidney stones, word finding difficulties, significant weight loss
• Severe Life Threatening: Oligohidrosis (may not sweat)

Answer 12

Topiramate (Tomapamax)
Drug Interactions:
- Drugs that increase the effect/concentration of Topiramate (CNS depressants, acetazolamide)
- Drugs that decrease the anticonvulsant effect of topiramate (Phenobarbital, phenytoin, valproic acid)
- Low potential for drug interactions (High doses may alter action of oral contraceptives)

Question 13

Side effects:

• Abdominal pain, Diarrhea, Indigestion, Loss of appetite, Nausea Taste sense altered
• Confusion, Dizziness, Insomnia, Memory impairment, Somnolence, Unable to concentrate
• Diplopia
• Agitation, Depression
• Disturbance in speech

Side effects with chronic therapy:
- Kidney stones
- Weight loss
Severe/Life threatening:
- Oligohidrosis

Answer 13

Zonisamide (Zonegran)
Drug Interactions:
- Drugs that decrease the effect of zonisamide: carbamazepine, phenobarbital, phenytoin, valproic acid

Question 14

Side effects:
- Upon Initiation: dizziness, fatigue, sedation
- Chronic therapy: none
- Severe Life threatening: none
Drug Interactions:
- No significant interactions noted to date

Answer 14

Levetiracetam (Keppra)