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May 2023 > 221019 PA Seizures > Flashcards

221019 PA Seizures Flashcards

1
Q
  1. Focal (partial) seizures (awareness)
A

1.1 Simple partial
1.2 Complex partial

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2
Q
  1. Generalized seizures (consciousness)
A

2.1 Absence (petit mal)
2.2 Generalized tonic-clonic (grand mal)
2.3 Atonic
2.4 Myoclonic

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3
Q

Seizure
Type: No impairment of awareness
(impaired awareness: someone who has suffered a traumatic brain injury or a stroke that has affected their ability to perceive and understand their surroundings. someone who has suffered a traumatic brain injury or a stroke that has affected their ability to perceive and understand their surroundings.)

A

Simple partial

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4
Q

Seizure
Type: No impairment of consciousness
(lost consciousness: someone who has fainted or suffered a sudden loss of consciousness, such as during a seizure or cardiac arrest. During these events, the person may suddenly fall to the ground and lose the ability to respond to stimuli or communicate with others. This can be a concerning situation, as it may indicate a serious underlying health condition, such as heart disease, a head injury, or low blood sugar levels.

A

Myoclonic

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5
Q

Seizure
From short to long duration of seizures

A
  1. < 5’’: myoclonic
  2. 5-10’’: absence (petit mal)
  3. < 15’’: Atonic
  4. < 60’’: Simple partial
  5. 1-2’: Complex partial + Generalized tonic-clonic (grand mal)
    => focal (partial) lasts longer (~1’)
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6
Q

Seizure
released

A

Atonic
Rũ anti chất bổ (released - atonic)

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7
Q

Seizure
stiff

A

Tonic

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8
Q

Seizure
convulsions

A

Clonic

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9
Q

Seizure
short muscle twitches - arms

A

myoclonic
Tay mỹ miều (Arm - myoclonic)
1st: Lê Đi mỹ (Leve, Divalproic)

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10
Q

Seizure
lose & regain consciousness
“spaced-out” - face

A

absence (petit mal)
Vắng mặt (Absence - face)

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11
Q

Seizure
Conditions to choose anti-epileptic drug (AED) (4)

A
  1. seizure type
  2. comorbidities
  3. potential DI
  4. SE
    Usually monotherapy. Fail: polytherapy
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12
Q

Seizure
Cross taper

A
  1. Initiate: low dose AED
  2. Increase AED and monitor SE
  3. Inadequate: add 2nd AED and titrate to desired dose
  4. Slow decrease and d/c 1st AED
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13
Q

Seizure
Causes (brain, disturbance)

A
  1. Brain:
    - Infection (meningitis, encephalitis)
    - Stroke (ischemic/hemorrhagic)
    - Head trauma
  2. Disturbance:
    - Oxygen lacking: hypoxia
    - Electrolyte (decrease Ca, Mg, Na, blood glucose)
  3. Idiopathic (unknown cause)
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14
Q

Seizure
Risk factors
modifiable (drugs Gây ĐỘNG trời: Số lượng high PHE NÓ BU THEO để uống ALCOHOL, nghiện TRAMADOL và Street drug, diseases)
nonmodifiable (age, sex, Hx)

A
  • Non-modifiable:
    1. Childhood, > 65
    2. Men
    3. Family history + prolonger seizures during childhood
  • Modifiable:
    1. Alcohol/drug withdrawal/toxicity
    2. Drugs that decrease seizure threshold (bupropion, theophylline, tramadol, high-dose phenothiazines, streed drugs)
    3. High fever in children
    4. Cerebral hemorrhage
    5. Renal and hepatic failure
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15
Q

Seizure
Lifestyles changes

A
  1. Avoid sleep deprivation
  2. Minimize use of pro-convulsants (alcohol, cocaine, amphetamine)
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16
Q

Seizure
Complementary therapy (diet, exercise, stimulation)

A
  1. Low-carbohydrate, high-fat diet, keto diet
  2. Yoga, meditation, acupuncture, relaxation
  3. Vagal nerve stimulation, deep brain stimulation
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17
Q

