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\author{Bailey\_Rickett}
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  /Title (pharmacology-of-seizure-disorders.pdf)
  /Creator (Cheatography)
  /Author (Bailey\_Rickett)
  /Subject (Pharmacology of Seizure Disorders Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pharmacology of Seizure Disorders Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Bailey\_Rickett} via \textcolor{DarkBackground}{\uline{cheatography.com/184326/cs/38670/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Bailey\_Rickett \\
  \uline{cheatography.com/bailey-rickett} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th May, 2023.\\
   Updated 13th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Seizure vs. Epilepsy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Seizure: high electrical discharge from an area of the CNS (foci), they are one and done, and there is usually a reason such as: vascular, infection, trauma, autoimmune, metabolic disorders, neoplasm, or idiopathic.} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Epilepsy: two or more seizures that do not resolve (they may become chronic) there is no VITAMIN reason.} \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Types of Epileptic Seizures}}  \tn
% Row 0
\SetRowColor{LightBackground}
Focal/Partial Seizures & Simple \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Complex \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Generalized Seizures & Generalized tonic-clonic: grand mal seizure, LOC, convulsions, muscle rigidity \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
Absence & usually in children, brief loss of consciousness, blanks out, stares off into space. \tn 
% Row Count 10 (+ 4)
% Row 4
\SetRowColor{LightBackground}
Myoclonic & sporadic (isolated), jerking movements \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
Clonic & Repetitive, jerking movements \tn 
% Row Count 14 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Tonic & Muscle stiffness, rigidity \tn 
% Row Count 15 (+ 1)
% Row 7
\SetRowColor{white}
Atonic & drop seizures, loss of muscle tone \tn 
% Row Count 17 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.84149 cm} x{3.13551 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Epileptic "Spasms"}}  \tn
% Row 0
\SetRowColor{LightBackground}
Benign Rolando & Twitching, numbness, or tingling or one side of tongue/face \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
West Syndrome & Infantile wiggles \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & "JackKnife" seizures (legs fly up) \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
 & Leads to autism or intellectual disabilities later in life. \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{Lennox-Gastaut} Syndrome & Multiple seizures every day (18-20) \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
 & Cannabis may eliminate these seizures. \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Carbamazepine {\bf{(Tegretol)}} (Carbatrol, Equetro)}}  \tn
% Row 0
\SetRowColor{LightBackground}
Class: & Na+ Channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
MOA: & Blocks Na+ channel blocker, a tricyclic compound (similar structure to TCA, no high affinity for MAO) \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Indications:} & Generalized or focal seizures *one of the most widely used, mostly for focal seizure. 1st line treatment for trigeminal neuralgia. \tn 
% Row Count 10 (+ 5)
% Row 3
\SetRowColor{white}
\seqsplit{Formulations:} & Carbatrol and Equetro (ER capsule), tablet, Tegretol (suspension), chewable tablet, XR tablet \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & Not a controlled substance \tn 
% Row Count 15 (+ 1)
% Row 5
\SetRowColor{white}
Side Effects: & N/V, dizziness, blurry vision, diplopia, sedation at high doses, benign leukopenia. \tn 
% Row Count 18 (+ 3)
% Row 6
\SetRowColor{LightBackground}
Serious ADRs: & Hyponatremia, Bone marrow suppression, SJS/TEN, osteomalacia, hepatotoxicity (very rare). Rash and hyponatremia are most common reasons for discontinuation. May worsen myoclonic seizures. \tn 
% Row Count 25 (+ 7)
% Row 7
\SetRowColor{white}
Drug \seqsplit{Interations:} & {\bf{Potent CYP inducer}} \tn 
% Row Count 27 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & Induces CYP3A4, 2C9, 2C19, PgP (will decrease levels of drugs metabolized by these) \tn 
% Row Count 30 (+ 3)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Carbamazepine {\bf{(Tegretol)}} (Carbatrol, Equetro) (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
