A quick review over the anticonvulsant drugs that are monitored using TDM testing, including: phenobarbital, primidone, phenytoin, valproic acid, carbamazepine, ethosuximide, clonazepam, felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide. Based on information from the Larson and Bishop textbooks.
Hi this is dr a with a clinical chemistry review we’re going to look at therapeutic drug monitoring of anti-epileptic drugs okay so anti-epileptic drugs are anti-covalence meaning um they will help with seizures most anti-epileptics will block sodium influx into the neurons that have damaged membranes and that will lessen the neuron firing numerous anti-epileptic
Drugs are available many patients may take multiple drugs to control their seizures many of these strokes required a specimen to the center of reference lab to be analyzed but phenytoin carbamazepine and vipric acid are commonly available on either clinical chemistry or amino acid analyzers and are done by clinical labs all over the country so the first anti-epileptic
Drug is going to be phenobarbital it is a slow-acting barbiturate that effectively controls several types of seizures it is a sedative it binds gaba receptors in the central nervous system it is used for anxiety and sleep also and the patient can develop tolerance independence so tolerance meaning that they’ll need more and more to have the effect independence
Meaning that they basically become addicted to it and the toxicity of phenobarbital is a central nervous system depression so it can easily overdose and kind of go into the coma primadone it metabolizes into phenobarbital and it binds gather receptors in the central nervous system it is an inactive form of phenobarbital chromadone is rapidly absorbing the gi
Tract and converted to its active form which is phenobarbital primadone is preferred over female barbitol when you need steady-state kinetics need to be established very quickly phanatorium also known as the latin uh or phosphanatoin um they are commonly used to treat seizures they inhibit the sodium channel it is this one is not a sedative it is used as a
Short-term prophylactic agent and brain injury to prevent a loss of functional tissue the toxicities exhibited as central nervous system depression and phosphenatorin is an injectable pro form of phenetoin that is rapidly metabolized about 75 minutes to form the parent drug senatorine vaporic acid also known as vibrate or depokine or depakote it is used as a
Monotherapy for the treatment of patemal or absence seizures it binds gaba transaminase in when there’s an overdose that will be in a coma carbomyzepine also known as territol it’s an effective treatment in various seizures disorders it keeps the voltage-gated sodium channels inactive um because of its serious toxic adverse effect it is less frequently used um
Mild toxicity will show vomiting ataxia rashes or copenhagen on the offshore vertical and fever reactions severe toxicity will show seizures and respiratory depression and many other symptoms um ethos success seizures it is a calcium channel blocker and the toxicity is shown with nausea vomiting anorexia dizziness lethargy and of course also coma clonazepam or
Klonopin is a benzodiazepine that is related to valium which is diazepam and it is used to treat panic disorders phthalabate or is primarily indicated for use in severe epilepsies it is an orlean minister drug that is nearly completely absorbed by the gi tract it is known for its toxicity it is primarily indicated in severe epilepsies such as the lenox gestalt
Syndrome in children and refractory epilepsy in adults gabapentin also known as neurotin may be indicated as a monotherapy or in conjunction with other anti-epileptic drugs in patients suffering from complex partial seizures with or without generalized seizures it is a chemical analog of gaba lamotrigine um is used to treat patients with partial and generalized
Seizures it is a gaba antagonist um leverager satan or kepra is indicated in partial and generalized seizures it has an unknown mechanism the toxic effects are decreased red cells manufactures and neutrophils and ox carbazepine also known as trileptol is indicated for the monotherapy of partial seizures and in secondarily generalized chronic clinic seizures
And to treat bipolar disorder it is a pro drug that is almost immediately metabolized into like carbizopine it blocks sodium ion channels which reduces neuronal firing and toxicity is evidenced as hyponatremia or gabatril is used in the treatment of partial seizures it is not known exactly how chia gavin works sorry i’m not 100 sure how that pronounced uh
But it does increases the amount of natural chemicals in the brain that prevents seizure activity the adverse central nervous system side effects have been noted including confusion difficulty in speaking clearly so stuttering mild sedation and a tingling sensation in the body’s extremities or paresthesia especially in hands and fingers to pyramid also known
As topomax topomax is indicated in partial and generalized seizures it is used as a preventative medicine for migraine headaches but it does it cannot relieve the pain of a migraine that has already started it decreases abnormal excitement in the brain by blocking voltage dependent sodium and calcium channels it also inhibits the excitatory glutamate pathway
While enhancing the inhibitory effects of gaba and last one is omnisomide or zonogran is indicated in partial and generalized seizures it works by decreasing the abnormal electrical activity in the brain it is believed to exert anti-convulsive effects by blocking sustained repetitive neuronal firing via a blockade of voltage-sensitive sodium uh channels and by
Reducing the voltage-sensitive t-tap calcium channels so again works on sodium and potassium sodium and calcium channels and blocks the firing of the neurons and stuff like that a lot of uh again these drug levels are going to be done via immunoassays some of them have to be sent to reference labs and um that’s it that’s it for you
Transcribed from video
Therapeutic Drug Monitoring: Anti-epileptics – clin chem review By Dr. A’s Clinical Lab Videos
