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Pharmacotherapeutics > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

A seizure is a discrete, time-limited alteration in brain function that includes what changes?

A

motor activity, autonomic functioning, consciousness, sensations

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2
Q

Abnormal and excessive discharge of a group of neurons within what?

A

cerebral cortex

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3
Q

What are some clinical manifestations?

A

indescribable bodily sensations, pins and needles, smells/sounds, fear/depression, hallucinations, head nods, staring with loss of awareness, convulsive movements

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4
Q

This is a specific type of seizure where the attack is primarily manifested by involuntary muscular contractions.

A

Convulsion

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5
Q

A condition characterized by recurrent seizures unprovoked by any immediately identificable cause.

A

Epilepsy

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6
Q

Subjective disturbance of perception that represents the start of certain seizures

A

Aura

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7
Q

The actual seizure itself.

A

Ictus or ictal phase

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8
Q

Period after the seizure where the individual may be sleepy, confused, disoriented or may experience temporary neurological dysfunction.

A

Post-ictal phase

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9
Q

Describe the imbalance in neurotransmitter processes in the brain.

A

Decreased GABA - inhibitory

Enhanced Glutamate - Excitatory

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10
Q

Involvement of a localized area of the brain at seizure onset, begin in one hemisphere of the brain.

A

Focal

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11
Q

Involvement of both hemispheres of the brain at seizure onset.

A

Generalized

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12
Q

What causes a focal seizure?

A

injury to the brain,( tumor, trauma, neurodengerative disease)

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13
Q

See tonic/clonic movements with which seizure?

A

focal without impairment of consciousness

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14
Q

Sensory seizures are what type of seizures?

A

focal without impairment of consciousness

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15
Q

What is the duration of a focal without impairment of consciousness?

A

30 seconds or less

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16
Q

A focal seizure without impaired consciousness that may precede a focal seizure with impaired consciousness or progression to a generalized seizure

A

Aura

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17
Q

What is the duration of a focal seizure with impairment of consciousness?

A

1-3 minutes

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18
Q

Repetitive motor activities such as mumbling, picking clothing, lip smacking are signs of?

A

Automatisms seen in focal seizure with impairment

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19
Q

Confusion, lethary, altered behavior, amnesic for event are of what phase?

A

Postictal

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20
Q

EEG findings: local contralateral discharge starting over the cortical area.

A

Focal without impairment

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21
Q

EEG findings: unilateral or bilateral discharge in the temporal or frontotemporal regions.

A

Focal with impairment

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22
Q

May progress through several stages reflecting spread of discharge to different brain areas.

A

Evolving to a bilateral, convulsive seizure

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23
Q

Seizures begins in both hemispheres. Loss of consciousness.

A

Generalized seizures

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24
Q

Loss of consciousness followed by sudden fall to ground. muscles become rigid, clonic movements of head, legs, arms.

A

Generalized tonic-clonic

25
Q

What is the duration of Generalized tonic-clonic?

A

2-5 minutes

26
Q

Patients with primary GTC seizures occur most commonly when?

A

awakening and lesser extent in evening when relaxing

27
Q

Brief episodes of staring with impairment of awareness and responsiveness that begin without warning and end suddenly.

A

Absence

28
Q

What is the duration of an absence seizure?

A

10-45 seconds

29
Q

EEG of 3 per second spike and wave pattern.

A

Absence

30
Q

Sudden and total loss of muscle tone and postural control that causes eyelids to drop, head to nod, and patients drop to the ground.

A

Atonic

31
Q

What is the duration of an atonic seizure?

A

10-60 seconds

32
Q

Sudden, brief, shock-like jerk of a muscle often occurs in healthy people as they fall asleep.

A

Myoclonic

33
Q

Sudden bilateral stiffening of the body, arms, or legs. More common during sleep.

A

Tonic

34
Q

Rhythmic, repetitive, jerking muscle movements.

A

Clonic

35
Q

ACTH, prednisone and vigabatrin can be used to treat?