 & Substrate of CYP3A4, 2C8, PgP \tn 
% Row Count 2 (+ 2)
% Row 10
\SetRowColor{white}
 & VPA and Lamotrigine can increases carbamazepine levels \tn 
% Row Count 4 (+ 2)
% Row 11
\SetRowColor{LightBackground}
 & Do not use with hormonal contraception (decreases efficacy of BC) \tn 
% Row Count 7 (+ 3)
% Row 12
\SetRowColor{white}
\seqsplit{Considerations:} & requires lab monitoring, can induce its own metabolism so levels may decrease over time. Not a sedative so a good choice if that is a concern. \tn 
% Row Count 13 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Oxcarbazepine}}  \tn
% Row 0
\SetRowColor{LightBackground}
Class: & Na+ channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
MOA: & Na+ channel blocker, less potent than carbamazepine. Pro-drug for S+licarbazepine \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Indications:} & adjunct therapy for partial seizures \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Formulations:} & tablet, oral suspension, ER tablet (Oxtellar XR) \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Not a controlled substance \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
Side Effects: & may have less than carbamazepine but similar, {\bf{higher risk of hyponatremia}} \tn 
% Row Count 12 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\seqsplit{Considerations:} & Less drug interactions than carbamazepine, check Na+ levels \tn 
% Row Count 15 (+ 3)
% Row 7
\SetRowColor{white}
 & {\bf{weak CYP3A4 inducer}}, does not auto-induce metabolism like carbamazepine \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Phenytoin {\bf{(Dilantin)}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
Class: & Na+ Channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
MOA: & Na+ Channel blocker (works similarly to Carbamazepine) oldest non-sedating epileptic drug \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Indications:} & focal (partial) onset seizure, generalized onset seizure (NOT first line), Status Epilepticus \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\seqsplit{Formulations:} & capsule, injection, oral suspension, chewable tablet \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Not a controlled substance \tn 
% Row Count 12 (+ 1)
% Row 5
\SetRowColor{white}
Side Effects: & Hirsutism, sedation, gingival hyperplasia (enlarged gums), \tn 
% Row Count 15 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & TOXIC EFFECTS: nystagmus, diplopia, ataxia \tn 
% Row Count 17 (+ 2)
% Row 7
\SetRowColor{white}
Serious ADRs: & SJS/TEN (especially asian), osteomalacia, peripheral neuropathy, tissue necrosis when IV, arrhythmias \tn 
% Row Count 21 (+ 4)
% Row 8
\SetRowColor{LightBackground}
\seqsplit{Considerations:} & may worsen other seizure types (absence, juvenile myoclonic, Dravet's syndrome) \tn 
% Row Count 24 (+ 3)
% Row 9
\SetRowColor{white}
 & When switching formulations keep in mind different dosage forms contain different amounts of PHT (ex. caps and injection are 92\% and susp. and chewable tablets are 100\%) \tn 
% Row Count 31 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Phenytoin {\bf{(Dilantin)}} (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & Extensively bound to albumin, free PTH is what is active. Drug or conditions that alter albumin will affect PHT levels. Many drugs compete with bound PHT and may cause displacement and lead to toxicity. Patients with liver disease, hypoalbuminemia, or renal failure can lead to abnormally high levels of PHT (toxic levels) \tn 
% Row Count 12 (+ 12)
% Row 11
\SetRowColor{white}
 & Metabolized by CYP2C19 and 2C9, induces 3A4, 2C9, 2C19, and 1A2. \tn 
% Row Count 15 (+ 3)
% Row 12
\SetRowColor{LightBackground}
 & Potent CYP inducer \tn 
% Row Count 16 (+ 1)
% Row 13
\SetRowColor{white}
 & Substrate and inducer of PgP and interacts with most oral contraceptives (decreases efficacy) \tn 
% Row Count 20 (+ 4)
% Row 14
\SetRowColor{LightBackground}
Lab monitoring & Free phenytoin levels should be checked in patients with hypoalbuminemia and renal failure. If you can't check free, check total and use given equations to adjust. \tn 
% Row Count 27 (+ 7)
% Row 15
\SetRowColor{white}
Therapeutic Levels & Total 10-20 mg/L \tn 
% Row Count 29 (+ 2)
% Row 16
\SetRowColor{LightBackground}
 & Free 1-2.5 mg/L \tn 
% Row Count 30 (+ 1)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Phenytoin {\bf{(Dilantin)}} (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
 & {\bf{Toxic \textgreater{}30 mg/L}} \tn 
% Row Count 1 (+ 1)
% Row 18
\SetRowColor{white}
 & Lethal level \textgreater{}100 mg/L \tn 