Seizure
Generalized tonic-clonic (grand mal) stiff - convulsion

A

1st line: Lớn rồi mà còn Vấp LÊ LếT
VPA - LEV - LTG
2nd line or adjunctive: 2nd Biện Pháp Clo, To
Clobazam, PER, TOP, Brivaracetam

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18
Q

Seizure
Avoid the meds in Absence and Myoclonic

A

(Cần Phải)2 tránh Vít ga2 Mặt Tay
CBZ, Oxcar, Phenytoin, Phenobarbital (Mặt), Gabapentin, Vigabatrin)
(face - Absence
arm - myoclonic)

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19
Q

Seizure
PHT
ETHO
GBP
LEV
LTG
TOP
PB
PER
PRM

A

phenytoin
ethosuximide
gabapentin
levetiracetam
lamotrigine
topiramate
phenobarbital
perampanel
primidone

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20
Q

Seizure
ETHO = 1st line of

A

absence
Mặt Em THOn
2nd: Lê Đi Làm mặt

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21
Q

Seizure
2 meds = 2nd line of every seizures

A

Clobazam
TOP

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22
Q

Seizure
1st line for Tonic-atonic

A

VANIC (Tonic-atonic) => Valproic acid
2nd: clobazam, TOP, lamotrigine, levetiracetam, especially, rufinamide

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23
Q

Seizure
Focal partial 1st line meds

A

CO giật VẤP Bụi LÊ LếT La
CBZ - OXC - VPA - Brivaracetam - LEV - LTG - Lacosamide

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24
Q

Seizure
Dose related to SJS so increase dose slowly, which medication?

A

LTG: lamotrigine

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25
Q

Seizure
SE (CNS&GI)

A

Higher risk: CBZ, LTG, VAP, TOP, PRM
Consider IR-release drug, slow release, frequent low dose

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26
Q

Seizure
SE skin rashes

A

Higher risk: CA LA PHÊ NY
W/in 6 wks
Take antihistamine and go to ER

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27
Q

Seizure
Low bone density and fractures

A

High risk: enzyme-inducing AEDs, VPA

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28
Q

Seizure
Enzyme-inducing AED
(CBZ, 4P, TR)

A

CBZ (esliCBZ, oxCBZ)
PER (from 12mg/day)
PB
PHT
PRM
Rufinamide
TOP (from 200mg)

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29
Q

Seizure
Non enzyme-inducing AED (B, ECG, 3L, 2V)

A

Brivaracetam
ETHO
Clobazam
GBP
LEV
LTG (estrogen decrease lamotrigine level)
Lacosamide
VPA (estrogen decrease valproic acid)
Vigabatrin

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30
Q

Seizure
1st line better tolerated than CBZ but similar efficacy?

A

LTG lamotrigine
(Large Randomized controlled clinical trials (RCTs))

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31
Q

Seizure
SE gingival hyperplasia
Tăng sinh lợi: Phe ny có CCB(cho con bú)Cý phần

A

Phenytoin
CCB
Cyclosporin

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32
Q

Seizure
1st line should be avoided in active liver disease and elderly

A

CBZ
SE: hepatotoxicity
anticholinergic

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33
Q

Seizure
1st line interact with OCPs, decrease hormonal dysfunction

A

LTG: lamotrigine

34
Q

Seizure
1st line avoided in liver/pancreatic disease
avoided in pregnancy/women of child-bearing age

A

VPA: valproic acid
SE: serious hepatic/pancreatic toxicities
teratogenic

35
Q

Seizure
Low risk of teratogenesis (3) LOL

A

LTG, LEV, OXC
(LOL)

36
Q

Seizure
1st line avoided if abuse potential or hx of mental illness

A

LEV: levetiracetam

37
Q

Seizure
Group decrease efficacy of hormonal contraceptives

A

Barbiturates (Phenobarbital, Primidone)
Renal elimination: 25%, 40-50%

38
Q

Seizure
MoA: potentiates GABA’s effect on the GABA receptor, increasing Cl- channel activity

A

Barbiturates
BZP (clobazam)

