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CPT (My own) > Anti-epileptic > Flashcards

Anti-epileptic Flashcards

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1
Q

Define the seizure?

A

Transient occurrence of symptoms due to abnormal electrical activity in the brain, leading to a disturbance of consciousness, behaviour, emotion, motor function or sensation

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2
Q

What receptor does glutamate act via?

A

NMDA receptor

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3
Q

What receptor does GABA act via?

A

GABAa receptor

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4
Q

Describe the effects of glutamate on NMDA receptors in terms of the effect on cations

A

Cation channels: let in Na and Ca and let K out
Depolarises the membrane
More likely to fire an action potential

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5
Q

Describe the effect of GABA on GABAa receptors and which channel is acted on

A

Cl- channel
Hyperpolarise membrane
Less likely to fire action potential

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6
Q

Describe a seizure in terms of the NTs

A

Loss of inhibitor signals (GABA)

Strong excitatory signals (Glutamate)

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7
Q

What are some causes of seizures?

A

Genetic differences in brain chemistry/receptor structure
Exogenous activation of receptors- drugs
Acquired changes in brain chemistry- drug withdrawal, metabolic changes
Damages to any of these networks e.g. strokes or tumours

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8
Q

What are the general symptoms and signs of epilepsy?

A 
Not just shaking!
Loss of consciousness
Changes in muscle tone
Aura
Post octal period
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9
Q

What are the signs and symptoms for generalised seizures?

A

Loss of consciousness often with changes in muscle tone and tongue biting

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10
Q

What are the signs and symptoms for tonic clonic seizures?

A

Initial hypertonic phase, followed by rapid clonus (shaking/jerking)

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11
Q

What is epilepsy?

A

A tendency toward recurrent seizures unprovoked by a systemic or neurological insult

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12
Q

What is the actual definition of epilepsy?

A

Atleast two unprovoked seizures occurring more than 24 hrs apart
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures

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13
Q

What are some potential stimuli for a reflex seizure?

A 
Photogenic
Musicogenic
Thinking
Eating
Hot water immersion
Reading
Orgasn
Movement
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14
Q

What are the 3 classifications of a seizure?

A

Focal
Generalised
Unknown

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15
Q

State some of the features/types of focal onset

A

Aware/impaired awareness
Motor/non-motor onset
Focal to bilateral tonic clonic

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16
Q

State some of the features/types of generalised onset

A

Motor- tonic/clonic

Non motor- absence

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17
Q

State some of the features/types of unknown onset

A

Motor- tonic/clonic
Non motor- absence
Unclassified

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18
Q

What is the difference between focal and generalised onset in terms of spread?

A

Focal- on 1 side of the brain, can spread but not rapidly

Generalised onset- bilateral involvement v rapidly

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19
Q

What is the difference between focal and generalised onset in awareness?

A

Generalised will always be unaware because too much of the brain is affected

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20
Q

Describe the distribution of generalised seizures

A

Originate at a point within and rapidly engage bilaterally distributed networks
Can include cortical and subcortical structures but not necessarily whole cortex

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21
Q

Describe the distribution of focal seizures

A

Originate within networks limited to one hemisphere and maybe discretely localised or more widely distributed

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22
Q

What is another term for generalised seizure?

A

Grand mal

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23
Q

What is another term for an absence seizure?

A

Petit mal

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24
Q

What is another term for a focal seizure?

A

Partial seizure

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25
Q

What is a provoked seizure and what can be inducers?

A 
Seizure as a result of another medical condition, examples include:
drug use or withdrawn
Alcohol withdrawal
head trauma and intracranial bleeding
Metabolic disturbances
CNS infections
Febrile seizures in infants
Uncontrolled hypertension
26
Q

What is the key in treatment of unprovoked seizures?

A

It is key to treat both the siezure and the underlying condition. Unlikely to need prolonged AED treatment

27
Q

What are some differentials for seizures?

A 
SUncopal episodes e.g. vasovagal syncope
Cardiac issues including reflex anorexic seizures, arrhythmias
Movment disorders e.g. Parkinsons
TIAs
Migraines
Non-epileptic attack disorders
28
Q

What is always the initial management of a seizure?

A

A- Airway
B- Breathing, sats reading/O2
C- circulation, expect high HR, wary of BP
D- disability, will have reduced consciousness in general seizures
E- recovery position

29
Q

What is status epileptics?

A

A seizure lasting more than 5 mins or more, or multiple seizures without a complete recovery between them

30
Q

What is the pharmacological treatment regime for status?

