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PMCOL 343 > antiseizure > Flashcards

antiseizure Flashcards

1
Q

what is the 2nd most common neurological disorder

A

epilepsy

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2
Q

is epilepsy just 1 disorder

A

no, it encompasses many disorders

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3
Q

what characterizes epilepsy

A

recurrent seizures (chronic disease) - heretogenous symptom complex

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4
Q

what is a seizure

A

finite period of brain dysfunction resulting from abnormal discharge of cerebral neurons

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5
Q

what is an electroencephalogram

A

electrodes placed at standard positions on scalp to record field potentials caused by currents flowing as neurons in the brain fire APs

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6
Q

how do you figure out the degree of neural activity with electroencephalograms

A

you compare between pairs of electrodes (this allows a degree of localization of neuronal activity)

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7
Q

what are all seizures cause by

A

an imbalance between excitation and inhibition in brain

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8
Q

what is the mechanism of all seizures

A

they all differ

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9
Q

what are 2 types of partial seizures

A

simple and complex

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10
Q

what characterizes partial seizures

A

they have a localized onset

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11
Q

what are simple seizures like (3)

A

abnormal discharge with minimal spread - consciousness preserved

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12
Q

is consciousness preserved in simple partial seizures

A

yes

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13
Q

what are complex seizures like (4)

A

localized dischange with wide bilateral spread, usually limbic, loss of consciousness

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14
Q

is consciousness preserved in complex partial seizures

A

no

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15
Q

what is an aura

A

a sense that the seizure is starting

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16
Q

what are some weird things that can happen during complex seizures

A

altered consciousness. automatisms

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17
Q

what are automatisms and when do they happen (which seizure type)

A

fragmented behaviours (like lip smacking, swallowing…) - complex partial seizures

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18
Q

can you have a partial seizure that then generalizes to a tonic clonic seizures

A

yes

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19
Q

what are 5 types of generalized seizures

A

generalized tonic clonic, abence (petit mal), myoclonic jerks, atonic seizures, infantile spasms

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20
Q

what do generalized tonic clonic seizures look like

A

full blown attack with rigidity (tonic), followed by alternating relaxation and rigidity, and jerking of body (clonic)

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21
Q

what does Tonic mean

A

stiffening/rigidity

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22
Q

what does clonic mean

A

rhythmical jerking of body

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23
Q

how long does generalized tonic clonic seizure last

A

1-2 mins

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24
Q

what happens after a generalized tonic clonic seizure

A

postictal stupor (confused)

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25
Q

the drugs used for generalized tonic clonic seizure are similar to the drugs for which other seizures? which ones are they not similar to?

A

same for partial seizures and most general, but not absence

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26
Q

can you use similar drugs for generalized tonic clonic seizure and partial

A

yes

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27
Q

can you use similar drugs for generalized tonic clonic seizure and absence

A

no

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28
Q

what do absence seizures look like

A

staring, altered consciousness, sometimes mild jerking of eyelids and extremeties

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29
Q

what is the length and onset of absence seizures like

A

sudden onset, and brief

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30
Q

how often can absence seizures happen for some people

A

100s a day :(

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31
Q

what is the way to characterize absence seizures in EEG

A

3Hz spike

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32
Q

what are myoclonic jerks

A

symptoms of variety of seizures, but also an entity by itself

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33
Q

what is atonic seizure

A

sudden loss of postural tone, drops to floor

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34
Q

what are infantile spasms

A

heterogenous syndrome

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35
Q

whats a heterogenous syndrome

A

where there are many diff symptoms possible, not just one thing

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36
Q

what is associated with infantile seizures

A

mental retardation

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37
Q

how effective is treatment for infantile spasms

A

not great, drugs only effective in some patients and it doesnt help the mental retardation

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38
Q

what is an old antiseizure drug that is still used today in infantile spamsm

A

phenobarbital

39
Q

how do most of the anti-seizure drugs nowadays work (3)

A

reduce sympathetic excitation, enhance synaptic inhibition, block ion channels

40
Q

which 2 ion channels are a target for seizures

A

Na+ and Ca++

41
Q

what do anti-seizure drugs do to the sodium channel (2)

A

prolong inactivation to make repetitive firing more difficult

42
Q

which kind of seizures do drugs that target Na+ channels work well for

A

partial seizures

43
Q

which 3 drugs affect sodium channels

A

phenytoin, carbamazepine, lamotrigine

44
Q

what is the affinity for drugs that affect Na+ channels like

A

good affinity when they are open - helps block cells that are excessively reactive

45
Q

which Ca++ channels are affected by anti-seizure drugs +what do they do to the activity

