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NUR 325 > E2 Seizures > Flashcards

E2 Seizures Flashcards

1
Q

Seizure

A

-Brief episode of abnormal electrical activity in nerve cells of the brain
-Can involve motor, sensory, or cognitive manifestations

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2
Q

Convulsions

A

More severe seizure characterized by involuntary spasmodic contractions of muscles

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3
Q

Seizure Disease- Epilepsy

A

-Chronic, recurrent pattern of seizures
-Paroxysmal seizure activity

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4
Q

Myoclonic

A

Brief, shock-like jerks of a muscle or group of muscles
-Jerk of hand and legs
-Several in a row
-Overlooked often as tick, tremor, clumsiness

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5
Q

Seizure: Pathogenesis

A

“Seizure focus”
-Group of abnormal neurons that spontaneously fire
-Often this area is found to have scar tissue (gliosis)

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6
Q

Are global or local seizures more dangerous?

A

global

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7
Q

Primary seizures

A

-Idiopathic
-Epilepsy
-50% of cases
-Some genetic predisposition

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8
Q

Secondary seizures

A

-Chemical imbalances: low blood sugar, drugs (demoral)
-Febrile (most common in kids)

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8
Q

Brain issues associated with seizures

A

-Traumatic brain injury
-Stroke
-Meningitis
-Tumors

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9
Q

What does idiopathic mean?

A

unknown cause

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10
Q

What is the criteria for epilepsy diagnosis?

A

-Must have no evidence of a reversible metabolic cause (no tumor, no blood sugar issues, no meningitis)
-An electrical storm (takes multiple seizures, doesn’t matter what kind)

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11
Q

What is used to measure a seizure?

A

EEG

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12
Q

Seizure threshold

A

-the likelihood of a seizure
-the higher the threshold the less likely it is that a seizure will happen

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13
Q

What will increase or decrease likelihood of seizure?

A

Increase: drinking, menzies, missed meds, stress, illness

Decrease: meds, getting enough sleep

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14
Q

3 key features of seizure identification

A
  1. Area seizure originates (focal or generalized)
  2. Level of awareness of the patient
  3. Other feathers (ex. motor, nonmotor involvement)
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15
Q

Generalized onset seizures

A

-Formerly ‘grand-mal’
-Neuronal activity originates simultaneously in both hemispheres of the brain (grey matter)
-Subtypes: Tonic-clonic & Absence seizure

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16
Q

Absence seizures

A

brief loss of awareness that commonly occurs with repetitive spasmodic eye blinking for up to 30 seconds
-usually occurs in childhood, usually stop at age 14

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17
Q

Tonic phase of tonic-clonic seizures

A

-Prolonged skeletal muscle contraction
-“Cry”

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18
Q

Clonic phase of tonic-clonic seizures

A

-Alternating skeletal muscle contraction and relaxation
-Arm and legs jerk

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19
Q

Focal onset seizures

A

Originate in a localized or focal region (one lobe) of the brain
-further subdivided based on level of awareness by the patient

20
Q

Phases of a seizure

A
  1. Prodromal: signs or activity that precede a seizure
  2. Aural phase: sensory warning
  3. Ictal phase: Actual seizure
  4. Post-ictal phase: recovery
21
Q

What is the Aura/ prodrome phase?

A

-Subjective sense of impending seizure
-Clue to seizure

22
Q

What is status epilepticus?

A

-Continuing series of multiple seizures without recovery period
-Last 30 mins or more

23
Q

Status epilepticus is a life-threatening disorder and the biggest concern of tonic-clonic what can it cause?

A

-Respiratory distress
-Hypoxia
-brain damage
-Death

24
Q

What is the goal of anti-epileptic drugs?

A

-to control or prevent seizures while maintaining a reasonable quality of life
-most cases can’t eliminate, so goal is to maximally reduce seizures incidence and minimize drug toxicity

25
Q

What is the big issue with anti-epileptic drugs?

A

They have lots of side effects

26
Q

Do not ______ anti-epileptic drugs?

A

abruptly stop

27
Q

MOA of anti-epileptic drugs

A
  1. Increase the threshold of activity in the motor cortex- more difficult to excite nerve
  2. limit the spread of seizure
  3. Decrease the speed of nerve impulse conduction
28
Q

What is the black box warning of all anti-epileptic drugs?

A

Increase the risk of suicidal ideation, increasing/worsening depression, and unusual changes in mood

When we mess with neurons we mess with NTs leading to mental health disorders

29
Q

Adverse effects of anti-epileptic drugs

A

-Teratogenic: higher rates of brith defects
-Dizziness/drowsiness
-GI upset

30
Q

What class is phenytoin

A

Hydantoins

31
Q

Indication of phenytoin

A

tonic-clonic seizures and partial [focal] seizures, first line

32
Q

How is phenytoin given?

A

PO (long half-life, 1x day)
IV (Push slow)

33
Q

Adverse effects of phenytion

A

-Gingival hyperplasia (dental)
-Hirsutism
-Osteoporosis
-hypertrophy of Sub-Q facial tissue
-Lethargy
-Abnormal movements
-Mental confusion
-Cognitive changes

34
Q

Why does phenytoin frequently interact with other meds?

A

It is highly protein bound

35
Q

Who is most at risk for phenytoin toxicity?

A

-Malnourished
-Chronic kidney disease
-Decreased protein (albumin)

36
Q

Indication for valproic acid?

A

-Treatment of generalized seizures (absence, myoclonic, tonic-clonic)
-Shown to work for partial seizures

-Bipolar Disorder

37
Q

How is valproic acid given?

A

PO
IV
Delayed release
Sprinkles (kids)

38
Q

Who is valproic acid contradicted for?

A

liver disease
urea cycle disorders

39
Q

Adverse effects of valproic acid?

A

Hepatoxicity
Pancreatitis

40
Q

Topiramate indication

A

-Adjunct therapy for partial and secondary generalized seizures, tonic-clonic

41
Q

MOA of topiramate

A

not well understood

42
Q

Adverse effects of topiramate

A

-General CNS depression
-GI upset
-Close-angle glaucoma
-Can interact with contraceptive drugs

43
Q

Indication of levetiracetam

A

-Adjunct therapy for partial seizures with and without generalization
-Usually only used in hospital when uncontrolled

44
Q

MOA of levetiracetam

A

Unknown

45
Q

Side effects of levetiracetam

A

generally well tolerated

46
Q

IV push ______ are gold standards for seizures

A

benzodiazepines

(Diazepam, lorazepam)

47
Q

Most seizures stop spontaneously with no intervention in ______

A

2 minutes

NUR 325 (21 decks)

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