Applied and Clinical Pharmacology

Clinical pharmacology of antiepileptics

Although the group of antiepileptic drugs may appear to be a typically neurologic topic, patients taking these drugs are seen in various medical disciplines. And because most of these drugs have a narrow therapeutic window, it is appropriate to understand their risk in a wide range of clinical situations.

Join us for a pre-class reading. Much of the information on antiepileptics you will remember from basic pharmacology. Now let's add the clinical context. The relevant chapter of the pre-class reading can be found here (chapter 12 of the book):

There is the question "For which of the antiepileptics is TDM appropriate?" at the very beginning of the pre-class reading. TDM was one of the topics in the last class. Can you answer it?

For which of the antiepileptics is TDM appropriate?

What is the typical setting of TDM in antiepileptic? What kind of sampling is usually required?

TDM is typical for phenytoin, valproate, lamotrigine, lacosamide, perampanel. But you can see other drug monitoring as well. Under some specific situations, TDM of levetiracetam may be appropriate. It might be easier to say in which drugs we usually don't do TDM - the answer would be benzodiazepines.

Typically, we monitor the minimum plasma concentration (trough concentration; before taking the medication). Sometimes, additional information are necessary, e.g., albumin level or renal functions. 

Test your knowledge after studying the pre-class reading and repeating basic pharmacology. 

Try taking the ROPOT test here:

And now you can look forward to the TBL lesson where we will focus on the use and management of antiepileptic drugs in the virtual patient.