Anticonvulsants Flashcards
what is a seizure?
sudden change in behavior dt abn synchronization and excessive electrical activity in the brain
during, neurons may fire as many times at 500 times a second (much faster than regular rate of 80x’s a sec)
definition of epilepsy?
recurrent, unprovoked seizures BUT there are multiple causes for a seizure to occur in individuals who do not have epilepsy
ssxs most seizures cause? other ssxs?
LOC, notable facial grimacing, jerking or shaking of body
others may present only w/staring spells, visual disturbances, disruption of smell or taste, some will experience an aura before onset of seizure
first aid for seizures?
cushion head remove any eyewear loosen tight clothing turn on side time seizure with a watch don't put anything in mouth look for ID don't hold down as seizure ends, offer help
environmental factors that can lead to increased likelihood of seizures?
flashing lights sleep deprivation EtOH consumption stress or anxiety illness
causes of non-epileptic seizures?
SOL in the brain head trauma drug SEs, toxicity, withdrawal fever meningitis, encephalitis metabolic/electrolyte abnormalities
classifications of seizures?
simple (no change in level of consciousness) or complex (change in level of consciousness)
partial/focal (one part or side of the body is affected) or generalized (entire body is affected)
can be further divided into simple partial, complex partial, generalized absence, generalized tonic, generalized clonic, generalized tonic-clonic, status epilepticus
60% of ppl w/epilepsy have what kind of seizure?
focal seizures
what will someone experience with a simple partial seizure?
will remain conscious but experience unusual feelings or sensations that can take many forms (fear, joy, anger, sadness out of context; hallucinations involving sight, sound, smell, taste, skin sensation)
what will someone experience in a complex partial seizure?
has a change in or loss of consciousness
may display strange, repetitious behaviors such as blinks, twitches, mouth movements, motions such as walking in a circle = automatisms
these seizures usu only last a few seconds
what will someone experience in absence seizures?
interruption in consciousness where person experiencing the seizure seems to become vacant and unresponsive for a short period of time
slight muscle twitching may also occur
sometimes referred to as petit mal seizures
what do tonic-clonic seizures produce as far as sxs?
stiffening of the body, repeated jerks of arms and/or legs as well as LOC
grand mal seizures
involve initial contraction of muscles (tonic phase) which may involve tongue biting, urinary incontinence and absence of breathing
followed by rhythmic muscle contractions (clonic phase)
“epileptic fit”
what is status epilepticus? when is a seizure considered an emergency?
refers to continuous seizure activity w/no recovery btw successive seizures
considered a medical emergency if lasts beyond 5 mins (or 2 mins longer than regular seizure length)
main 4 MOAs of antiepileptics?
sodium channel blockade calcium channel (T-type) blockade potentiate GABA (inhibitory neurotransmission) decrease glutamate (excitatory neurotransmission)
is it possible to determine who will experience SEs from anticonvulsants or at what does?
NO
how do anticonvulsants affect electrical d/cs?
either block initiation of electrical d/c from focal area or prevent the further spread of the abn electrical d/c to adjacent brain areas
3 first line anticonvulsants? 3 second line drugs? 3 new antiepileptic meds?
1st line: carbamazepine, sodium valproate, lamotrigine
2nd line: levetiracetam, topiramate, pregabaline
new: zonisamide, eslicarbazepine, retigabine
initial drug tx is meant to accomplish what two things? usu based on what?
meant to suppress or reduce the incidence of seizures
determine what type to use based on the seizures the individual is experiencing
basic rules for anticonvulsant therapy?
tx should be simple, consisting of monotherapy
“start low, increase slow”
6 drugs that are potentially effective against partial seizures?
carbamazepine/tegretol phenytoin/dilantin diazepam/valium primidone/mysoline valproic acid/depakote lamotrigine/lamactil
3 drugs that are potentially effective against abscene seizures (petit mal)
ethosuximide/zarontin
valproic acid/depakote
clonazepam/klonapin
what drug is used to tx epilepsy in children and adults? also approved for tx’ing what?
topiramate
also approved for prevention of migraines, bipolar d/o or to counteract wt gain associated w/numerous antidepressants
can also, also tx tremor, bulimia, OCD, alcoholism, smoking cessation, neuropathic pain, cluster h/a, cocaine dependence, borderline personality d/o
4 drugs potentially effective for tx’ing status epilepticus?
diazepam/valium
lrazepam/ativan
midazolam/versed
phenobarbital/phenobarb
what do you give to a pt who is having a status epilepticus episode? then what?
give benzodiazepine then restart on anti-seizure drug they have been on or start on phenytoin/dilantin