39
Q

Seizure
2 metabolites (active, inactive)
renal elimination 94%
withdrawal if no taper

A

Clobazam
active: norclobazam

40
Q

Seizure
SE: polycystic ovarian syndrome, menstrual cycle abnormalities, hyperammonemia
hepatic toxicity, pancratitis, alopecia, blood dyscrasias

A

VAP
valproic acid/ divalproex

41
Q

Seizure
SE: alopecia
>< SE: increase body hair

A

Alopecia: SE of VAP
Increase body hair: SE of PHT

42
Q

Seizure
SE of weight (gain (3), loss, neutral)

A

Weight gain: VAP, Gabapentin, Perampanel
Weight loss: TOP
Weight neutral: LTG

43
Q

Seizure
SE: pedal edema

A

Gabapentin
weak medication but well-tolerated

44
Q

Seizure
2 Medications affects to vision, mainly eliminate renally

A

GAP: vision changes (90% renal elimination)
Vigabatrin: permanent vision loss (80% renal elimination (unchanged))

45
Q

Seizure
Saturation kinetics

A

phenytoin

46
Q

Seizure
Group has SE: hyponatremia, rash

A

CBZ, OXC (higher risk), Eslicarbazepine (lowest risk)
MoA: blocks voltage -gated Na+ chanel
Monitor: CBC, LFT, electrolyte (Na+)

47
Q

Seizure
Mặt Em THOn
Monitor?

A
  1. CBC (esp. platelet)
  2. LFT
  3. Rash
  4. Urine analysis
    Take with or w/o food, give after meals. Do not stop abruptly
48
Q

Seizure
SE: psychosis, renal elimination

A

Levetiracetam (66%)
Brivaracetam (95%)

49
Q

Seizure
Handle when usage (titration/when + COC)

A

Lamotrigine
Very slow titration
Addition of hormonal contraceptives reduces LTG serum levels by up to 50%: consider doubling LTG dose after starting COC

50
Q

Seizure
Medications in pregnancy

A

Lamotrigine
levetiracetam
Avoid: Valproic acid, phenytoin, primidol

51
Q

Seizure
Adjust LTG in pregnancy

A
  1. LTG levels can drop by 50% during 2nd & 3rd trimester => increases dose from 100% as necessary
  2. Measure monthly serum levels
  3. After delivery (within 1-2 wks): LTG levels rise quickly => dose adjusted early to avoid toxicity
52
Q

Seizure
levetiracetam handling in pregnancy

A

Monitor serum levels b/c levetiracetam levels may also drops

53
Q

Seizure
Breastfeeding safe and caution

A

Safe: CBZ, PHT, VPA, LTG
Caution: PB, PRM, ETHO

54
Q

Seizure
Enzyme-inducing AEDs vs vitamin K

A

Enzyme-inducing AEDs increase fetal vit K degradation => vit K routinely administered to newborns after delivery to prevent hemorrhagic diseases

55
Q

Seizure
Complete BMD bone mineral density and treat with calcium/vit D when?

A
  1. after 5 years of AED use
  2. before starting AED in postmenopausal women
    b/c bone breakdown after using AED for a long time
56
Q

Seizure
Stop AED?

A

Lifelong
D/c if:
1. Free for 2-4 years
2. Complete control in 1 year
3. Onset seizures between 2-35
4. Normal neurological exam
5. Normal EEG

57
Q

Seizure
Poor prognosis

A
  1. High frequency of seizures
  2. Multiple episodes
  3. Combination of seizure types
  4. Development of abnormal mental functioning
58
Q

What medication is used for all 1st choice, except absence?
SE? Tiêu mật gan - Tăng cân - Rụng tóc - Run - Máu - Quái Thai

A

Valproic acid
GI, pancretitis, hepatotoxicity - Weight gain - alopecia - Tremor - thrombocytopenia - teratogenicity

59
Q

Thải trừ qua thận: Lê Lạc ở xa tới gần PR

A

Levetiracetam, Lacosamide, oxcarbazepine, topiramate, gabapentin/pregabalin

60
Q

Topiramte SE
Tóp: CNS/ GI cũng ảnh hưởng tới tóp/ stone

A

CNS (word-finding difficulties, and cognitive impairment)
GI: pain, anorexia, nausea, metabolic acidosis
Kidney stones

