Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cpt > Anti Epileptic > Flashcards

Anti Epileptic Flashcards

You may prefer our related Brainscape-certified flashcards:
NASM ® CPT flashcards
1
Q

What is a seizure

A

sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a convulsion

A

uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an aura

A

a perceptual disturbance experienced by some prior to a seizure, e.g. strange light, unpleasant smell, confusing thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is epilepsy

A

neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is status epilepticus

A

epileptic seizures occurring continuously without recovery of consciousness in between

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can seizures be classified

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Compare partial vs generalised seizures

A

Partial happens in a single focus - one part of the brain. Generalised - seizure all over the brain - might start as a focus nd the spread uncontrolled throughout the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are partia lseizures

A

PARTIAL SEIZURES • Part of the brain
• Simple or complex – Simple = Same consciousness - no loc
– Complex —> COnsciousness is iMPaired - loc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are common types of partial seizures

A

• Temporal lobe epilepsy
– 1st/2nd decade in most people, following seizure with fever or an early injury to the brain
– auras –e.g. auditory hallucination, rush of memories
• Frontal lobe epilepsy – next most common
- Abnormal movements when motor areas affected (contralateral side)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are types of generalised seizures

A
  • Tonic-clonic: 2 parts - 1st tonic (muscles Tense), 2nd clonic (Convulsions)
  • Absence:‘daydreaming’
  • Statusepilepticus:medicalemergency
  • Myoclonic:briefshock-likemusclejerks
  • Atonic:‘without tone’ – drop attack
  • Tonic:increasedtone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the vestigatins to confirm/exclude diagnosis

A

INVESTIGATIONS
• Clinical history • EEG
• MRI
• (ECG,bloods)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be asked about when asking a history abt seizure

A

Before

  • pmh, fh
  • triggers
  • auras
  • first sign/symptoms

During

  • description of seizure
  • duration
  • abrupt or gradual Ed

After

  • post-coal state
  • tongue biting
  • incontnence
  • neurological defecit

Vial to take collateral history where possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are causes of epilepsy

A 
• Can be primary or secondary
• Primary (idiopathic) 
– No apparent cause 
– May be inherited
• Secondary (symptomatic)
– Known cause for epilepsy
  • Vascular:Stroke,TIA
  • Infection: Abscess, Meningitis
  • Trauma:Intracerebralhaemorrhage
  • Autoimmune:SLE
  • Metabolic:Hypoxia,Electrolyteimbalance, Hypoglycaemia,Thyroid dysfunction
  • Iatrogenic: Drugs, Alcohol Withdrawal
  • Neoplastic:Intracerebralmass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is an eeg

A

EEG
• EEG not diagnostic - supports diagnosis
• In first unprovoked seizure – assess risk of seizure recurrence (unequivocal epileptiform
activity on EEG)
• Standard EEG assessment involves photic stimulation and hyperventilation - patient warned that it may induce a seizure
• Do NOT use if:
– Probable syncope (risk of false positive result)
– Clinical presentation supports diagnosis of non-epileptic event – In isolation to make a diagnosis of epilepsy
• Ifunclear,consider:
– Repeated standard EEGs
– Sleep EEGs (sleep deprivation or melatonin in children/young people) – Long-term video or ambulatory EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are other investigations

A

OTHER INVESTIGATIONS
• To exclude other suspected causes of seizure • ECG as standard in adults
• MRI – in all patients with new-onset seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some classes of anti epileptic drugs

A
  • Na channel blockers • GABA potentiators • Ca channel blockers
  • Other drugs affecting GABA • Levetiracetam
17
Q

How to Na+ channels work and what are some examples

A 
• Cause Na channels to remain in an inactive state
• Prevent axons from firing repetitively
• Examples
– Carbamazepine
– Phenytoin
– Lamotrigine
– Sodium valproate – Topiramate
18
Q

