Anticonvulsants - Carbamazepines

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Anticonvulsants - Carbamazepines by Mind Map: Anticonvulsants - Carbamazepines

1. Rational Drug Selection

1.1. diethylpropion - one of the safest nonadrenergic appetite suppressants. may be used w/ pt with moderate htn

2. Pharmacokinetics

2.1. A&D: absorb thru stomach, suspension being absorbed quicker than tablet form. Drug is highly lipophilic, resulting in high body tissue binding. 67% protein bound 40% active metabolites. eslicarbazepine is highly bioavailable after oral admin

2.2. M&E: metabolized in liver - unique ability to induce its own metabolism (autoinduction). induces metabolism of many CYP450 enzymes. Excret urine / feces

3. Precautions

3.1. use with caution in pt with increase intraocular pressure. and with those with cardiac, renal, or hepatic impairment

3.2. Cross sensitivity with TCAs,

4. Contraindications

4.1. CI - bone marrow suppression, MAOI use, glaucoma, any hematologic reaction to drugs, cardiac renal hepatic impairment – lots of contraindications

5. Black box / Preg Category

5.1. carbamazepine Cat D, teratogenic defects have occurred black box warning of SJS and toxic epidermal necrolysis (esp asian) - oxcarbazepine is cat C

6. ADRS

6.1. carbamazepine has black box warning for development of SJS and toxic epidermal necrolysis in pts of chinese ethnicity. Can alos cause blood dyscrasias. depresses bone marrow and can lead to leukopenia, thrombocytopenia, aplastic anemia

6.2. SE from oxcarbazepine is dizziness, diplopia, somnolence, fatigue, nausea, vomiting, ataxia, abd pain, tremor, dyspepsia.

7. Drug Interactions

7.1. concurrent admi of propoxyphene, hydantoins, cimetidine, some antibiotics, can increase plasma level of drug to toxic levals

7.2. beta blocked

8. Clinical Use

8.1. carbamazepine - partial complex siezure disorder, trigemical neuralgia, bipolar disorder, aggresive behavioir

8.2. oxcarbazepine - monotherapy for partial seizures

9. Cost

9.1. $15-30

10. Monitoring

10.1. Watch TSK and blood levels

11. Patient Education

11.1. no grapefruit juice,

11.2. report any symptom of skin lesions, bruising, fever , or sore throat.

11.3. administration with food will increase absorption

11.4. can be sedating, exercise caution when needing to be mentally alert

12. Comments

13. Pharmacodynamics

13.1. thought to affect the sodium channel, slowing influx of sodium in the cortical neurons and close the spread of abnormal activity

14. Carbamazepine (Tegretol), oxcarbazepine (Trileptal), eslicarbazepine (Aptiom)