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Epilepsy Drugs or Antiepileptic Drugs (Carbamazepine (Tegretol) (Adverse…
Epilepsy Drugs or Antiepileptic Drugs
Phenytoin (Dilantin)
Selective inhibition of Na channels
Slows recovery of Na channels from inactive state
Delays further influx of Na into axon and prevents depolarization
Delays further action potential
Drug levels: 10-20 mcg/mL
Caution: poorly metabolized by liver, stays in body longer, risk for toxicity
Adverse Effects
Sedation
Nystagmus
Gingival hyperplasia
Measle-like rash
If given IV:
Purple glove syndrome (infiltration)
Give slowly to prevent HTN
Interactions
Interacts with MANY drugs!
Induces metabolism of other drugs so decrease in levels of other drugs
Carbamazepine (Tegretol)
Selective inhibition of Na channels
Slows recovery of Na channels
Delays further influx of Na into axon and prevents depolarization
Delays further action potential
Drug levels: 4-12 mcg/mL
CYP450 substrate and INDUCER!
Adverse Effects
Visual disturbances
Vertigo
Administer at bedtime to reduce effect
Bone marrow suppression
Leukopenia
Anemia
Thrombocytopenia
Measles-like rash
Interactions
Because it's an inducer
Will decrease levels of warfarin and contraceptives
Because it's a substrate
Grapefruit juice is an CYP450 inhibitor and would increase levels of Carabamazepine
Valproic acid (Depakote, Depakene)
Selective inhibition of Na channels
Slows recovery of Na channels
Delays further action potential
Delays further influx of Na into axon and prevents depolarization
Blocks Ca influx
Reduces release of neurotransmitters into synapse
Augments inhibitory effect of GABA
Inhibits action potential
Drug levels: 50-100 mcg/mL
Adverse Effects
GI effects (common)
Liver failure (rare)
HIGHLY TERATOGENIC
Phenobarbital
CYP450 INDUCER
Anticonvulsant barbiturate
Binds to GABA receptors
Potentials the inhibitory effect of GABA
Drug levels: 15-40 mcg/mL
Adverse Effects
Drowsiness
Only at first. With prolonged use drowsiness will fade
Administer at bedtime to reduce this effect
Physical dependence (it's a barbiturate)
HIGHLY TERATOGENIC
GABApentin (Neurontin)
Analog of GABA but doesn't affect GABA receptors
May enhance GABA release
Increased inhibitory effect of GABA
Adverse effects
Somnolence (drowsiness)
Dizziness
Fatigue
Nystagmus
Administer at bedtime to reduce effects
Levetiracetam (Keppra)
MoA is unknown.
This makes it unique and different than the others!
Adverse Effects
Drowsiness (most common)
Anxiety, depression, psychosis