% Row Count 2 (+ 1)
% Row 19
\SetRowColor{LightBackground}
 & Draw levels within 2-3 days of starting therapy and then get second level within 5-8 days of therapy initiation and with subsequent dose adjestments \tn 
% Row Count 8 (+ 6)
% Row 20
\SetRowColor{white}
 & In stable patients, can draw levels at 3-12 month intervals \tn 
% Row Count 11 (+ 3)
% Row 21
\SetRowColor{LightBackground}
 & Phenytoin kinetic are non liner -\textgreater{} a small dose increase may cause a BIG increase in plasma concentration \tn 
% Row Count 15 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fosphenytoin (Cerebyx)}}  \tn
% Row 0
\SetRowColor{LightBackground}
Class: & Na+ Channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Indication: & Same as phenytoin, {\bf{preferred over phenytoin for parenteral administration}} if needed. \tn 
% Row Count 5 (+ 4)
% Row 2
\SetRowColor{LightBackground}
 & Still prefer Benzos in SE because of delayed effects \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Formulations:} & injection \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & not a controlled substance \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
Side Effects: & same as phenytoin \tn 
% Row Count 12 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & same as phenytoin \tn 
% Row Count 14 (+ 2)
% Row 7
\SetRowColor{white}
Special Notes: & a prodrug of phenytoin (each mL= 50mg of phenytoin equivalents) \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Take Home Points}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Skin \seqsplit{rashes/hypersensitivities} (SJS, TEN, rash)- highest risk with: lamotrigine, phenytoin, carbamazepine, phenobarbital} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{DO NOT USE VPA in women of childbearing age, especially if they are not on effective birth control} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Phenytoin levels needs to be checked.} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Safer pregnancy option: lamotrigine, levetiracetam (Use as monotherapy when at all possible. Pregnancy can lower drug levels so dose adjustments may be required)} \tn 
% Row Count 10 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Most of the medications decrease effectiveness of hormonal contraceptives.} \tn 
% Row Count 12 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Therapy is seizure and patient specific.} \tn 
% Row Count 13 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{If a patient doesn't respond to monotherapy, those meds with similar MOAs will likely not be effective so choose another med as adjunct.} \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Some medications are chosen due to comorbidities.} \tn 
% Row Count 17 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{VPA is mood disorder or migraine.} \tn 
% Row Count 18 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pregabalin in neuropathic pain} \tn 
% Row Count 19 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Epileptic Spasms}}  \tn
% Row 0
\SetRowColor{LightBackground}
Benign Rolando & Lamotrigine \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
West Syndrome & Vigabatrin \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Lennox-Gastaut Syndrome & Valproate \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
 & Topiramate \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Lamotrigine \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
 & Cannabidiol \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & If really refractory Felbamate \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{3.43413 cm} x{1.54287 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adverse Reactions}}  \tn
% Row 0
\SetRowColor{LightBackground}
SJS & \seqsplit{Ethosuximide} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & \seqsplit{Carbamazepine} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Lamotrigine \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
Cardio/Respiratory Depression & Benzos \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & \seqsplit{Barbiturates} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
 & Propofol \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Hepatotoxicity & Valproate \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
 & \seqsplit{Carbamazepine} \tn 
% Row Count 11 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & Felbamate \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
