Ch. 14- Antiepileptic Drugs

Question 1

What is a seizure vs. a convulsion?

Answer 1

A seizure is a brief episode of abnormal electrical activity in nerve cells of the brain, which may or may not lead to convulsion.
A convulsion is more severe seizure characterized by involuntary spasmodic contractions of any or all voluntary muscles throughout the body

Question 2

What percentage of patients with epilepsy have normal EEGs?

Answer 2

50%

Question 3

What age groups does epilepsy appear the most in?

Answer 3

Children and older adults

Question 4

What is primary epilepsy?

Answer 4

Epilepsy without an identifiable cause

Question 5

How much of the epilepsy population has primary epilepsy?

Answer 5

50%

Question 6

What is secondary epilepsy?

Answer 6

There is a distinct cause, such as trauma, infection, cerebrovascular disorder, or other illness

Question 7

What are febrile seizures?

Answer 7

Occur in children six months to five years of age, and by definition are caused by fever

Question 8

In adults, what is the most common cause of secondary epilepsy?

Answer 8

Brain disorders- head injury, disease or infection of brain/spinal cord, stroke, metabolic disorders, adverse drug reactions

Question 9

What are the three major classifications of seizures?

Answer 9

Partial onset, generalized onset, and underclassified seizures

Question 10

What are generalized onset seizures?

Answer 10

Characterized by neuronal activity that originates simultaneously in the gray matter (cerebral cortex) of BOTH HEMISPHERES

Question 11

What are tonic-clonic seizures?

Answer 11

Begin with muscular contraction throughout the body (tonic phase), and progress to alternating contraction and relaxation (clonic phase)

Question 12

What are tonic seizures?

Answer 12

Involve spasms of the upper trunk with flexion of the arms

Question 13

What are clonic seizures?

Answer 13

Same as tonic-clonic but without the tonic

Question 14

What are atonic seizures?

Answer 14

AKA drop attacks. Sudden global muscle weakness and syncope (fainting)

Question 15

What are myoclonic seizures?

Answer 15

Brief muscular jerks, not as extreme

Question 16

What are absence seizures?

Answer 16

Brief loss of awareness that commoly occurs with repetitive spasmodic eye blinking for up to 30 seconds–primarily in childhood, rarely after age 14

Question 17

What are partial onset seizures?

Answer 17

Originate in a localized or focal region of the brain

Question 18

What are simple partial onset seizures?

Answer 18

Brief loss of awareness but without loss of consciousness or spasmodic eye blinking

Question 19

What are complex partial onset seizures?

Answer 19

Level of consciousness is reduced but is not completely lost

Question 20

What are secondary generalized tonic-clonic seizures?

Answer 20

When partial onset seizures progress to generalized tonic-clonic seizures

Question 21

What is postictal confusion?

Answer 21

The confused mental state that follows seizure activity

Question 22

What are unclassified seizures?

Answer 22

Those that do not fit into any particular category

Question 23

What is status epilepticus?

Answer 23

Multiple seizures occur with no recovery between them. If not treated immediately, hypotension, hypoxia, brain damage, and death can ensue. Medical emergency

Question 24

How long is a person usually on antiepileptic drugs?

Answer 24

Their whole life

Question 25

If a patient is seizure free for 1-2 years, what happens?

Answer 25

They can slowly discontinue the medication with medical supervision

Question 26

What is the mechanism of action for antiepileptic drugs (AEDs)?

Answer 26

• Prevent generation and spread of excessive electrical discharge from abnormally functioning nerve cells
• Protect surrounding normal cells

Question 27

What three things do AEDs do?

Answer 27

Increase the threshold of activity, reducing the nerve’s ability to be stimulated
Limit the spread of impulses
Decrease the speed of nerve impulses

Question 28

What is the black box warning on antiepleptic drugs made in 2008?

Answer 28

Suicidal thoughts and behavior

Question 29

What could happen if you use oral phenytoin therapy long-term?

Answer 29

Gingival hyperplasia, as well as acne, hisutism, and hypertrophy of subq facial tissue (dilantin facies)

Question 30

What are barbiturates?

Answer 30

Classification of AEDs including phenobarbital and primidone.

Question 31

What is significant about phenobarbital?

Answer 31

It usually sedates the patient

Question 32

What is phenytoin indicated for?

Answer 32

The management of tonic-clonic and partial seizures

Question 33

What is topiramate (Topamax) indicated for?

Answer 33

adjunct therapy for partial and secondarily generalized seizures, for generalized tonic-clonic seizures, and for drop attacks.

Question 34

What must you do for IV antiepileptic drugs?

Answer 34

Given very slowly