Epilepsy

Question 1

What are the clinical manifestations of epilepsy?

Answer 1

Alterations f consciousness, motor, sensory, automatic or psychic events

Question 2

Which drugs can causes seizures?

Answer 2

Antimicrobials, anesthetics and analgesics, immunosuppressant, theophylline, sedative hypnotic drug withdrawal, drugs of abuse, flumazenis

Question 3

What is the most common neurologic disorder in children?

Answer 3

seizures

Question 4

Seizures originate from what matter?

Answer 4

Gray

Question 5

What does prolonged seizure activity result in?

Answer 5

Lactic acidosis, rhabdomylosis, hyperkalemia, hyperthermia, and hypoglycemia,

Question 6

What are some causes of 2ndary epilepsy ?

Answer 6

Tumor, head injury, hypoglycemia, meningitis, rapid ETOH withdrawal

Question 7

Does focal or generalized account for 80% of

Answer 7

Focal

Question 8

What are the automatic symptoms of focal seizures?

Answer 8

Pallor, flushing, vomit, sweat, vertigo, tachycardia

Question 9

What is a prodrome?

Answer 9

Awareness of an impending seizure

Question 10

What is an aura?

Answer 10

Simple focal

Question 11

What are examples of automatisms

Answer 11

Lip smacking, chewing, swallowing, abnormal tongue mvmt, thrashing, fumbling or snapping

Question 12

Drugs that modulate GABA receptors affect what?

Answer 12

Arousal and attention, memory formation, anxiety, sleep, muscle tone,

Question 13

What are the 3 ways anticonvulsants work in the brain?

Answer 13

Prolonged inactivation of voltage sensitive Na channel

Enhanced GABA-mediated inhibition
Reduced glutamate

Question 14

What AEDs affect voltage gated Na channels

Answer 14

Carbamazopinem, oxcarbazepine, phenytoin, lamotraine, zanisamide, lacosamide, rufinamide, eslicarbazepine

Question 15

Is carbamazepine indicated in absence seizures

Answer 15

NO

Question 16

Phenytoin blocks NA channels and affects what other system?

Answer 16

2nd messenger

Question 17

Lamotrigine is used in what type of seizure?

Answer 17

Absence

Question 18

Which if the NA channel AEDs cannot be given to ppl with a sulfa allergy?

Answer 18

Zonisamide

Question 19

T/F- lacosamide is 100% absorbed orally?

Answer 19

TRUE

Question 20

Which AED specifically inhibits Ca channels? What is it indicated for?

Answer 20

Ethosuximide

DOC(drug of choice) for absence seizures

Question 21

What are the GABA affecting AEDs

Answer 21

Phenobarbital, vigabatrin, benzos, tiagabine, clobazam

Question 22

Which of the GABA affecting AEDs is an irreversible inhibitor of GABA transaminase?

Answer 22

Vigabatrin

Question 23

Which drugs affect Glutamate receptors?

Answer 23

AMPA/ NMDA antagonists,

Question 24

When are NMDA antagonists strictly used? What can this lead to? Is this a black box warning?

Answer 24

Refractory Lennox- gastault syndrome

Aplastic anemia and liver failure
YES

Question 25

What are the most important factors in choosing a drug

Answer 25

Tolerability and long term safety

Question 26

After how many years can AEDs be discontinued?

Answer 26

Seizure free 2-5 years and have a normal neuro exam and IQ

Question 27

If drugs are discontinued, how should you stop them?

Answer 27

Titrate off over several months

Question 28

What are the 3 phases for treating SE?

Answer 28

Initial assessment and supportive care, initial therapy with a benzo, urgent therapy that achieves LT control with non-benzo AED

Question 29

1st and 2nd line tx for SE

Answer 29

Benzo, then nonbenzo AED

Question 30

How do benzos work

Answer 30

Act as positive allosteric modulators by enhancing channel gating presence of GABA

Question 31

When are benzos not indicated?

Answer 31

If sz has already stopped or for maintenance therapy

Question 32

Why is lorazepam preferred to diazepam secondary to DOA?

Answer 32

Diazepam is highly liophilic and quickly redistributes out of the brain to other fat stores

Question 33

Which benzo can be given IM

Answer 33

Midazolam

Question 34

What is given second line if sz continues after 2-3 doses of benzos

Answer 34

Hydatoins, LOADING dose

Question 35

Phenytoin is an antiarrhythmic and a what?

Answer 35

Teratogen- fetal hydatoin syndrome

Question 36

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

Answer 36

Phenobarbital better with pediatrics