 & \seqsplit{Barbiturates} \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pathophysiology of Seizure}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Overactive glutamate in the brain (over excitation) that continues to cause {\bf{Na+ and Ca2+}} influx leading to continuous action potentials and stimulation.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{To improve that we want to increase actions of GABA which is inhibitory, and decreases the effects of Glutamate.} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{We can work on the voltage gated channels, directly on GABA, etc.. to decrease seizure activity. }}} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Seizures can be provoked or unprovoked. {\bf{Provoked}} could be due to electrolyte disturbances, infection, TBI, inflammation, fever, toxicities, etc. {\bf{Unprovoked}} could be epilepsy (genetic or chronic pathologic process)} \tn 
% Row Count 15 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.4931 cm} x{3.4839 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Three Major Seizure Patterns}}  \tn
% Row 0
\SetRowColor{LightBackground}
Focal & One area of the cortex, isolated to motor of sensory. \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & With or without loss of consciousness \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Generalized & starts in a foci and spreads over the entire cortex. \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
Epileptic "Spams" & Benign Rolando (around the central sulcus) \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & West Syndrome \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
 & Lennox-Gastaut's Syndrome \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Overview of How These Drugs Work}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ultimate goal is to inhibit the local generation of seizure discharges to reduce the ability of neurons to fire at high rate and reduced neuronal synchronization.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Modulate Na+, Ca2+, or K+ channels} \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Enhance fast acting GABA-mediated synaptic inhibition (we want to increase overall inhibition, increase GABA)} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Modification of synaptic release processes (sv2A, alpha2delta-1)} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Diminishing effects of fast glutamate mediated excitation (decreases excitatory effects, decreased Glutamate)} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lamotrigine}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & Na+ Channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & adjunct for Lennox-Gastaut syndrome, adjunct for generalized tonic-clonic, mono or adjunct for focal seizures. \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & tablet, chewable tablet, titration kits as well \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
 & not a controlled substance \tn 
% Row Count 9 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & sometimes insomnia instead of sedation, dyspepsia, peripheral edema, HA, dizziness, rash \tn 
% Row Count 13 (+ 4)
% Row 5
\SetRowColor{white}
Serious ADRs: & Fatal Rash (SJS) worsened if combined with VPA use \tn 
% Row Count 15 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & VPA greatly increases levels of drug, increased SJS risk. OCPs or other estrogen containing medications reduce lamotrigine levels and may increase seizure occurrence. \tn 
% Row Count 22 (+ 7)
% Row 7
\SetRowColor{white}
Special Notes: & normally well tolerated and widely used, safer in pregnancy than others due to lower fetal risk. Rash (as a hypersensitivity) can be reduced by a slow titration of the dose (children at higher risk) \tn 
% Row Count 30 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Valproic Acid {\bf{(Depakene)}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & exact mechanism unknown, has broad spectrum efficacy (multiple seizure types) \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & generalized tonic-clonic, focal (may not be as effective as carbamazepine/phenytoin) absence, myoclonic (juvenile myoclonic), atonic/akinetic (Lennox-Gastaut) \tn 
% Row Count 9 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & capsule, DR sprinkle, oral solution, IV, DR tablet, ER tablet \tn 
% Row Count 12 (+ 3)
% Row 3
\SetRowColor{white}
 & Not a controlled drug \tn 
% Row Count 13 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Side effects: & N/V. GI pain and heartburn (Divalproex has lowest GI risk), weight gain, tremor (dose related) OP \tn 
% Row Count 17 (+ 4)
% Row 5
\SetRowColor{white}