What are ccbs and how do they work

A 
CALCIUM CHANNEL BLOCKERS
• Prevent activity of Ca channels
• Prevent depolarisation causing “spike and wave” discharge 
• Used in absence seizures
• Examples
– Ethosuximide
– Sodium valproate
19
Q

What are gaba potentiators and gaba

A 
• GABA = inhibitory neurotransmitter, so rapidly alters excitability
• Involved with neurotransmitter modulation in a third of brain impulses
• GABA potentiators enhance the effect of GABA at the synaptic junction
– Examples
• Barbiturates (Phenobarbital)
• Benzodiazepines (Midazolam)
• GABA-transaminase inhibitors 
– Prevent breakdown of GABA 
– Vigabatrin
• Increased GABA production
– Improve utilisation of glutamate 
– Gabapentin
20
Q

What is levetiracetam

A

• Trade name Keppra
• Binds to synaptic vesicles (SV2A glycoprotein)
to inhibit pre-synaptic calcium channel activity
• Therefore, inhibiting neurotransmitterrelease from the pre-synaptic neuron

21
Q

When would antiepileptic be considered for use

A

• Epilepsy specialist/neurologist once diagnosis confirmed
• Considered if first unprovoked seizure and…
– Neurological deficit
– EEG shows unequivocal epileptic activity
– Risk of a further seizure is unacceptable
– Imaging reveals a structural abnormality
• Take into account the seizure type, patient’s age, lifestyle and preferences

22
Q

How are antiepileptics initiated

A

• Start with monotherapy and if ineffective change to monotherapy with different AED
• First-line for generalised or tonic-clonic seizures – sodium valproate (or lamotrigine)
– If ineffective, other adjuncts considered (e.g. Levetiracetam, topiramate or sodium valproate AND lamotrigine)
• Titrate up to achieve a balance of therapeutic effect vs adverse side effects

23
Q

What are ways anti epileptics can interact with other drugs

A 
• Beware of interactions
– Liver enzyme inducers 
• Carbamazepine
• Phenyotin
– Liver enzyme inhibitors
• Sodium valproate
24
Q

What are some side effects of aeds

A

Ss

25
Q

Why may aeds be changed

A

• Change if unacceptable side effects, failure of treatment or on inappropriate drug
• Start at initial dose and slowly increase to middle of recommended therapeutic range
• Then slowly withdraw old drug over about 6 weeks
Keep patient on the drug, start a new one, slowly titrations up until middle of therapeutic range, then take the old one away. Want them to overlap - initial one may have had some kind of effect

26
Q

When might aeds be stopped

A

• Consider if patient seizure free for at least 2 years
– 60% will have no further seizure when medication withdrawn
• However, bear in mind the increased risk of seizure compared to those who continue on treatment
– Epilepsy since childhood
– Patients on more than one drug
– Myoclonic or tonic-clonic seizures – Abnormal EEG in last year
– Known underlying brain damage
• Need to think about patient’s livelihood
• DVLA recommends no driving for 6 months after stopping medication

27
Q

How are aeds stopped

A

CESSATION OF ANTIEPILEPTICS
• Gradually taper off
• Aim is to avoid withdrawal features – Recurrent seizures
– Anxiety and restlessness
• Lamotrigine, carbamazepine, phenytoin, sodiumvalproate, vigabatrin – Reduce dose by 10% every 2-4 weeks
• Ethosuximide, barbiturates, benzodiazepines – Reduce dose by 10% every 4-8 weeks
• If on more than one drug, withdraw from one drug at a time
– 1 month between complete withdrawal from one drug and starting withdrawal from another

28
Q

What are the effects of some aeds in pregancy

A

• Risk of congenital malformations
– E.g.neuraltubedefects, hypospadias, cardiacdefects

• Carbamazepine
– Generally perceived as safe in pregnancy, although still carries risks

• Sodium Valproate
– Thought to cause decreased serum folate -> neural tube defects
– Craniofacial and skeletal abnormalities
– Developmental disorders after birth (mental and physical)

