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Epilepsy & Bipolar

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sgthuan's version from 2017-07-12 03:28

Anti-epileptic, BBW - Risk of Suicidality, strong INDUCERS - alternative or replace hormone contraceptives

genericBrandClassDrug pearls
levetiracetamKeppra, Keppra XR, SpritamAEDs - Ca2+ & Gaba500 BID or 1000 qd (XR), ** IV to PO 1-1, CrCl < 80 reduced dose, SE irritability, dizziness, weakness --> psychotic symptoms, ** Skin RASH, ** NO DDI, *** Spritam uses ZipDose tech --> rapidly dissolve with a sip of water
lamotrigineLamictal, Lamictal ODT or XR, Lamictal starter packAEDs - Na+ only, NO Gabatitrate up slowly from 25mg, *** Higher dose 50mg with inducers - carbamazepine, phenytoin, phenobarbital, *** Lower dose 25mg qod with inhibitor - Valproate, **** Serious Skin Rash or "SJS", DRESS reactions, ONLY for Bipolar with depressant episode (NOT maniac)
carbamazepineTegretol, Carbatrol, Epitol, Equetro (for bipolar)AEDs - Na+ & Gaba, Bipolar, Trigeminal neuralgiaAUTOINDUCER, *** BBW - SJS, aplastic anemia & Agranulocytosis, *** test for HLA-B*1502 for Asian, SE - dry mouth, photosensitivity, rash, GI upset, ** BONE Loss (vit.D and Calcium supp.), HYPONATREMIA (SIADH), Hypothyroidism, ** Hepatotoxicity, * Teratogenic, ** Strong Inducer --> Use alternative, non-hormonal contraceptives
oxcarbazepineTrileptal (sus), Oxtellar XRAEDs - Na+ & Gaba, NOT a mood stabilizerincreased risk of SJS --> test for HLA-B*1502, DRESS reaction, *** HYPONATREMIA (SIADH), hypothyroidism, ** BONE loss (vit.D and Calcium supp.), * Teratogenic, Strong Inducer, **** Take Oxtellar XR on EMPTY stomach
valproic acidDepakote, Depacon (IV)AEDs - Na+ & Gaba, bipolar, migraine prophyBBW - Hepatic Failure (HaVe A SIT) --> check LFTs q6m, **** teratogenic & Folate deficiency --> neural tube defects, **** Fatal PANCREATITIS, **** Mitochondrial disease, ** Hyperammonemia especially used with topiramate --> encephalopathy, SE N/V, anorexia, alopecia, ** Weight Gain, dose-related thrombocytopenia, BONE loss (Vit.D and Calcium supp), *** low albumin <3.5 valproate level is higher
phenytoinDilantin, Dilantin infatabs (chewable), Phenytek (extended release)AEDs - Na+BBW - CV risk with rapid infusion --> IV max 50mg/min --> Vesicant, IV to PO is 1-1, **** IV is ONLY compatible with NS, require FILTER and stable for 4 HOURS, do NOT refrigerate, LD 15-20mgk/kg, *** Enteral Feeding decrease phenytoin absorption, *** low albumin <3.5 phenytoin level is higher, TOXICITY - nystagmus, ataxia, confusion, blurred or double vision, shakiness, SE - gingival hyperplasia, * Hair Growth, BONE loss (vit.D and Calcium supp and FOLATE), ** Hepatotoxicity, peripheral neuropathy, hyperglycemia, * Teratogenic, ** Strong Inducer
fosphenytoinCerebyx (IV only)AEDs - Na+BBW - CV risk with rapid infusion --> IV max 150mg PE/min, 1mg PE = 1.5mg fosphenytoin, *** IV compatible with NS & D5W, refrigerated OK, stable 48h at room temp and 30d in fridge, TOXICITY - nystagmus, ataxia, confusion, blurred vision, SE - gingival hyperplasia, BONE loss (vit.D and Calcium supp.), hepatotoxicity, peripheral neuropathy, hyperglycemia, * Teratogenic, Strong Inducer
topiramateTopamax, Topiragen, Qudexy XR (c), Trokendi XR (c - also migraine prophy)AEDs - Na+ & Gaba --> NOT a mood stablizer, migraine prophy [same as zonisamide]**** CI - recent alcohol use 6 hours, Metabolic Acidosis with metformin, ** decreased NaHCO3, titrate slowly MAX 400mg qd, Oligohydrosis (reduced perspiration, hyperthermia like fever), ** Nephrolithiasis, ** Weight Loss, *** Hyperammonemia especially with valproate, BONE loss (vit.D and Calcium supp), CrCl < 70 reduced dose, weak inducer, * Teratogenic, *** Increase IOP (from glaucoma chapter)
gabapentinNeurontin, Fanatrex (sus), Gralise, Horizant ER (postherpetic neuralgia, restless leg syndrome)AEDs - Ca2+ & Gaba, structurally related to Gaba but do NOT bind to Gaba or BZD receptors300mg TID MAX 3,600mg qd, CrCl < 60 reduced dose, DRESS rxn, SE dizziness, peripheral edema - caution with TZD, ** Weight Gain, dry mouth, diplopia, blurred vision, used off-label for fibromyalgia, drug abuse, alcohol withdrawal, *** NO DDI
pregabalinLyrica (C-V)AEDs - Ca2+ & Gaba, structurally related to Gaba but do NOT bind to Gaba or BZD receptors75mg BID, CrCl < 60 reduced dose, SE dizziness, peripheral edema - caution with TZD, ** Weight Gain, dry mouth, ataxia, diplopia, blurred vision, used off-label for fibromyalgia, drug abuse, alcohol withdrawal, *** NO DDI
phenobarbitalNONE (C-IV)AEDs - bind to Gaba-a receptor --> increase durationhalf life 100 hours, **** CI - hepatic impairment, ** Hepatotoxicity --> check LFTs, SJS, *** hypotension with IV, SE somnolence, cognitive impairment, depression, BONE loss (vit.D and Calcium supp), ** Strong Inducer
PrimidoneMysolineAEDs - bind to Gaba-a receptor --> increase durationprodrug of phenobarbital and PEMA, 100-125mg QHS, **** CI - hepatic impairment, ** Hepatotoxicity --> check LFTs, SJS, *** hypotension with IV, SE somnolence, cognitive impairment, BONE loss (vit.D and Calcium supp), ** strong inducers
ethosuximideZarontinAEDs - Ca2+ (for absence ONLY)500mg qd, max 1500, SJS & blood dyscrasias, SE N/V, ** Weight Loss, hiccups, major substrate of 3A4
lacosamideVimpatAEDs - Na+CrCl<30 Max 300mg qd, *** Prolong PR interval & risk of Arrhythmias --> EKG at baseline, SE N/V blurred vision, ataxia, tremor
lithiumLithobid, EskalithMood stabilizer150-900 TID or QID, narrow therapeutic range 0.6-1.2 mEq/L, SE GI upset, Movement - tremor, N - nephrotoxicity, O - hypothyroidism, P - pregnancy, *** Toxicity > 1.5 tremor, diarrhea, ataxia, > 2.5 CNS depression, arrhythmias, seizures, coma
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Other AEDs

