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Anti-Epileptic Drugs (MOA Na+ channel blockers Use-dependent Inhibit…
Anti-Epileptic Drugs
MOA
Na+ channel blockers
Use-dependent
Inhibit action potential generation
Carbamazepine
Tegretol
SE
Skin reactions (e.g. SJS)
Blood dyscrasias (↓WCC)
↓Na+ (SIADH)
Foetal NTDs
GI upset
Dose-related
Dizziness/vertigo
Ataxia
Diplopia
Unpaced AV conduction
defects
Hx of BM depression
Porphyria
MAOIs
Has active metabolite produced
in the liver
CYP inducer
Monitor levels + U+Es, LFTs, FBC
Phenytoin
Acute SE
Drowsiness
Cerebellar fx (DANISH)
Rash
Chronic SE
Gingival hyperplasia
Hirsutism + acne
↓ folate
Don’t give IV if cardiac
dysrhythmias
Caution: DM, ↓BP, L/H,
P (cleft palate)
V. albumin bound
CYP inducer
Saturable kinetics
dose ↑ → t½ ↑
Monitor
FBC
↓s fx of:
COCP
Doxy
corticosteroids
anti-epileptics (inc. CBZ)
nifedipine
Warfarin
levels ↑d by:
macrolides
cimetidine
diltiazem and verapamil
EtOH
NSAIDs
esomeprazole
levels ↓d by:
rifampicin
antipsychotics
Valproate
SE
Hepatotoxicity
Appetite ↑ → ↑wt.
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Most teratogenic AED
6%
Tremor,
Thrombocytopenia
Encephalopathy: due to ↑
ammonia
CI
Acute porphyria
Personal/fam hx of
severe liver dysfunction
L/P
fx ↓d by:
antimalarials
antidepressants
antipsychotics
some anti-epileptics
levels ↑d by cimetidine
↑s fx of:
aspirin
lamotrigine
warfarin
1st line for primary generalised
seizures
CYP inhibitor
Monitor
FBC, LFTs
Vigabatrin
SE Visual field defects
Inhibits glutamate release
Lamotrigine
SE
Rashes (SJS, TEN, lupus) Stop if any sign of a rash
Cerebellar fx
Blood dyscrasias
Hepatotoxic
CI in L
fx ↓d by:
OCP
phenytoin, CBZ
TCAs and SSRIs
levels ↑d by valproate
Monitor
U+Es, LFTs, FBS, clotting
Safest drug for pregnancy
Ca2+ channel blocker
Ethosuximide
SE GI upset
?makes tonic-clonics worse
Only used for childhood
absence seizures