Epilepsy- nueropsych drugs

tegretol

• CI: MAO inhiitor use within last 14 days or w/ use. 
• concomitant nafazodone, hx of BM depression, hypersensitivites to TCA** 
• concomitant delarirdine or NNRTIs
• 10,11 epoxide are active metabolites and metabolized by epoxide hydrolase -> can get serum concentration
• carbamazepine metabolized by Cyp 3A4
• to its metabolites

can exacerbate absence seizure and primary GTC

• Equetro: acute mania, mixed episodes w/ bipolar 1 disorder
• Carbatrol, tegretol and tegretal XR : mixed seizure patterns, trigeminal neuralgia, glossopharyngeal neuralgia

• Off label use: restless leg syndrome, PTSD
• 200mg BID

acute: CNS effects (diplopia, dizziness, ataxia, drowsiness, lethargy )

• idiosyncratic: Blood dycrasis ** (BBW)
• leukopenia - dc if WBC <2500 &ANC <1000

Rash (BBW)- asian, 1502 allele (TEN/SJS)

• Chronic: hyponatremia ( elderly, thiazide diuretic users at risk)
• osteopathy

• 1st line in absence. & only for absence
• brand: zarontin

• acute: ataxia
• GI upset N/V (alleviate w/ lower dose commonly)
• hiccups 

• idiosyncratic : blood dyscrasias, rash
• chronic behavioral changes, HA

• felbatol
• patient should sign a consent form to use
• CI in hepatic disease and hx of blood dyscrasis
• acute: anorexia n/v insomnia
• Idiosyncratic: Aplastic anemia (BBW) 
• Acute hepatic failure (BBW) 
• chronic : osteopathy

• potiga
• 1st in class 
• MOA: K channel opener
• active metabolite- NAMR
• schedule 5 

• Acute: confsional state, psychotic symptoms 
• hallucinations (all 3 concentration dependent )

somnolence, dizziness, vertigo, abnl coordination attention disturbance, memory impair 

• idiosyncratic: QT prolongation 
• Chronic: urinary retention(if w/ anticholinergic drug, worry)
•  blue skin, retinal abnormalities (if turning blue, stop. not sure if reversible )

• enurontin
• (never mono or 1st line) not effective 
• off label: neuropathic pain, diabetic peripheral neuropathy , fibromyalgia, postoperative pain, restless leg syndrome, vasomotor symptoms

acute: dizziness, fatigue, ataxia, aggressive behavior in children 

• idiosyncratic: peripheral edema 
• chronic: wt gain, abrupt discontinuation cause w/d syndrome (anxiety, insomnia, sweating)

vimpat, schedule v

acute: dizziness, HA, N/V, ataxia,  QT prolongation (EKG prior, if cardiac issue, not CI but cautious)

• other label: maintenance tx bipolar 1 disorder
• dose 25mg daily,
• 25mg every other day w/ VPA, 50mg  w/ inducers 
• all for 1-2 wks and specific guideline after. 

• acute : ataxia, dizziness, diplopia, HA 
• idiosyncratic: Rash (BBW), aseptic miningitis

• Keppra, 
• FDA approved adjunctive, but always mono therapy especially for hepatic dysfunction 

• acute: dizzy, drowsiness, 
• idiosyncratic: behavioral disturbances/psychosis (if become agressive, take off!)

• onfil
• schedule 4
• active metabolite:
• n- desmethylclobazam. 
• can be used for pron in refractory patients. 
• all benzos are antiseizure but not used for out pts as scheduled meds.

• Actue: CNS depression, somnolence, lethargy
• ataxia, drooling constipation

idiosyncratic: anterograde amnesia

chronic: physical and psychological dependence w/d symptoms (seizure, psychosis, hallucination,, etc) 

• IV in NS 
• 40% propylene glycol - hypotension and cardiac arrhythmias 
• iv : phlebitis, extravasation of tissue
• contraindication: delavirdine, other NNRTIS,
• IV phenytoin: sinus bradycardia, sinoatrial block , adams strokes syndrome

• dose: loading: 15-20mg/kg  followed by maintenance dose 100mg TID (q8h)
• IV max : 50mg/min
• ER capsules used for once a day (this is the formulation typically used)
• IR IV: given TID
• suspension: interact w/ tube feeding