genericBrandClassDrug pearls
clobazamOnfiBZDsSJS/TEN, physiological dependence, drooling, *** supplement with vit.D & Calcium, ** decrease efficacy of oral contraceptives
brivaracetamBriviactOthersbehavioral effects - psychotic sx, irritability, depression, aggressive, anxiety
eslicarbazepineAptiomAEDs - Na+active metabolite of oxcarbazepine, increased risk of SJS --> test for HLA-B*1502, DRESS reaction, *** HYPONATREMIA (SIADH), hypothyroidism, ** BONE loss (vit.D and Calcium supp.), Strong Inducer
ezogabinePotigaOthersretinal abnormality, *** skin discoloration (mostly blue), urine discoloration, QT prolong --> check EKG & eye exam
felbamateFelbatolOthers*** Hepatic failure & aplastic anemia --> check LFTs and CBC, ** Weight Loss
perampanelFycompaOthersneuropsychiatric events - irritability, aggression, anger mostly in the first 6 weeks, *** supplement with vit.D & Calcium, ** decrease efficacy of oral contraceptives
rufinamideBanzelOthers - Na+CI - patients with familial short QT syndrome
tiagabineGabitrilOthersworsening of seizures when used off-lable for other indications, SJS/TEN
vigabatrinSabrilOthersBBW - permanent vision loss --> eye exam at baseline and q3month, *** ONLY available through SHARE distribution program
zonisamideZonegranOthers - Na+ & Ca2+ [same as topiramate]*** Sulfa allergy, risk for skin rash & SJS/TEN, SE similar to topiramate including Oligohydrosis(hyperthermia - fever), ** Weight Loss, ** nephrolithiasis, NO hyperammonemia warning
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