Therapeutics - Epilepsy 2

  1. Ezogabine Considerations:
    Consider risk factors for urinary retention. Adjust dose for renal and hepatic dysfunction.
  2. Felbamate Primary Mechanism:
    Blocks NMDA site on glutamate rcptr, inhibition of Na+/Ca++ channels
  3. Felbamate FDA approved Indications:
    Partial (adjunct, refractory)
  4. Felbamate Adverse effects:
    • Common: GI
    • Rare: aplastic anemia (1:3000), liver failure (1:10,000)
  5. Felbamate Monitoring:
    CBC, LFT’s
  6. Felbamate Inducer/Inhibitor:
  7. Felbamate Considerations:
    Use only for refractory seizures due to side-effect profile.
  8. Gabapentin Primary Mechanism:
    Modulates Ca++ influx by hyper-excited neurons
  9. Gabapentin FDA approved Indications:
    Partial (adjunct)
  10. Gabapentin Adverse effects:
    Common: CNS, fatigue, weight gain, tremor, N/V
  11. Gabapentin Monitoring:
  12. Gabapentin Inducer/Inhibitor:
  13. Gabapentin Considerations:
    Need tid dosing due to saturable mechanism of absorption. Adjust for renal dysfunction.
  14. What is the goal of treatment?
    Decrease frequency
  15. What is the #1 reason for treatment failure?
  16. What are the criteria that must be met when considering a trial drug taper?
    • Seizure > or = 2 years
    • Normal neurological exam/IQ
    • EEG normalized on medication
    • Seizures were under control within 1 year of first episode (Resistant seizure, not recommended for removal of drug)
    • Age of onset between 2 and 35 years
    • One type of seizure
  17. What drugs are indicated as monotherapy (not adjunct) for Epilepsy?
    • Oxcarbazapine
    • Phenobarbitol-Primidone
    • Topirimate
    • Valproic Acid
    • Carbamazapine
    • Ethosuximide
    • Lacosamide
  18. When checking phenytoin levels, what lab will give you the most accurate information?
    Free drug
  19. What are the laboratory thresholds for Phenytoin?
    Corrected phenytoin needs to be calculated if total phenytoin is measured and the patient has albumin <4.4 g/dL, or severe renal dysfunction (CrCl<24)
  20. What is the therapeutic range for Phenytoin?
    10-20mcg/ml, free 0.5-3mcg/ml
  21. What side-effects are associated with chronic phenytoin therapy?
    • Gingival hyperplasia
    • Vitamin D deficiency – bone softening (Ricketts- kids or osteomalacia- adults)
    • Folic acid deficiency
    • Peripheral neuropathy
    • Hirsutism – hair growth
    • Coarsening of facial features- masculinization
  22. Lacosamide Primary Mechanism:
    Enhances slow inactivation of Na+ channels
  23. Lacosamide FDA approved Indications:
  24. Lacosamide Adverse effects:
    • Common: CNS
    • Rare: asymptomatic AV block
  25. Lacosamide Monitoring:
    Baseline ECG in those at risk
  26. Lacosamide Inducer/Inhibitor:
  27. Lacosamide Considerations:
    Not for severe liver dx. IV does not have to be diluted.
  28. Lamotrigine Primary Mechanism:
    Inhibition of Na+ channels
  29. Lamotrigine FDA approved Indications:
    Partial (“switch” therapy), 1º Generalized Tonic-clonic (adjunct)
  30. Lamotrigine Adverse effects:
    • Common: CNS, diplopia, headache
    • Rare: SJS, TEN (1:1000 adults, 1:100 children), aseptic meningitis
  31. Lamotrigine Monitoring:
    CBC, LFT’s
  32. Lamotrigine Inducer/Inhibitor:
  33. Lamotrigine Considerations:
    Incidence of life-threatening side effects higher with valproic acid use. Approved for monotherapy if >16yo.
Card Set
Therapeutics - Epilepsy 2
Therapeutics - Epilepsy