61
Q

Gan safer
Gan toxic

A

Ga3, liver (leve)
Toxic (toin, acid), Ca3

62
Q
  1. Thuốc gây Congenital malformation
    Congress formation: hội nghị có người bụng to và top
    Bụng Phệ no trong TOP va chạm
  2. Low rate of teratogenicity LOL
A
  1. phenobarbital and topiramate, valproic acid
  2. Lamotrigine, oxcarbazepine, levetiracetam
63
Q

Weight gain: gain, W, Ca3, Pera
Weight loss

A

Ga3, Valproic acid, CBZ, Perampanel
Topiramate

64
Q

Which type of seizures is typically very brief and often occurs in patients with intellectual impairment and childhood-onset epilepsy

A

Atonic seizures consist of an abrupt loss of consciousness and muscle tone with no other motor features.

65
Q

Which is an essential study used in the diagnostic evaluation of epileptic seizures?

A

The EEG is an important study in the diagnostic evaluation of epileptic seizures. If abnormal, a routine EEG may aid in supporting the diagnosis of epileptic seizures and may also suggest whether a patient has generalized or focal seizures. However, a normal EEG does not rule out epilepsy, and many EEG abnormalities may be nonspecific.

66
Q

Seizure triggers (stimulation, hormone changes)

A

hyperventilation,
photostimulation,
physical and emotional stress,
sleep deprivation,
sensory stimuli,
hormonal changes that occur around the time of menses, puberty, and pregnancy.

67
Q

Phenytoin
Narrow AED
Important to counsel pt. on early recognition of fatal SE
Long-term SE
IV adminitratrion SE

A

Treat: Focal seizures
Counsel: blood dyscrasias
Long-term SEs: peripheral neuropathy, osteomalacia (bone soften), CNS, liver, gingival hyperplasia
IV: hypotension and severe cardiac => monitor and change to oral

68
Q

SE blood dyscrasias
VAmPire Blood

A

Valproic acid and Phenytoin

69
Q

Levetiracetam SE

A

Psychosis +> avoid if abuse potential or Hx of mental illness

70
Q

ARD is most commonly associated with cognitive impairment and speech problems

A

TOPiramate
TOP => đỉnh => thần kinh CNS
Tóp teo => hệ tiêu hóa: chán ăn, chuyển hóa acid, đau bụng, nôn
Top => stone: kidney stones

71
Q

Hepatoxicity SE

A

Ca Vang Hepibirthday
CZB, Valproic acid

72
Q

Hyponatremia
Cốc nước ít điện giải

A

CBZ, Oxcarbazepine
Carbamazepine can also cause hyponatremia, but less so than with oxcarbazepine.

73
Q

Autoinduction/ induce its own mechanism

A

CBZ

74
Q

AEDs increase the risk of combined oral contraceptive COC failure

A

Enzyme-inducing AEDs can reduce the efficacy of hepatically metabolized drugs (e.g. oral contraceptives), resulting in an increased risk of combined oral contraceptive (COC) failure.
CBZ 4P-, TR

75
Q

Which antiseizure drug’s serum level is most affected by pregnancy?

A

Lamotrigine: 40% reduction in serum concentration => decrease seizure control in pregnancy => monitor lamotrigine closely, dose change considered

76
Q

AEDs: cytochrome CYP P450 inhibitor

A

Valproic acid

77
Q

AEDs available in parenteral formulation

A

3 popular broad: Leve, Lamo, Valproic acid
2 rare narrow: Phenytoin, Phenobarbital

78
Q

Low albumin => risk of toxic of AED

A

phenytoin
low serum albumin => decrease protein binding => increase in free fraction of phenytoin

79
Q

1st line: Trigeminal Neuralgia

A

CBZ

80
Q

AED is indicated for the prophylaxis of migraine headache in patients 12 years of age or greater.

A

Topiramate

May 2023 (9 decks)

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