Drug \seqsplit{Interactions:} & a CYP inhibitor of metabolism (will increase levels of phenobar and ethosuximide) displaces phenytoin from albumin so increasing free phenytoin levels (toxicity). Increases levels of lamotrigine by inhibiting it's clearance. \tn 
% Row Count 26 (+ 9)
% Row 6
\SetRowColor{LightBackground}
Warnings: & {\bf{Do not use in women of childbearing age, VPA induced hepatic failure}} (children \textless{}2 at most risk) The worst teratogen. \tn 
% Row Count 31 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Valproic Acid {\bf{(Depakene)}} (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & Highly protein bound like phenytoin \tn 
% Row Count 2 (+ 2)
% Row 8
\SetRowColor{white}
 & Initial dosing of 15 mg/kg recommended with slow titration up to a therapeutic dose. \tn 
% Row Count 6 (+ 4)
% Row 9
\SetRowColor{LightBackground}
 & Therapeutic levels are usually anywhere from 50-100 mcg/mL \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{VPA}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683922859_IMG_2240.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Ethosuximide}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & CCB, inhibits low voltage activated T type Ca2+ channels \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
Indication: & absence seizure (first line agent) \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Long half life, taken once daily qhs \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Formulations:} & capsule, oral solution \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & not a controlled substance \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
Side effects: & N/V, HA, anorexia, lethargy, sedation, unsteadiness, urticaria, pruritus, hiccups \tn 
% Row Count 13 (+ 3)
% Row 6
\SetRowColor{LightBackground}
Serious ADRs: & {\bf{Neutropenia, SLE (Systemic Lupus Erythematosus), SJS, suicidal ideation}} \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
Drug \seqsplit{interactions:} & Substrate for CYP3A4, can reduce VPA levels (reason unknown), very few other drug interactions. \tn 
% Row Count 20 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Barbiturates (Phenobarbital and Primidone)}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & GABA receptor agonist, opens Cl- channels, can block AMPA receptors as well. Long half life, preferably taken once daily qhs. Primidone is metabolized to phenobarbital and acts more on Na+ channels than phenobarbital. \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & generalized tonic-clonic (not first line), simple or complex with or without secondary generalization (not first line), refractory status epilepticus \tn 
% Row Count 15 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & elixir, oral solution, injection, tablet \tn 
% Row Count 17 (+ 2)
% Row 3
\SetRowColor{white}
 & Schedule IV controlled substace \tn 
% Row Count 19 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Side effects: & {\bf{SEDATION}}, rashes, N/V, sedative/hypnotic effects \tn 
% Row Count 21 (+ 2)
% Row 5
\SetRowColor{white}
Serious ADRs: & SJS/TEN, respiratory depression, {\bf{narrow therapeutic window}}, serum concentrations need to be 15-40 mcg/mL, drug accumulates in renal impairment \tn 
% Row Count 27 (+ 6)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & {\bf{POTENT CYP INDUCER}}, also a substrate and inducer for PgP pump. Reduces efficacy or oral contraceptives, including progestin only and etonogestrel implant (Nexplanon) \tn 
% Row Count 34 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Barbiturates (Phenobarbital and Primidone) (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
Special Notes: & usually D/C due to ADRs so not a first line option, long term use leads to {\bf{dependance with withdrawal}} leads to more seizures. May WORSEN infantile spasms and absence seizures. \tn 
% Row Count 7 (+ 7)
% Row 8
\SetRowColor{white}
 & It is the oldest anti-epileptic but no longer used. \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pregabalin {\bf{(Lyrica)}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & same as gabapentin, {\bf{Ca2+ channel alpha2delta subunit}} (even though structure is similar to GABA, doesn't bind to GABA receptors) \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & adjunct for focal onset (immediate release only) also more for neuropathy \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & capsule (IR only for seizure) \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
 & Schedule V Controlled Substance \tn 
