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Y3 PPNP Midterms > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

How does epilepsy occur?

A

As a result of abnormal electrical activity originating in brain which give rise of electrical storm that produces seizures

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2
Q

What is a seizure

A

Seizure is the abnormal movement/behaviour as a result of epilepsy

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3
Q

What are the types of seizures?

A
  1. Epileptic seizure
  2. Non-epileptic seizure (psychological/stress-induced)
  3. Provoked seizure (trauma/hypoglycaemia/drug-abuse)
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4
Q

When do idiopathic generalised seizure occur?

A

During childhood/adolescence (but may not be diagnosed till adulthood)

*can be EEG seizure but no nervous system abnormalities and normal intelligence

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5
Q

What are the types of idiopathic generalised seizures?

A
  1. General tonic-clonic (unconscious > muscle stiffening [tonic phase] > violent jerking [clonic phase] > deep sleep [post ictal phase])
  2. Absence (brief LOC; interrupts an activity & stares blankly; may occur several times a day)
  3. Myoclonic (sporadic jerking, both side of body jerking movements - jerks are described as electrical shocks)
  4. Clonic (rhythmic jerks of both sides of body - *may not be full body)
  5. Tonic (muscle stiffness/rigidity)
  6. Atonic (loss of muscle tone in all 4 limbs)
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6
Q

What is the difference between generalised and partial epilepsy?

A

Generalised = entire brain
Partial = small part of a brain

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7
Q

When do idiopathic partial epilepsy occur?

A

Begins in childhood and may be a part of fam hx
- outgrown by puberty and nvr diagnosed in adult
- seizure tends to happen during sleep
- partial motor seizure that involve face

*diagnosed by EEG

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8
Q

What are the types of idiopathic partial epilepsy?

A
  1. Simple (awareness intact)
    a) motor (jerking, muscle rigidity, spasms, head turning)
    b) sensory (unusual sensations involving 5 senses - vision, hearing, smell, taste, feel)
    c) psychological (memory/emotional disturbances)
  2. Complex (awareness impaired)
    • automatism (lip smacking, chewing, fidgeting, walking, other repetitive, involuntary coordinated movements)
  3. Partial seizure with secondary generalisation
    • conscious > LOC and convulsions
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9
Q

What is an aura?

A
  • a warning sign of an impending seizure/feeling that seizure is coming
  • not always present
  • experience immediately before seizure
  • a sensation (specific taste/smell)
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10
Q

What are the some triggers of epilepsy?

A
  1. Hypoglycaemia
  2. Alcohol
  3. Sleep deprivation
  4. Pyrexia
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11
Q

Who has a lower risk of recurrent seizures?

A

Patient who has
- a single seizure
- a normal EEG
- a normal brain scan

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12
Q

Who has a higher risk of seizures?

A

Patient who has
- previous/hx of undiagnosed seizures
- epileptiform EEG
- abnormal brain scans

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13
Q

What is the pathophysiology behind epilepsy?

A

Unbalanced excitatory and inhibitory receptor/ion channel function which favour depolarisation

Dysregulated discharge/synchronous firing of multiple neurons tgt from one region of a brain

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14
Q

What are the investigations for epilepsy?

A
  1. Electroencephalogram (EEG)
    • May show normal waves between seizures so will need to use triggers like sleep deprivation and hyperventilation to elicit pathological mechanism
  2. Blood tests (LFT, blood chemistry)
  3. MRI/CT (May show abnormal brain structures)

*others - lab, spinal punctures

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15
Q

What are the main goals of antiepileptics?

A

To reduce membrane excitability by:
1. Altering Na+ and Ca2t (excitatory NT) conductance during action potentials
2. Enhance effects of inhibitory GABA NT (mainly signal through GABA receptors)

*not all compounds are effective against all types of seizures

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16
Q

What are the first-line anti-epileptics for newly diagnosed generalised and partial tonic-clonic seizures?

A
  1. Phenytoin
  2. Carbamazepine
  3. Valporate
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17
Q

Which of the first line antiepileptics are not for pregnant women and why?

A

Phenytoin - AE: tetragenic (birth defect: malformation of fetus/baby)

18
Q

Which of the first line antiepileptics cause an accelerated elimination of other drugs, resulting in a need for an increased dosage of such drugs?

A

Carbamazepine

19
Q

What is the MOA of phenytoin and carbamazepine?

A

Block voltage dependent Na channels = reduce excitatory Na signals

20
Q

Which antiepileptic can be used for absence seizure?

A

Valporate

21
Q

What is the implication of phenytoin?