A 
Wait 5 minutes
Benzodiazepine
Benzodiazepine x2
Phenytoin (or Levetiracetam)
Thiopentone/anaesthesia (call ITU)
31
Q

What are benzodiazepines?

A

Class of GABA agonist that increase Cl- conductance so more negative resting potential, less likely to fire
No firing of neurones= no more seizure

32
Q

What are some side effects of benzos?

A

Addiction, CVS collapse, airway issues

33
Q

What can benzos also be used as?

A

Anxiolytics, sleep aids, alcohol withdrawal

34
Q

What are the benzo options for status epilepticus?

A

IV Lorazepam
Rectal Diazepam
Buccal or intranasal Midazolam

35
Q

What is the issue with using EEGs as an investigation for epilepsy?

A

Relies on capturing an episode or abnormal pattern but many people with epilepsy don’t have abnormal EEGs

36
Q

What is the imaging method of choice for diagnosis?

A

MRI

May detect vascular or structural abnormalities

37
Q

What are the 6 main AEDs?

A 
Carbamazapine
Phenytoin
Na Valorate
Lamotrigine
Levetiracetam
Benzodiazepine
38
Q

What is a serious outcome of epilepsy?

A

Sudden unexplained death in epilepsy (SUDEP)

39
Q

What is the main mechanism of action of Carbamazepine?

A

Sodium channel blocker

40
Q

How does blocking of Na channels in central neurones help epilepsy?

A

It slows down the recovery of neurones from inactive to closed which reduces neuronal transmission

41
Q

What are the 3 states of Na channels, and at which state do Na channel blockers work?

A

Open
Inactivated
Closed
Work at inactivated to increase refractory period

42
Q

What are other uses of Carbamzepine?

A

Bipolar and chronic neuralgic pain

43
Q

What are some side effects of Carbamazepine?

A

Suicidal toughts
Joint pain
Bone marrow failure

44
Q

What is the mechanism of action of Phenytoin?

A

Na channel blocker

45
Q

What are the uses of Phenytoin?

A

Status epileptics or as an adjunct in generalised seizures

46
Q

Describe the metabolism of phenytoin

A

Zero order kinetics so it is eliminated at a constant rate so need to be careful about dosing

47
Q

What are specific side effects for Phenytoin?

A

Bone marrow suppression
Hypotension
Arrythmias

48
Q

What is the mechanism of action of Na Valporate?

A

Mix of GABA agonist effects and Na channel blocks as well as some Ca channel blocking

49
Q

What does it say in the guidelines about Na Valporate?

A

1st line for generalised epilepsy

50
Q

What are specific side effects of Na Valporate?

A

Liver failure
Pancreatitis
Lethargy

51
Q

What is the MOA of Lamotrigine?

A

Na channel blocker and some Ca channel blocking

52
Q

What is the main use of Lamotrigine?

A

Focal epilepsy

Used where Valporate is contraindicated

53
Q

What is the MOA of Levetiracetam (Keppra)?

A

Synaptic vesicle glycoprotein binder, stops the release of NT into the cleft and reduced neuronal activity

54
Q

What are the uses for Levetiracetam?

A

Focal and generalised seizures

55
Q

What are the advantages of Levetiracetam?

A

Easy dosing
Well tolerated
Safe in pregnancy

56
Q

What are the side effects of AEDs in general?

A 
Tiredness/drowsiness
Nausea/ vomiitng
Mood changes and suicidal ideation
Osteoporosis 
Rashes
Anaemia, thrombocytopenia or bone marrow failure
57
Q

What is the rash condition that could occur as a side effect and which drugs are most likely to cause it?

A

Steven Johnson Syndrome- mucocutaneous breakdown

Caused by Carbamazepine or Phenytoin

58
Q

What are the implications of so many side effects of AEDs?

A

Anti-epileptics and warfarin need close monitoring
Ideally patients shouldn’t consume alcohol
Valporate can increase concentration of other AEDs
Carbamazepine and Phenytoin can impair antibiotic effectiveness and oral contraceptive effectiveness

59
Q

What are some AEDs that induce CYP enzymes?

A

Phenytoin
Carbamazepine
Barbituates

60
Q

What are some non AEDs that induce CYP enzymes?

A

Rifampicin
Alcohol
Sulphonylureas

61
Q

What are some AEDs that inhibit CYP enzymes?

A

Valporate

62
Q

Which AED is preferential in pregnant or potential conceiving mothers?

A

Lamotrigine and especially Levetiracetam

CPT (My own) (6 decks)

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