• Try not to prescribe sodium valproate to females of childbearing age
• Prescribe lowest effective dose
– Divided over the day
– Controlled-release tablets
• Start folate supplementation before pregnancy
• If no suitable alternative, counsel on risks and appropriate contraception
• Specialist prenatal monitoring

29
Q

What are the effects of phenytoin

A 
PHENYTOIN
• Common congenital malformations
– Cleft lip and palate
– Congenital heart defects (septal defects)
• Anticonvulsant (epilepsy)
• Cardiac depressant (arrhythmias)
• Levels peak at 3 – 9 hours post dose
• Therapeuticlevels:10mg/l–20mg/l
  • Toxicity  nausea, CNS dysfunction (confusion, nystagmus, ataxia), decreased consciousness, coma!
30
Q

Describe teh pk of phenytoin

A

• Narrow therapeutic window
• Non-linear pharmacokinetics
• Therapeutic drug monitoring to:
– Establish individual therapeutic concentration
– Aid diagnosis of clinical toxicity
– Assess compliance
– Guide dose adjustments in patients with greater pharmacokinetic variability
• Following loading dose, checked at 3-4 days, then 3-12 monthly if stable

31
Q

What are treatments for partial seizures

A

Treatment of partial seizures (simple & complex)
• Lamb
– Lamotrigine
• Top
– Topiramate: can’t be explained off the Top a Ma Head
– Also used in migraines
• Gave
– Gabapentin: wishes it worked like GABA but has pent up frustration
• Funny
– Phenytoin: can’t be funny for too long, so use in Status Epilepticus
• Carbs
– Carbamazepine: keeps Na channels inactive like phenytoin

32
Q

What are the treatment of general seizures

A

eneral seizures:
• Barbara
– PheNObarbitol: NO barb means don’t use unless desperate
• Valiantly
– Sodium valproate: valiantly tries to do many things (including “attacking the liver enzymes”)
• Sux
– Ethosuximide: Sucks to learn it, but make sure it doesn’t go absent from revision
• Good-Pam
– Ends in Pam, so it’s a benzo
– Acts quickly, so it’s good 1st line for status epilepticus

33
Q

Describe the initial management of seizures

A

ABCDE -> lorazepam or midazolam benzodiazepines)

Pre-hospital: PR or buccal Hospital: IV

34
Q

What is status epilepticus

A

= epileptic seizures occurring continuously without recovery of consciousness in between
Neither Funny nor Good
So use Phenytoin or Benzodiazepines

35
Q

What is first fit c.liic

A

• Following first seizure, patient deemed safe for discharge • Referral to First Fit Clinic follows
• Advise patient of lifestyle changes in the meantime
• If treatment initiated:
AIM = CONTROL of seizures on FEWEST drugs with LOWEST dose and LEAST side effects

36
Q

What are daily living considerations

A

• Driving:
– Epilepsy when awake, licence is taken away until 1 year seizure-free
– If due to medication change: 6 months seizure-free
– Seizures whilst asleep or don’t affect driving or consciousness – assessment of case by DVLA
– If one-off seizure then can apply when 6 months seizure-free and assessment by DVLA
• Do not operate dangerous machinery
• Avoid potentially dangerous work or activities, e.g. swimming, climbing ladders
• Bathe with supervision or leave bathroom door unlocked
• Do not bathe babies alone
• Do not cycle on busy roads
• Avoid consuming alcohol

37
Q

What are the long term considerations

A

• Annual review
– Check seizure control and if any precipitants
– Compliance
– Consider advice on contraception, pregnancy, employment issues and benefits
• SUDEP (sudden unexpected death in epilepsy)
– Increased risk in patient with uncontrolled seizures
– Risk increases to 1 in 150 with poorly controlled seizures
• Increased risk of mental health illness
– Abnormal activity of neurotransmitters – Structural abnormalities
– Functional abnormalities

Cpt (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions