1.  **binds to GABA (A) receptors and prolongs amount of time chloride can flow into neuron (hyperpolarization)

2.  decrease release of excitatory NT (glutamate)

3.  decrease calcium channel activity

Best documented liver enxymes inducer; leads to drug-drug interactions

Causes decreased levels of other drugs that are metabolized by the liver enzymes

gingival hyperplasia

hypertrichosis

thickened facial features

folate deficiency

peripheral neuropathy

20 mg/L--> nystagmus

30mg/L--> nystagmus, ataxia

40mg/L--> ataxia, lethargy and decreased cognitive function

exhibits MM (linear) kinetics--> small dose can result in large increase in plasma levels

IV incompatabilities.

GTCS

partial epilepsy

trigeminal neuralgia

bipolar disease

autoinduction--> starts enhancing its own metabolism in the liver; takes 3-4 weeks to stabalize.

Levels should be monitored for the first ~28 days, followed by a dose adjustment

10, 11 epoxide metabolite (active and can be increased by valproate)

Keto-analog of CBZ

Less side effects but less potent

Approved for monotherapy for newly diagnosed patients and refractory partial epilepsy

GI

vision effects (diplopia)

hematologic effects (leukopenia--> usually transient; drug should be stopped is under 2500.)

thrombocytopenia

rash

1.Inhibits GABA metabolism (GABA transaminase and sicinic semialdehyde DH)

2.prevents GABA reuptake

3.stimulates GABA synthetic enzymes (from glutamate)

4.  enhances sodium channel inactiavation (prolonged recorvery after AP)

5.  Some effect on T-type calcium channels

GI--common

alopecia (usually temp)

weight gain

hepatotoxicity (particularly of concern in patient under 2 yo on multi drugs)

metabolic effects

thrombocytopenia (increased ammonia, glucose, urea)

Diazepam (status and alcohol withdrawal)

Lorazepam (status and alcohol withdrawal)

Clonazepam (akinetic seizures, myoclonic seizures, lennox-gastaut)

abuse potential

tolerance (longterm use)

relatively safe unless combined with ethanol

adjunct for complex partial

Lennox-Gastaut (MR and mutliple seizure types)

**aplastic enemia and deadly hepatotoxicity

Rarely used; never first-line

complex partial seizures

monotherapy for refractory partial seizures

binds to alpha2delta subunit of calcium channels and decreases calcium influx (decreases release of several NT)

inhibits Na currents

stimulates GABA release

it is eliminated by kidneys and water soluble, so not many drug interactions

reduced absorption with antacids

eliminated by kidneys and water soluble, not many drug interactions

blurred vision, peripheral edema, dry mout, weight gain

inhibits sodium channels

enhances GABA

attenuates kainate-induced seizures

AMPA antag?

nervousness, tremor

spike-wave stupor--> do not use off-label

binds selectively to SV2A

(which may be modifying synaptic release of glutamate and GABA)

poorly understood; inhibits voltage gated sodium currents adn T-type calcium channels (in vitro)

infantile spasms

refractory epilepsy (last line)

GABA transaminase inhibitor

inhibition of GABA reuptake

enhances slow actiavtion of sodium channels

100% bioavailable

no significant drug interaction

PR-interval prolongation (caution when using with other drugs causing prolonged PR or people with cardiac disease)

shortened QT interval, hypersensetivity (rash)

(caution when using other drugs that shorten QT interval like digoxin and lamotrigine)

EUPHORIA-- Schedule V controlled substnace

fetal anticonvulsant syndrome

neural tube defects (cleft lip, cleft palte, spinal cord like myelomeningocele)

poor cognitive outcome (especially Valproate)

thin upper lip

small, upturned nose

long, flat nasal bridge

mild to moderate MR

ptosis

occular hypertelorism

long philtrum

hypoplasia of distal phalanges

small nails

Might be caused by folate deficiency or interruption of hyaluronic acid metabolism

-caused by various anticonvulsants like lamotrigine, carbemazepine, barbiruates, phenytoin, ethosuxamide

-severe febrile hypersensitivity reaction

-array of macules, papules, vesicles, and cytotoxicty

-remove causative agent and admin IV steroids and antibiotics

- SE of ethosuxamide, phenytoin and phenobarbital and other anticonvulsants

-under 20,000 platelets

-echymoses, petechial hemorrhages in skin and MM

-might be due to drug-induced folate deficiency

-teratogenic effects

-steven-johnson syndrome

-thrombocytopenia

-hepatic failure

-aplastic anemia and bone marrow suppression

-lupus-like sydrome

-rashes (urticaria, 'fixed drug eruption,' etc)

-gingival hyperplasia (phenytoin)

-angioedema

-cystic acne (phenytoin)

-hirsutism (phenytoin)

-thickened facial features (phenytoin)

-alopecia (valproate)

rufinamide

topiramate

felbemate

clonazepam