Anticonvulsant Pharmacology: Seizure Drugs, Uses & Adverse Effects

Phenytoin: brand name

Dilantin

Dilantin: generic name

Phenytoin

Phenytoin: drug class

Hydantoin anticonvulsant (Na+ channel blocker)

Phenytoin: main use

Tonic-clonic and partial seizures

Phenytoin: top 3 ADRs

Gingival hyperplasia, Nystagmus/ataxia, Hirsutism

Phenytoin: Therapeutic level

10-20 mcg/mL ("TEEN")

Phenytoin: IV complication

Purple glove syndrome

Phenytoin: Effect on CYP450

Inducer (many interactions)

Fosphenytoin: brand name

Cerebyx

Cerebyx: generic name

Fosphenytoin

Fosphenytoin: drug class

Hydantoin prodrug (IV)

Fosphenytoin: main use

Status epilepticus (after the benzodiazepine)

Fosphenytoin: top 3 ADRs

Hypotension, Arrhythmias (infuse slowly), Itching/paresthesias

Fosphenytoin: Advantage over IV phenytoin

Less tissue damage

Carbamazepine: brand name

Tegretol / Carbatrol

Tegretol: generic name

Carbamazepine

Carbatrol: generic name

Carbamazepine

Carbamazepine: drug class

Iminostilbene anticonvulsant (Na+ channel blocker)

Carbamazepine: main use

Complex partial seizures, trigeminal neuralgia, bipolar disorder

Carbamazepine: top 3 ADRs

Agranulocytosis/aplastic anemia, SJS/TEN, Hyponatremia (SIADH)

Carbamazepine: First-line seizure type

Complex partial

Carbamazepine: Genetic test before starting (Asian ancestry)

HLA-B*1502 (SJS risk)

Carbamazepine: Unique metabolism fact

Autoinduction: it induces its own metabolism

Oxcarbazepine: brand name

Trileptal

Trileptal: generic name

Oxcarbazepine

Oxcarbazepine: drug class

Iminostilbene anticonvulsant

Oxcarbazepine: main use

Partial seizures

Oxcarbazepine: top 3 ADRs

Hyponatremia, Dizziness/diplopia, Rash

Oxcarbazepine: Relationship to carbamazepine

Cousin with fewer drug interactions

Oxcarbazepine: Effect on oral contraceptives

Lowers their effect

Ethosuximide: brand name

Zarontin

Zarontin: generic name

Ethosuximide

Ethosuximide: drug class

Succinimide (T-type Ca2+ channel blocker)

Ethosuximide: main use

Absence (petit mal) seizures ONLY

Ethosuximide: top 3 ADRs

GI upset, Drowsiness, Headache

Ethosuximide: Mnemonic

"ethoSUXimide: ABSENCE SUX"

Valproate: brand name

Depakote / Depakene / Depacon

Depakote: generic name

Valproate

Depakene: generic name

Valproate

Depacon: generic name

Valproate

Valproate: drug class

GABA enhancer and mood stabilizer

Valproate: main use

All seizure types and bipolar mania

Valproate: top 3 ADRs

Hepatotoxicity, Pancreatitis, Tremor, weight gain, hair loss

Valproate: Black box warnings

Liver failure, pancreatitis, teratogen

Valproate: Birth defect

Neural tube defects

Gabapentin: brand name

Neurontin

Neurontin: generic name

Gabapentin

Gabapentin: drug class

GABA analogue

Gabapentin: main use

Neuropathic pain/PHN, restless legs, adjunct for partial seizures

Gabapentin: top 3 ADRs

Drowsiness, Dizziness/ataxia, Peripheral edema

Gabapentin: How it is cleared

Kidneys (no CYP interactions)

Pregabalin: brand name

Lyrica

Lyrica: generic name

Pregabalin

Pregabalin: drug class

GABA analogue

Pregabalin: main use

Neuropathic pain/fibromyalgia, adjunct for partial seizures

Pregabalin: top 3 ADRs

Drowsiness, Dizziness, Weight gain/edema

Pregabalin: DEA schedule

C-V (gabapentin is not controlled)

Tiagabine: brand name

Gabitril

Gabitril: generic name

Tiagabine

Tiagabine: drug class

Selective GABA reuptake inhibitor

Tiagabine: main use

Adjunct for partial seizures

Tiagabine: top 3 ADRs

Dizziness, Drowsiness, Confusion

Tiagabine: Mnemonic

"TIAgabine Takes It Away" (blocks GABA reuptake)

Vigabatrin: brand name

Sabril

Sabril: generic name

Vigabatrin

Vigabatrin: drug class

GABA transaminase inhibitor

Vigabatrin: main use

Refractory complex partial seizures, infantile spasms

Vigabatrin: top 3 ADRs

Permanent vision loss, Drowsiness, Weight gain

Vigabatrin: Monitoring

Eye exam every 6 months ("VIsion GAne")

Lamotrigine: brand name

Lamictal

Lamictal: generic name

Lamotrigine

Lamotrigine: drug class

Anticonvulsant (Na+ channel)

Lamotrigine: main use

Most seizure types, bipolar maintenance

Lamotrigine: top 3 ADRs

SJS/rash, Dizziness/diplopia, Headache

Lamotrigine: How to dose

Start low, go slow (rash risk)

Lamotrigine: Drug that doubles its level

Valproate

Topiramate: brand name

Topamax

Topamax: generic name

Topiramate

Topiramate: drug class

Miscellaneous anticonvulsant

Topiramate: main use

Partial and tonic-clonic seizures, migraine prevention

Topiramate: top 3 ADRs

Cognitive slowing, Kidney stones, Weight loss

Topiramate: Drugs it lowers by 30%

Oral contraceptives and digoxin

Topiramate: Eye side effect

Acute angle-closure glaucoma

Levetiracetam: brand name

Keppra

Keppra: generic name

Levetiracetam

Levetiracetam: drug class

Miscellaneous anticonvulsant

Levetiracetam: main use

Partial-onset and myoclonic seizures

Levetiracetam: top 3 ADRs

Behavioral changes ("Keppra rage"), Drowsiness, Weakness

Levetiracetam: Signature side effect

Psychotic/behavioral symptoms

Lacosamide: brand name

Vimpat

Vimpat: generic name

Lacosamide

Lacosamide: drug class

Anticonvulsant (Na+ channel)

Lacosamide: main use

Partial seizures

Lacosamide: top 3 ADRs

Dizziness, Diplopia, PR prolongation

Lacosamide: ECG to watch

PR interval (heart block)

Zonisamide: brand name

Zonegran

Zonegran: generic name

Zonisamide

Zonisamide: drug class

Sulfonamide anticonvulsant

Zonisamide: main use

Partial seizures

Zonisamide: top 3 ADRs

Kidney stones, Drowsiness, Rash