% Row Count 12 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & sedation, increased BP, dizziness, confusion, rash, nystagmus \tn 
% Row Count 15 (+ 3)
% Row 5
\SetRowColor{white}
Drug \seqsplit{Interactions:} & none significant \tn 
% Row Count 17 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Special Notes: & additional indication for neuralgia and neuropathic pain \tn 
% Row Count 20 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Felbamate}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & AMPA receptor antagonist, although there is strong evidence that it can also block NMDA receptors. GABA potentiation. \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & focal seizures, and Lennox-Gastaut syndrome ({\bf{never first line}}) \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & tablet and suspension \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
 & Not a controlled substance \tn 
% Row Count 11 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & N/V, HA, dizziness, {\bf{hepatotoxicity}}, anorexia \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
Serious ADRs: & {\bf{Aplastic anemia (wipe out of bone marrow), Hepatic failure ONLY USE IF NO OTHER OPTION}} \tn 
% Row Count 17 (+ 4)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & Inhibits CYP2C19, reduces efficacy or oral contraceptives \tn 
% Row Count 20 (+ 3)
% Row 7
\SetRowColor{white}
Special Notes: & {\bf{REQUIRES INFORMED CONSENT COMPLETED AND SIGNED}} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.9954 cm} x{3.9816 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Status Epilepticus}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Definition} & Occurrence of two or more convulsions without recovery of consciousness between attacks. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & A fixed and enduring epileptic condition (for 30 min or more) \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Treatment} & Initial treatment with IV Lorazepam (Benzo) 4mg or midazolam is usually helpful regardless of the type of status epilepticus. \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
 & Then if needed phenytoin, then carbamazepine, and other drugs may also be needed to obtain and maintain control in complex partial status epilepticus. \tn 
% Row Count 14 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Targets of Anti-Seizure Meds}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683916324_IMG_2239.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Targets of Anti-Seizure Drugs}}  \tn
% Row 0
\SetRowColor{LightBackground}
1 & Na+ channels \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
2 & Ca2+ channels (what allows the vesicles of glutamate to fuse with the membrane) \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
3 & sv2A receptor on the glutamate filled vesicles. \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
4 & AMPA or NMDA receptors \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
5 & GABA-A receptor coupled with a Cl- channel \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
6 & Targets the reuptake of GABA (inhibit the reuptake) \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
7 & Targets GABA transaminase that breaks down GABA (inhibit GABA breakdown) \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Targets of Therapy}}  \tn
% Row 0
\SetRowColor{LightBackground}
1- Na+ Channel Blockers & many drugs, pick and choose based on tolerance and contraindications. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
 & Carbamazepine \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Oxcarbamazepine \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
 & Phenytoin \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Fosphenytoin \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
 & Lomotrigine \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Topiramate \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
 & Valporate* \tn 
% Row Count 11 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Lacosamide \tn 
% Row Count 12 (+ 1)
% Row 9
\SetRowColor{white}
2. Ca2+ Channel Blockers & Ethosuximide \tn 
% Row Count 14 (+ 2)
% Row 10
\SetRowColor{LightBackground}
 & Maybe gabapentin, but now used for anxiety and neuropathy. \tn 
% Row Count 17 (+ 3)
% Row 11
\SetRowColor{white}
3. sv2A blockers & Levetiracetam \tn 
% Row Count 18 (+ 1)
% Row 12
\SetRowColor{LightBackground}
4. AMPA/NMDA Receptor Blockers & Felbamate-AMPA \tn 
% Row Count 20 (+ 2)
% Row 13
\SetRowColor{white}
 & Ketamine- NMDA \tn 
% Row Count 21 (+ 1)
% Row 14
\SetRowColor{LightBackground}
5. GABA-A Receptor Agonists & feel good drugs, puts you to sleep \tn 
% Row Count 23 (+ 2)
% Row 15
\SetRowColor{white}
 & Benzodiazepines- lorazepam, midazolam, diazepam, clobazam (increase in the {\bf{frequency}} of Cl- ion channel opening) \tn 
% Row Count 29 (+ 6)
% Row 16
\SetRowColor{LightBackground}
 & Barbiturates- phenobarbital, pentobarbital (increase in the {\bf{duration}} of Cl- channel opening) \tn 
% Row Count 34 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Targets of Therapy (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
 & Propofol \tn 
% Row Count 1 (+ 1)
% Row 18
\SetRowColor{white}
 & Topiramate (Dual action, also a Na+ channel blocker) \tn 
% Row Count 4 (+ 3)
% Row 19
\SetRowColor{LightBackground}
6. GABA reuptake inhibitors & Tiagabine (used in really refractory cases) \tn 
% Row Count 6 (+ 2)
% Row 20
\SetRowColor{white}
7. GABA Transaminase Inhibitors & Valproate \tn 
% Row Count 8 (+ 2)
% Row 21
\SetRowColor{LightBackground}
 & Vigabatrin \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Lacosamide}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & Na+ Channel blocker \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Indications: & monotherapy or adjunct for focal (partial) seizure \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Forumlations:} & tablet, injection, oral solution \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & {\bf{Controlled Schedule V drug}} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & dizziness, HA, N/V, diplopia, ataxia, blurry vision \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
Serious side effects: & slowed cardiac conduction, monitor PR interval \tn 
% Row Count 11 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & substrate for CYP3A4, 2C9, 2C19, but interactions are minimal (not an inducer or inhibitor) \tn 
% Row Count 15 (+ 4)
% Row 7
\SetRowColor{white}
Special Notes: & dose adjust for renal/hepatic impairment, well tolerated \tn 
% Row Count 18 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Topiramate}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & broad spectrum, Na+ channels, GABA receptors, and AMPA glutamate receptors \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & Monotherapy or adjunct in focal onset or generalized tonic-clonic, adjunct for Lennox-Gastaut \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & ER capsule, sprinkle capsule er and regular, tablet \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
 & Not a controlled drug \tn 
% Row Count 10 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & dizziness, sedation, dose related impairment, suicidal thoughts, paresthesia's, weight loss, speech difficulties \tn 
% Row Count 15 (+ 5)
% Row 5
\SetRowColor{white}
Serious ADRs: & {\bf{Kidney stones, metabolic acidosis}}, decreased sweating/hyperthermia, increased IOP, encephalopathy (when used with VPA) \tn 
% Row Count 20 (+ 5)
% Row 6
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & inhibits CYP2C19, induces 3A4, substate of PgP, may increase lithium levels, CYP inducers will decrease topiramate levels, may decrease digoxin levels, may reduce efficacy of estrogen and progestin containing contraceptives. \tn 
% Row Count 29 (+ 9)
% Row 7
\SetRowColor{white}
Special Notes: & Cognitive side effects are a big reason for discontinuation \tn 
% Row Count 32 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Levetiracetam (Keppra)}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & Broad spectrum, {\bf{SVA2 binding on vesicle to decrease glutamate release}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & focal seizure, generalized: adjunct for juvenile myoclonic epilepsy, adjunct for primary tonic-clonic \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & tablet, oral solution, IV, ER tablet, disintegrating tablet \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
 & Not a controlled substance. \tn 
% Row Count 11 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & HA, somnolence, N/V \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
Drug \seqsplit{Interactions:} & not metabolized in the liver, so limited drug interactions. \tn 
% Row Count 16 (+ 3)
% Row 6
\SetRowColor{LightBackground}
Special Notes: & {\bf{favorable ADR profile, lack of drug interactions}} almost complete oral absorption \tn 
