Epilepsy Flashcards
What are the clinical manifestations of epilepsy?
Alterations f consciousness, motor, sensory, automatic or psychic events
Which drugs can causes seizures?
Antimicrobials, anesthetics and analgesics, immunosuppressant, theophylline, sedative hypnotic drug withdrawal, drugs of abuse, flumazenis
What is the most common neurologic disorder in children?
seizures
Seizures originate from what matter?
Gray
What does prolonged seizure activity result in?
Lactic acidosis, rhabdomylosis, hyperkalemia, hyperthermia, and hypoglycemia,
What are some causes of 2ndary epilepsy ?
Tumor, head injury, hypoglycemia, meningitis, rapid ETOH withdrawal
Does focal or generalized account for 80% of
Focal
What are the automatic symptoms of focal seizures?
Pallor, flushing, vomit, sweat, vertigo, tachycardia
What is a prodrome?
Awareness of an impending seizure
What is an aura?
Simple focal
What are examples of automatisms
Lip smacking, chewing, swallowing, abnormal tongue mvmt, thrashing, fumbling or snapping
Drugs that modulate GABA receptors affect what?
Arousal and attention, memory formation, anxiety, sleep, muscle tone,
What are the 3 ways anticonvulsants work in the brain?
Prolonged inactivation of voltage sensitive Na channel
Enhanced GABA-mediated inhibition
Reduced glutamate
What AEDs affect voltage gated Na channels
Carbamazopinem, oxcarbazepine, phenytoin, lamotraine, zanisamide, lacosamide, rufinamide, eslicarbazepine
Is carbamazepine indicated in absence seizures
NO
Phenytoin blocks NA channels and affects what other system?
2nd messenger
Lamotrigine is used in what type of seizure?
Absence
Which if the NA channel AEDs cannot be given to ppl with a sulfa allergy?
Zonisamide
T/F- lacosamide is 100% absorbed orally?
TRUE
Which AED specifically inhibits Ca channels? What is it indicated for?
Ethosuximide
DOC(drug of choice) for absence seizures
What are the GABA affecting AEDs
Phenobarbital, vigabatrin, benzos, tiagabine, clobazam
Which of the GABA affecting AEDs is an irreversible inhibitor of GABA transaminase?
Vigabatrin
Which drugs affect Glutamate receptors?
AMPA/ NMDA antagonists,
When are NMDA antagonists strictly used? What can this lead to? Is this a black box warning?
Refractory Lennox- gastault syndrome
Aplastic anemia and liver failure
YES
What are the most important factors in choosing a drug
Tolerability and long term safety
After how many years can AEDs be discontinued?
Seizure free 2-5 years and have a normal neuro exam and IQ
If drugs are discontinued, how should you stop them?
Titrate off over several months
What are the 3 phases for treating SE?
Initial assessment and supportive care, initial therapy with a benzo, urgent therapy that achieves LT control with non-benzo AED
1st and 2nd line tx for SE
Benzo, then nonbenzo AED
How do benzos work
Act as positive allosteric modulators by enhancing channel gating presence of GABA
When are benzos not indicated?
If sz has already stopped or for maintenance therapy
Why is lorazepam preferred to diazepam secondary to DOA?
Diazepam is highly liophilic and quickly redistributes out of the brain to other fat stores
Which benzo can be given IM
Midazolam
What is given second line if sz continues after 2-3 doses of benzos
Hydatoins, LOADING dose
Phenytoin is an antiarrhythmic and a what?
Teratogen- fetal hydatoin syndrome
What is a 3rd line agent given if sz persists despite 2-3 doses of benzos and a loading dose of hydantoin? Could be 2nd line if hydatoins are contraindicated
Phenobarbital
better with pediatrics
