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Phenytoin FDA approved Indications:
- Partial,
- 1º generalized tonic-clonic, not absence
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Phenytoin Adverse effects:
- Common: CNS, N/V, ataxia, rash
- Toxic: nystagmus, seizures, coma
- Long-term: ging. hyperplasia, hirsutism, periph. neuropathy, osteomalacia
- Rare: SJS, Lupus-like syndrome, bone marrow suppression, hepatotoxicity
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Phenytoin Monitoring:
CBC, LFT’s, levels
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Phenytoin Inducer/Inhibitor:
Inducer
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Phenytoin Considerations:
Not for absence. Use one brand. Measure free levels when interaction suspected.
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Pregabalin Primary Mechanism:
Modulates Ca++ influx by hyper-excited neurons
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Pregabalin FDA approved Indications:
Partial (adjunct)
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Pregabalin Adverse effects:
- Common:
- Dizzy, somnolence, p. edema, weight gain, vision changes, euphoria
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Pregabalin Monitoring:
None
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Pregabalin Inducer/Inhibitor:
None
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Pregabalin Considerations:
Adjust for renal dysfunction.
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What drug is associated with Steven's Johnson Syndrome, and toxic epidermal necrolysis, and should not be used in anyone <16 years of age?
Lamotrigine
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Primidone is a pro-drug of what other anti-epileptic drug?
Phenobarbitol
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What advantages does oxcarbazepine have over carbamazepine?
Not an auto-inducer
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Is it necessary to check both primidone and phenobarbital drug levels? Should PEMA levels be checked?
No, if Primidone is therapeutic, then do not check phenobaritol
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What are the therapeutic ranges for Phenobarbitol and Primidone?
- Phenobarbital 10-40mcg/ml
- Primidone 5-10mcg/ml
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Which anti-epileptic is associated with frequent weight loss?
Topirimate
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Which is the only drug approved for both absence seizures and other seizure types?
Valproic Acid
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What is the plasma concentration of valproic acid that must be achieved prior to labeling a therapeutic failure? How does this compare to the "normal" therapeutic range?
- Normal range: 50-100mcg/ml (Free fraction 4-15mcg/ml)
- Threshold level for a failure: at least 80mcg/ml
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Hair loss is associated with which anti-epileptic drug?
Valproic Acid
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Patients taking zonisamide are at risk if they have an allergy to what?
Sulfa drugs
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What potentially life-threatening side-effects are associated with valproic acid?
- Rarely:
- Hepatotoxicity – usually occurs in the first 6 months, not always reversible
- Thrombocytopenia – may resolve with decreased dose
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Tiagabine Primary Mechanism:
Inhibition of GABA reuptake
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Tiagabine FDA approved Indications:
Partial (adjunct)
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Tiagabine Adverse effects:
Common: nervousness, dizziness, tremor, depression
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Tiagabine Monitoring:
None
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Tiagabine Inducer/Inhibitor:
None
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Tiagabine Considerations:
May only increase dose once weekly to usual range 32-56mg. May take weeks to see effect.
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Topiramate Primary Mechanism:
Modulates Na+ & Ca++ channels, GABA potentiation, inhibits glutamate
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Topiramate FDA approved Indications:
- Partial,
- 1º generalized tonic-clonic
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Topiramate Adverse effects:
- Common: CNS, memory difficulty, cognitive slowing
- Long-term use: weight loss, nephrolithiasis
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Topiramate Monitoring:
None
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Topiramate Inducer/Inhibitor:
Inducer (mild) if >200mg/day
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Topiramate Considerations:
Weight loss can be significant. Caution if hx of renal stones. Can cause mental cloudiness (nicknamed “stupamax”). ↑ risk of cleft palate (preg cat. D).
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