Chapter 24 - Epilepsy

Question 1

Epilepsy - def

Answer 1

group of disorders characterized by excessive neuron stimulation within the CNS

Question 2

Brief unconsciousness, violent convulsions, etc are part of….?

Answer 2

Epilepsy.

Question 3

Seizure - def

Answer 3

all types of epileptic events.

Question 4

Convulsion - def

Answer 4

abnormal motor responses (Jerking movements in grand-mal seizure.)

Question 5

What initiates a seizure?

Answer 5

high-frequency discharge from a group of hyper-excitable neurons called a FOCUS.

Question 6

What causes the FOCUS?

Answer 6

Congenital defects, hypoxia at birth, head trauma, cancers.

Question 7

Symptoms depend upon location of ___ and how discharge ___ to other portions of the brain.

Answer 7

FOCUS/spreads.

Question 8

Partial (focal) seizures - located where?

Answer 8

located in cerebral cortex.

Question 9

Simple partial seizure - def

Answer 9

convulsions in single limb or muscle group.

Question 10

Complex partial - def

Answer 10

involve impairment of consciousness.

Question 11

Generalized seizures - def

Answer 11

throughout the brain.

Question 12

Convulsive (tonic-clonic) - def

Answer 12

major convulsion

Question 13

Non-convulsive Seizure (absence seizure)

Answer 13

loss of consciousness for a brief time - petit mal (eye blinking.)

Question 14

Grand-mal seizure -

Answer 14

muscle rigidity followed by muscle jerk.

Question 15

How do anti-epileptic drugs work?

Answer 15

They suppress neuronal discharges at the seizure’s focus and brain.

Question 16

MOA of anti-epileptic drugs -

Answer 16

Suppression of sodium influx (can’t depolarize), Suppression of calcium influx, and potentiation (increase) of GABA.

Question 17

What are some seizure drugs for Partial Seizures? 3

Answer 17

Valproic Acid, Carbamazepine, Phenytoin

Question 18

What are some seizure drugs for Generalized Seizures? 2

Answer 18

Valproic Acid (Tonic-clonic, Grand-mal) and Ethosuzimide (Absence, petit-mal.)

Question 19

Drug selection for epilepsy requires……

Answer 19

Physical, neurological, and lab evaluations - like age of onset of seizures, frequency, duration, etc.

Question 20

Until drug evaluation is done, make sure patients do not participate in activities that could be dangerous if seizure occurs. T/F?

Answer 20

False

Question 21

Phenytion (Dilantin) A ___ AED

Answer 21

Broad Spectrium.

Question 22

MOA - Phenytion -

Answer 22

selective inhibition of sodium channels.

Question 23

Pharmacokinetics of Phenytion -

Answer 23

varies. Half life = 8-60 hours, varied oral absorption, etc.

Question 24

Adverse effects of Phenytion -

Answer 24

nystagmus (continuous eye movement), sedation, ataxia (staggering gait), Diplopia (double vision), cognitive impairment, teratogenic effects.

Question 25

Drug interactions - Phenytion -

Answer 25

Decreases effect of oral contraceptives, warfarin, and glucocorticoids (anti-inflammatory/immunosuppressive).

levels can be increased if used with diazepam, isoniazid, cimetidine, alcohol, valproic acid, etc.

Question 26

Phenobarbital - uses

Answer 26

partial and generalized tonic-clonic seizures. Promotes sleep and sedation.

Question 27

Adverse effects - phenobarbital.

Answer 27

Physical dependance, porphyria (changes in the amount of porphyrin), nystagmus (continuous eye movement), ataxia (staggering gait), CNS depression.

Question 28

Carbamazepine - Tegretol - uses

Answer 28

partial and tonic-clonic seizures. Bipolar disorders. Trigeminal neuralgias (severe, stabbing pain along the course of nerves.)

Question 29

Adverse effects - tegretol -

Answer 29

nystagmus, ataxia. Anemia, leukopenia, etc.

Question 30

Valproic Acid - number 1 drug for ___

Answer 30

Bipolar Depression.

Question 31

Valproic Acid - uses

Answer 31

absence seizures, other seizures, and migraine.

Question 32

Adverse effects - valproic acid.

Answer 32

Hepatoxicity, teratogenic effects.

Question 33

Antiseizure therapy during pregnancy -

Answer 33

balance risks, especially during first trimester.