A

Infantile spasms

36
Q

Convulsions brought on by a fever greater than 102F. What seizure and how do you treat?

A

Febrile seizure

Diazepam orally or rectally

37
Q

Triad of intractable seizures, mental and developmental retardation, and slow spike and wave pattern.

A

Lennox-Gastaut Syndrome

38
Q

Myoclonic seizures begin around puberty in early morning. What seizure and how do you treat?

A

Juvenile myoclonic epilepsy

Treat: valproic acid

39
Q

What other conditions may look like epilepsy?

A

pseudoseizure, syncope, breath holding spells, narcolepsy, hemiplegic migraines, drug toxicity, transient ischemic attack

40
Q

What factors define epilepsy?

A

abrupt onset, loss of consciousness, brief duration, rapid recovery, stereotypic episodes

41
Q

What are some underlying causes of seizures?

A

hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia, withdrawal, sleep deprivation, fever, stimulants

42
Q

What tests should be ran?

A

CBC, LFT, serum albumin, urinalysis, serum electrolytes, EEG, MRI

43
Q

What are signs of need for immediate medical attention?

A 
Seizure lasting 10 minutes or more
Difficulty rousing in 20 minutes
Vision complaints
Vomiting
Persistent Headache after rest period
Unconsciousness with failure to respond
Unequal size pupils or excessively dilated
44
Q

What are the nonpharmacologic treatments for seizures?

A

Surgery - temporal lobectomy
Vagal nerve stimulation
Ketogenic diet

45
Q

What are the toxic effects of AED?

A

somnolence, fatigue, dizziness, vision changes, nystagmus, ataxia, tremor, GI, difficulty thinking, behavioral disorders

46
Q

Chronic adverse effects of AED long term therapy?

A

connective tissue, endocrine, GI, hematologic, neurologic disorder

47
Q

Fetal hydantoin syndrome is associated with which drug? Manifestations?

A

phenytoin

Cranial facial abnormalities, cleft lip/palate, wide mouth, prominent lips, digit hypoplasia, mental retardation

48
Q

What should be given to pregnant women?

A

Folic acid 1-4mg daily

Vitamin K during 8th month

49
Q

Recurrent epileptic seizures without full recovery of consciousness before next full seizure begins.Continuous clinical or electrical seizure activity lasting more than 30 minutes, regardless of consciousness.

A

Status epilepticus

50
Q

Continuous seizure activity lasting more than 5 minutes. two or more seizures without complete recovery of consciousness

A

Status epilepticus

51
Q

Persistent state of impaired consciousness and motor/sensory seizure without impaired consciousness.

A

Non-Convulsive Status Epilepticus

52
Q

Involves the entire brain. Full body tonic-clonic motor seizures. Impaired consciousness.

A

Generalized Convulsive Status Epilepticus

53
Q

What can cause status epilepticus?

A

CNS tumor or infection, trauma, hypoxia, stroke, metabolic disorder, chronic alcohol abuse, drug toxicity, AED change in levels

54
Q

What drug is given first for SE?

A

Thiamine 100mg + Glucose if hypoglycemic

55
Q

What drug is given in 10 minutes for SE?

A 
Lorazepam 0.1mg/kg IV 
OR
Diazepam 10mg PR
OR
Midazolam 0.2mg/kg IM
56
Q

What drug is given in 10-30 minutes for SE?

A

Phenytoin 15-20 mg/kg IV

57
Q

What drug is given in 30-60 minutes for SE?

A

Additional phenytoin bolus 5-10mg/kg
OR
Phenobarbital 20mg/kg

58
Q

What drug is given in 60 minutes for SE?

A 
Bolus phenobarbital 10mg/kg
Valproate sodium 20mg/kg
Midazolam 2mg/kg Bolus
Propofol 1mg/kg bolus
pentobarbital 10-15 mg/kg

Pharmacotherapeutics (12 decks)

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