% Row Count 20 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Benzodiazepines}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & {\bf{GABA receptor agonist}} clobazam is slightly different structurally from other benzos but acts similarly \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & adjunct generalized tonic-clonic (clobazam), absence (clobazam, clonazepam-not first line), myoclonic (clobazam-not first line), Status Epilepticus (IV diazepam, midazolam, lorazepam) acute repeated or prolonged seizure in outpatient setting (diazepam rectal gel), atonic/akinetic (clonazepam), adjunct for simple or complex partial (clobazam, clorazepate) adjunct Lennox Gustaut (clobazam) \tn 
% Row Count 19 (+ 15)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & Clobazam (onfi tablet/oral film "Sympazan"/suspension), Lorazepam ("ativan" injection), Clonazepam ("Klonopin" tablet), Diazepam ("Diastat" rectal gel/injection), clorazepate ("Tranzene" tablet), midazolam (injection/nasal spray) \tn 
% Row Count 28 (+ 9)
% Row 3
\SetRowColor{white}
 & Schedule IV Controlled Substances \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Benzodiazepines (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
Side Effects: & Hypotension and respiratory arrest with IV use, sedation, slowed breathing. \tn 
% Row Count 3 (+ 3)
% Row 5
\SetRowColor{white}
Serious ADRs: & Clobazam can lead to SJS and TEN \tn 
% Row Count 5 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Special Notes: & Clobazam, clonazepam, and clorazepate: check blood counts and LFTs periodically \tn 
% Row Count 8 (+ 3)
% Row 7
\SetRowColor{white}
 & Among the most sedating of antiepileptics- CNS depressants \tn 
% Row Count 11 (+ 3)
% Row 8
\SetRowColor{LightBackground}
Drug \seqsplit{Interactions:} & CYP2C19, CYP3A4 \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Gabapentin}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & {\bf{Ca2+ channels alpha2delta subunit}} inhibition AP so explains analgesic, anticonvulsant, and anxiolytic activity. (Even though structurally similar to GABA, doesn't bind to GABA receptors) \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & adjunct for focal (partial onset) seizure, more for neuropathy \tn 
% Row Count 11 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & capsule, solution, tablet (medication cannot be crushed) \tn 
% Row Count 14 (+ 3)
% Row 3
\SetRowColor{white}
 & Controlled substance schedule V in Alabama (abuse potential) \tn 
% Row Count 17 (+ 3)
% Row 4
\SetRowColor{LightBackground}
Side Effects: & sedation, increased BP, dizziness, confusion, rash, nystagmus \tn 
% Row Count 20 (+ 3)
% Row 5
\SetRowColor{white}
Drug \seqsplit{interactions:} & none significant \tn 
% Row Count 22 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Special Notes: & requires renal dose adjustments in impairment \tn 
% Row Count 24 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.83689 cm} x{2.14011 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Indications}}  \tn
% Row 0
\SetRowColor{LightBackground}
Focal Seizures & Carbamazepine \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Oxcarbamazepine \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Levetiracetam \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
 & Lamotrigine \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Phenobarbital (Neonates) \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
Generalized Absence Seizures & Ethosuximide (Preferred) \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Valproate 2nd \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
 & Lamotrigine \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
Generalized Myoclonic Seizures & Valproate (BEST) \tn 
% Row Count 12 (+ 2)
% Row 9
\SetRowColor{white}
 & \seqsplit{Levetiracetam/Lamotrigine} \tn 
% Row Count 14 (+ 2)
% Row 10
\SetRowColor{LightBackground}
 & Benzos \tn 
% Row Count 15 (+ 1)
% Row 11
\SetRowColor{white}
Generalized Tonic-Clonic Seizures & Valproate- very good \tn 
% Row Count 17 (+ 2)
% Row 12
\SetRowColor{LightBackground}
 & Levetiracetam \tn 
% Row Count 18 (+ 1)
% Row 13
\SetRowColor{white}
 & Lamotrigine \tn 
% Row Count 19 (+ 1)
% Row 14
\SetRowColor{LightBackground}
 & Topiramate \tn 
% Row Count 20 (+ 1)
% Row 15
\SetRowColor{white}
 & \seqsplit{Phenytoin/Fosphenytoin} \tn 
% Row Count 22 (+ 2)
% Row 16
\SetRowColor{LightBackground}
 & Phenobarbital- neonates \tn 
% Row Count 24 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Teratogens}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Valproate-inhibits folic acid- the most teratogen risk} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Phenytoin/Fosphenytoin (Fetal hydantoin syndrome)} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Carbamazepine (Cleft palate, cleft lip)} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}