A

Need to titrate and monitor phenytoin doses due to its narrow therapeutic index

22
Q

Why do the dosage of other medications increase when taking carbamazepine?

A

Carbamazepine is a hepatic enzyme induce (CYP450), causing a med half life to shorten with repeated doses and accelerated elimination of other drugs (even carbamazepine)

23
Q

What is the AE of carbamazepine?

A

Aplastic anaemia (bone marrow cannot produce all kinds of blood cells - potentially fatal)

24
Q

What is the MOA of valporate?

A

Block voltage-dependent Na and Ca channels + inhibit GABA transaminase = increase GABA

25
Q

What is the implication of valporate?

A

It displaces other antiepileptics as it strongly binds to plasma proteins

26
Q

What is the contraindication for valproate?

A

Patient on multi-therapy for epilepsy (will displace other drugs = increase in plasma conc, therefore need to readjust dose of other meds)

27
Q

Why is benzodiazepines not used as a first line medication for epilepsy?

A

It has a high addictive potential

28
Q

What is the MOA behind benzodiazepines?

A

Enhance effects of inhibitory GABA NT
- more Cl ions enter cell = decrease membrane potential = hyperpolarised state of cell = overall inhibitory tone

29
Q

What is the MOA behind benzodiazepines?

A

Enhance effects of inhibitory GABA NT
- more Cl ions enter cell = decrease membrane potential = hyperpolarised state of cell = overall inhibitory tone

30
Q

What type of benzodiazepines are used for epilepsy and why?

A

Intermediate and long acting as medication for epilepsy are needed for long term (taking a short term medication like midazolam [3hrs] and triazolam [2.3hrs] will only increase risk of SE & addictive potential as a higher frequency will be needed to control seizures)

  1. Intermediate
    a) clonazepam (30hrs)
    b) lorazepam (12hrs)
  2. Long acting - diazepam (43hrs)
31
Q

What is midazolam used for?

A

Anxiety, induction of GA, procedural sedation

32
Q

What is triazolam used for?

A

Insomnia

33
Q

What is clonazepam used for?

A

Panic disorders, seizures

34
Q

What is lorazepam used for?

A

Anxiety, insomnia and status epilepticus

35
Q

What antiepileptic is a second line drug for refractory seizures?

A

Intermediate acting benzodiazepines (clonazepam and lorazepam)

36
Q

What is diazepam used for?

A
  1. Alcohol withdrawal syndrome
  2. Anxiety
  3. Sedation
  4. Status epilepticus
  5. Refractory seizures
  6. Seizure
  7. Adjunct skeletal muscle spasm
37
Q

What is diazepam used for?

A
  1. Alcohol withdrawal syndrome
  2. Anxiety
  3. Sedation
  4. Status epilepticus
  5. Refractory seizures
  6. Seizure
  7. Adjunct skeletal muscle spasm
38
Q

What is status epilepticus?

A

A severe state of ongoing seizure activity for 5mins or more (emergency)

39
Q

What are the general AE of antiepileptics?

A

Dose-related SE (frequency and severity increases with increasing dosage)
1. Drowsiness
2. Confusion
3. Nystagmus
4. Ataxia
5. Nausea
6. Unusual behaviour
7. Mental changes
8. Coma

Non-dose related SE (*can also occur with low dose)
1. Hirsutism (excessive hair growth)
2. Acne
3. Gingival hyperplasia
4. Folate deficiency
5. Osteomalacia (softening of bone tissue)
6. Hypersensitivity reactions (incl Steven Johnson syndrome - bad eczema with sloughing of dead skin, potentially fatal)

40
Q

What are the considerations when choosing an antiepileptic?

A
  1. Seizure type
  2. Epileptic syndrome
  3. Co-medication (other meds can be affected by antiepileptic pharmacokinetics and pharmacodynamic properties)
  4. Co-morbidity
  5. Lifestyle
  6. Preferences
41
Q

How many medications should an epileptic patient be on at any one time and why?

A

Monotherapy/One medication (& at lowest dosage possible) only to prevent long term AE since patient will be taking it for long term

*if there is an AR to initial drug/unsuccesful initial monotherapy = to try monotherapy of another drug

42
Q

When should antiepileptic levels be monitored?

A

When
1. Assessing for compliance in patients with refractory seizure

  1. Assessing symptoms due to possible antiepileptic drug toxicity (e.g pt with new condition like liver disease which decreases ability to metabolise drug = increase conc of drug and cause toxicity)
  2. Titrating phenytoin dose (due to its narrow therapeutic index)

*routing checking of antiepileptic levels w/o - clear indication is not req and not cost-effective

Y3 PPNP Midterms (7 decks)

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