Neurology

Anti Epileptics


Na channel blockers:

Depakore- valproike acid: ( VPA )
Enz inhibitor Pro binding 95%
increase INR ! hypoglycemia
side effect fat , pco,hairy , pancreatitis , no rash !
increase ammonia level ,don't freak out if asymptomatic
asprine displace it from pro/ and increase its level.

Lamictal-lamotrigine ( LTG )
first line generalized sz
Rash
Pregnancy precaution

Keppra-levetiracetam ( LTC )
renal excretion
UMOA

Topomax-topiramate (TPM )
Enz inducer hperglycemia (metformin),decrease INR (Coumadin)
Diamox (used for NPH) like effect tingling and numbness


Dilantin-phenytoin ( PHT )
pro binding 90% increase INR ! hypoglycemia
Enz inducer decrease INR, hperglycemia
Half life 22h
Side effect : megaloblastic anemia,dupuytran contracture, rash
PHT decrease CBZ level to one third !!! , but CBZ increase dilanine level !!!

Tegretol-carbatrol-carbamazepine ( CBZ )
may induce absence status
Enz inducer decrease INR, hperglycemia
typical case: nursing home pt on this drug, physican prescrib darvocet or propoxiphen for pain and pt goes to coma (altered mental status) !!( increase level )
Side effect :hyponatremia , 10% rash ,diplopia
PHT decrease level to third !!
Cimetedine, verapamil,diltiazem, propoxyphen ,erythromycine isoniiazide increase the level.

trileptal-oxacarbamazepine
worse than carbamazepin in hyponatremia induction !
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CA channel blocker-only one !

zarontyn-ethosuximide absence sz
side effect : ataxia, rash
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GABAERGICS (most have ga, ba in their names ), (chloride chane GABA 1 , K increase and Ca decrease GABA2)

Primidone-Mysoline ( PRM ). Will metabolize to PB and other metabolites
Side effect : impotence,….
felbatol-felbamateside effect aplastic anemia and liver dysfunction
tiagan-tiagabine-gabatril
neurontin-gabapentinrenal excretion
Phenobarbital ( PB )hard to taper offEnz induce decrease INR, hyperglycemia
Side effect : dupuytran contracture , rash
Zonegram-zonisamide ( ZNS )diamox like effect tingling and numbnessSulfa allergy
Vigabatrinretinal deposition

which medication can normaliz the EEG:Depakote and PHB can normalize the EEG don't get full

case:if 21 year old pt with generalized sz new onset no etiology find, is geneticand need to be on med for the rest of life , don't full with sz free episodes or normal EEG
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Therapeutic levels
Carbamazapin 5-10 ug/ml ,
Dilantin 10-20
Phenobarbital 20-40 , 90-120mg po phs, could start iv 300-800 mg iv. load for status epilepticus could use 10-20 mg/kg iv
Valporate 50-100, 10-60mg/kg TID (250cap),
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LOADING
Only : PHT/VPA/PB
Loading for pht and vpa the same 10-15 mg/kg
Expect for each gram the level raise 10
PB : don’t load more than 200 the first time (respiratory distress and ..), but you can reload 100 or 60 till level therapeutic later on /


H/F LIFE