A

T-type calcium channels - suppressed activity

46
Q

what is an example of a anti-seizure drug that supressed T-type ca channels

A

ethosuxamide

47
Q

what does ethosuxamide do

A

block t type ca channel to stop oscillatory behaviour/ bursts

48
Q

what kind of seizure is ethosuximide good for

A

absence

49
Q

what do anti-seizure drugs want to do to GABA A receptors DIRECTLY

A

potentiate their action

50
Q

what do anti-seizure drugs want to do to GABA A receptors INDIRECTLY

A

reduce GABA uptake or metabolism

51
Q

which 2 drugs directly potential GABA A receptor action

A

benzos and barbs

52
Q

which 3 drugs indirectly increase GABA levels

A

gabapentin, tiagabine, vigabatrin

53
Q

how do gabapentin, tiagabine, vigabatrin block uptake of GABA

A

because they look a lot like it

54
Q

what do you want to do to glutamate action with someone who has seizures

A

reduce

55
Q

which 2 drugs reduce glutamate action

A

phenobarbital and topiramate

56
Q

where does phenytoin act (which receptors)

A

Na+ K+ Ca++

57
Q

what does phenytoin do to Na+ and K+ channel

A

block repetitive firing

58
Q

what does phenytoin do to Na+ channel specifically

A

use dependent block

59
Q

how does phenytoin do use dependent block of Na+ channel

A

it binds preferentially to inactive state of channel

60
Q

what does phenytoin do to Ca+ AND what does this cause

A

blocks influx so there is less ca-dependent secretory processes

61
Q

which kind of seizures in phenytoin best for

A

partial and generalized tonic clonic

62
Q

which 3 drugs are good for partial and generalized seizures

A

phenytoin, carbamazepine, phenobarbital

63
Q

what is the action of carbamazepine

A

similar to phenytoin (blocks K+ Ca+ Na+)

64
Q

how is carbamazepine used as medication for seizures

A

first-line for partial, or combined with other drugs (like phenytoin)

65
Q

what drug is used for trigeminal neuralgia

A

carbamazepine

66
Q

what is the drug of choice for patients under 2yo

A

phenobarbital

67
Q

how does phenobarbital work (2)

A

suppresses (heavily)excitatory transmission, potentiates GABA A receptor activation

68
Q

what are 3 main drugs just for generalized seizures

A

ethosuximide
valproid acid
benzos

69
Q

how does ethosuximide work

A

supresses T type Ca++ channels

70
Q

what is the type of seizure that ethosuximide is best for

A

absence seizures

71
Q

how is ethosuximide best for absense seizures

A

suppresses the characteristic 3Hz spike-and-wave

72
Q

what is the mechanism of action for valproic acid

A

increase neuropeptide Y levels in brain

73
Q

what kind of seizures is valproic acid good for (3)

A

absence, myoclonic, primary general tonic clonic

74
Q

when are benzos good for seizures

A

for acute seizure, not for long term

75
Q

why dont you want to use benos long term for seizures (2)

A

tolerance and sedation

76
Q

what is the mechanism of action of vigabatrin (2)

A

irreversible inhibitor of GABA-transaminase (breaks down GABA) AND inhibits GABA transporter

77
Q

what does GABA-transaminase do

A

breaks down GABA

78
Q

what kind of seizures is vigabatrin good for

A

partial seizures

79
Q

what happens with the amount of GABA near synapse with vigabatrin

A

increases

80
Q

what is the mechanism of action of tiagabine

A

GABA uptake inhibitor (GAT-1)

81
Q

what kind of course of treatment is tiagabine usually used

A

useful as adjunctive therapy, sometimes monotherapy

82
Q

what is the mechanism of action of lamotrigine

A

like phenytoin on Na+, also Ca+ (blocks)

83
Q

what kind of epilepsy is lamotrigine best used for

A

focalpartial epilepsy and absence

84
Q

what kind of course of treatment is lamotrigine usually used

A

add on or monotherapy for focal/partial

85
Q

what is the main drawback for lamotrigine

A

rash can be life threatening especially for kids!!!

86
Q

what is the mechanism of action of felbamate

A

blocks NMDA on glycine sites (NR1 and NR2B)

87
Q

what kind of seizure is felbamate best for

A

focal/partial

88
Q

what is another name for focal seizures

A

partial

89
Q

what kind of course of treatment is felbamate usually used

A

only as add on therapy

90
Q

what are 2 really bad adverse effects for felbamate

A

aplastic anemia and severe hepatitis

91
Q

which drug is good for refractory epilepsies and lennox-gasteaut syndrome

A

felbamate (its okay if you dont know)

92
Q

what is the mechnamism of action for topiramate

A

inhibits Na+ channels, potentiates GABA effects, inhibits AMPA receptors

93
Q

what kind of course of treatment is topiramate usually used

A

monotherapy

94
Q

what is the unique structure like of topiramate

A

substituted monosaccharide

PMCOL 343 (31 decks)

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