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Levetiracetam Primary Mechanism:
Unknown-binds to synaptic vesicle protein (SV2A)
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Levetiracetam FDA approved Indications:
- Partial (adjunct),
- 1º generalized tonic-clonic (adjunct), myoclonic (adjunct)
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Levetiracetam Adverse effects:
Common: Somnolence or asthenia, psychotic symptoms
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Levetiracetam Monitoring:
SCr
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Levetiracetam Inducer/Inhibitor:
None
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Levetiracetam Considerations:
Not protein bound, so no binding interactions. Dose adjustment for renal dysfunction.
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Oxcarbazepine Primary Mechanism:
Inhibition of Na+ channels
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Oxcarbazepine FDA approved Indications:
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Oxcarbazepine Adverse effects:
Common: CNS, GI, hyponatremia
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Oxcarbazepine Monitoring:
Na+
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Oxcarbazepine Inducer/Inhibitor:
Inducer
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Oxcarbazepine Considerations:
Not autoinducer. CBZ Cross allergy possible. Pro-drug.
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Perampamel Primary Mechanism:
Non-competitive AMPA receptor antagonist
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Perampamel FDA approved Indications:
Partial (adjunct)
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Which drug is an auto-inducer?
- Carbamazepine
- Auto-induction begins within 3-5 days – seizure activity breaks through
- Completse at 4 weeks
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What is the therapeutic range for Carbemazapine?
4-14mcg/ml (dosed to effect)
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What labs must be monitored for patients taking carbamazepine? When must the drug be stopped? What is the risk associated with the side-effect in question?
- Check WBC early in therapy
- Blood dyscrasias Black box warning: Aplastic Anemia, Thrombocytopenia and Leukopenia
- Stop therapy if WBC<2500/mm3 or ANC<1000/mm3
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What ethnic group is most at risk for SJS with carbamazepine use? How is this determined?
- Asian
- HLA-B*1502 antigen presence
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What is the drug of choice for patients with absence seizures alone?
Ethosuximide (Zarontin)
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Why is felbamate reserved for patients with refractory seizures?
- Due to its toxicity profile: Aplastic Anemia (1:3000) and Acute liver failure (1:10,000)
- Get LFTs and CBCs while using
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Why must gabapentin be dosed three times a day?
- Saturable carrier protein mediated absorption limits dose
- half-life is only 8 hours
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Perampamel Adverse effects:
- Common: CNS, weight gain
- Rare: Psychiatric effects (suicidal/
- homicidal ideation, aggression)
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Perampamel Monitoring:
None
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Perampamel Inducer/Inhibitor:
None
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Perampamel Considerations:
Average t1/2=105 hours, dose adjust if hepatic impairment (do not use if severe).
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Phenobarbital- Primidone Primary Mechanism:
GABA rcptr agonist, glutamate inhibition, Na+, Ca++ and K+ modulation
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Phenobarbital- Primidone FDA approved Indications:
- Partial,
- 1º generalized tonic-clonic
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Phenobarbital- Primidone Adverse effects:
Common: Cognitive and behavioral, sedation, nystagmus
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Phenobarbital- Primidone Monitoring:
Drug level
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Phenobarbital- Primidone Inducer/Inhibitor:
Inducer
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Phenobarbital- Primidone Considerations:
Not primary for any adult seizures. Primidone is pro-drug of Phenobarb.
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Phenytoin Primary Mechanism:
Inhibition of Na+ channels
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