Top 300 Week 2 Ambulatory Care 2026

Lacosamide brand name and class?

• Vimpat, Motpoly XR

• Class: Anticonvulsant, miscellaneous. C-V

Lacosamide common FDA label indication, dosing, and titration?

• Partial-onset seizure: initial, monotherapy, immediate-release, 100 mg po bid; monotherapy, extended-release, 200 mg po daily may titrate by 100 mg increments to max 400 mg/d; for adjunctive therapy, immediate-release, 50 mg po bid, may titrate by 50 mg increments to max 200 mg po bid; for adjunctive therapy, extended-release, 100 mg po daily may titrate by 100 mg increments to max 400 mg/d

• Primary tonic-clonic seizures, adjunct treatment: immediate release, 50 mg po bid may titrate by 50 mg increments to max 200 mg po bid; extended release, 100 mg po daily may titrate by 100 mg increments to max 400 mg/d

Lacosamide MOA?

Lacosamide stabilizes hyperexcitable neuronal membranes and inhibits neuronal firing.

Lacosamide box warnings?

None

Lacosamide contraindications?

Hypersensitivity

Lacosamide drug interactions?

• CYP2C9, CYP3A4/5 inhibitors → decreased lacosamide metabolism increases risk of lacosamide toxicity → consider dose decreases of lacosamide if concurrent strong CYP3A4/5 or CYP2C9 inhibitors or poor renal or hepatic function, monitor and consider dose reduction if concurrent moderate inhibitors

• CYP2C9, CYP3A4/5 inducers → increased lacosamide metabolism decreases lacosamide efficacy → consider dose increases of lacosamide if concurrent strong CYP3A4/5 or CYP2C9 inhibitors, monitor and consider dose increase if concurrent moderate inhibitors

• Benzodiazepines, centrally acting muscle relaxants, opioids, droperidol → additive CNS depression → monitor and consider dose adjustments of interacting agent

• Mefloquine → decreased efficacy of lacosamide and increased risk of seizures → avoid use of mefloquine for malaria prophylaxis in patients with history of seizures

Lacosamide ADRs?

• Common - dizziness, drowsiness, headache, nausea

• Less common - syncope, diarrhea, fatigue, pruritus, nystagmus, increase liver enzymes

• Rare but serious - acute psychosis, bradycardia, hepatotoxicity, agranulocytosis, suicidality, cardiac arrythmias, Steven-Johnson syndrome, toxic epidermal necrolysis

Lamotrigine brand name and class?

• Lamictal, Subvenite

• Class: Phenyltriazine Anticonvulsant

Lamotrigine common FDA label indication, dosing, and titration?

• Bipolar I disorder

• Partial seizure, adjunct or monotherapy, tonic-clonic seizure, Lennox-Gastaut syndrome, adjunctive

Lamotrigine MOA?

Lamotrigine is a phenyltriazine derivative unrelated to other marketed antiepileptic drugs (AEDs). Lamotrigine inhibits voltage-dependent sodium channels, thereby stabilizing neuronal membranes and reducing the release of excitatory neurotransmitters such as glutamate and aspartate.

Lamotrigine box warnings?

Serious skin reactions

Lamotrigine contraindications?

Hypersensitivity

Lamotrigine drug interactions?

• Enzyme inducers, rifampin, carbamazepine → increased lamotrigine metabolism decreases lamotrigine efficacy → monitor seizure control and consider dose increase of lamotrigine

• Escitalopram → increased risk of myoclonus through additive effect on calcium channels → caution with concurrent use

• Ethinyl estradiol and other estrogen-based birth control products → decreased lamotrigine concentrations via increased metabolism → use an alternative form of birth control or consider dose increase of lamotrigine

• Risperidone → increased risperidone plasma concentrations and risk of adverse effects via unknown mechanism → monitor and use with caution

• Mefloquine → decreased efficacy of lamotrigine and increased risk of seizures → avoid use of mefloquine for malaria prophylaxis in patients with history of seizures

• Benzodiazepines, centrally acting muscle relaxants, opioids, droperidol → additive CNS depression → avoid concurrent use or monitor for sedating effects

Lamotrigine ADR?

• Common - nausea

• Less common - vertigo, anxiety, depression, dysmenorrhea, diplopia, rhinitis, rash, somnolence, migraine

• Rare but serious - Stevens-Johnson syndrome, anemia, leukopenia, disseminated intravascular coagulation, thrombocytopenia, liver failure, aseptic meningitis, suicidal thoughts

Levetiracetam brand name and class?

• Keppra, Keppra XR, Roweepra, Spritam

• Class: Anticonvulsant

Levetiracetam common FDA label indication, dosing, and titration?

• Myoclonic seizure, adjunct

• Partial seizure, adjunct

• Tonic-clonic seizure, primary generalized, adjunct

Levetiracetam MOA?

Levetiracetam is a pyrrolidine derivative that is structurally unrelated to other AEDs. Its mechanism of action is unclear and does not relate to any known mechanisms of neuronal excitation or inhibition. The action of levetiracetam in animal models of seizures and epilepsy is unique from other AEDs.

Levetiracetam box warnings?

None

Levetiracetam contraindications?

Hypersensitivity

Levetiracetam drug interactions?

• Carbamazepine → increased risk of carbamazepine toxicity → use caution with concomitant therapy; monitor for side effects

• Benzodiazepines, centrally acting muscle relaxants, opioids, droperidol → additive CNS depression → avoid concurrent use or monitor for increased sedative effects

Levetiracetam ADR?

• Common - asthenia, abnormal behavior, fatigue, headache, somnolence, vomiting, increased BP

• Less common - agitation, depression, diarrhea, dizziness, hostile behavior, irritability, loss of appetite, mood swings, nausea, nasopharyngitis, neck pain

• Rare but serious - pancytopenia, hepatotoxicity, suicidal thoughts, suicide, Stevens-Johnson syndrome