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Pharmacology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the different types of epileptic seizure?

A 
Generalised seizure (grand mal)
Absence seizure (petit mal)
Focal seizure (partial seizure)
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2
Q

What is a seizure and the pathophysiology?

A

Transient occurrence of signs or symptoms due to abnormal electrical activity in the brain, leading to a disturbance of consciousness, behaviour, emotion, motor function or sensation.

Abnormal and excessive excitation and synchrony of neurones within the brain, due to either a loss of inhibitory signals or too much excitatory signals.

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3
Q

What is the most important excitatory neurotransmitter and its receptor?

A

Glutamate - NMDA receptor

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4
Q

What is the most important inhibitory neurotransmitter and its receptor?

A

GABA - GABAa receptor

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5
Q

What might be the cause of a seizure?

A

Genetic differences- brain chemistry or receptors
Drugs inducing exogenous activation of receptors
Acquired brain chemistry changes- drug withdrawal, metabolism.
Damage to the networks- strokes/tumours

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6
Q

List some signs and symptoms of a seizure

A
  • loss of consciousness
  • change in muscle tone
  • hypertonic phase
  • shaking/jerking
  • post-ictal period lasting minutes to hours
  • aura prior to seizure
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7
Q

Why is epilepsy just as common in the over 60s?

A

Incidence increases with age, related to cerebral vasculature and strokes.

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8
Q

How is epilepsy defined ?

A
  • at least 2 unprovoked (or reflex) seizures occuring >24hrs apart
  • one unprovoked (or reflex) seizure and a probability of further seizures similar to the general reoccurrence risk (at least 60% over next 10 years).
  • diagnosis of an epilepsy syndrome
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9
Q

What is a reflex seizure and suggest some triggers?

A

A seizure brought on by a particular stimulus.

  • photogenic
  • musicogenic
  • eating
  • hot water immersion
  • reading
  • orgasm
  • movement
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10
Q

What happens in a generalised seizure?

A

They originate at one point and rapidly engage bilateral networks. This can include cortical and subcortical structures. Not necessarily the entire cortex.

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11
Q

What occurs in a focal seizure?

A

Originates within networks limited to one hemisphere and this may be discreetly organised or more widely distributed.

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12
Q

What is meant by a provoked seizure?

A

A seizure which is a result of another medical condition.

  • drug use/withdrawal
  • alcohol withdrawal
  • head trauma/ intracranial bleed
  • CNS infections
  • metabolic disturbance - hyponatraemia or hypoglycaemia
  • uncontrolled hypertension
  • febrile seizure in infants
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13
Q

What are some differential diagnoses?

A

Syncope
Cardiac issues- reflex anoxic seizure, arrhythmia
Movement disorders
TIA
Migraines
Non-epileptic attack disorders (pseudo seizures)

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14
Q

What is the initial management of a seizure?

A 
Airway 
Breathing - sats/o2 
Circulation - high HR, wary of BP
Disability- reduced or full consciousness 
E- recovery position if able

Get help and start a timer

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15
Q

How long should you wait before giving drugs?

A

5 minutes

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16
Q

What is status epliepticus?

A

A seizure lasting more than 5 minutes or multiple seizures without a complete recovery between.
It is a medical emergency and has a 30 day mortality of 20%.

17
Q

What is the pharmacological treatment for status epilepticus?

A 
Wait 5 mins 
Benzodiazepines 
Benzodiazepines 
Phenytoin or levetiracetam 
Call intensive care - thiopentone/anaesthetic
18
Q

How do benzodiazepines work and what are the ADRs?

A

GABAa agonists, ending in the suffix -apam.

Increased Cl conductance= more negative resting potential, less likely to fire. Work best in positive membranes.

They can be addictive, cause cardiovascular collapse and airway issues.
Also used as sleep aids, alcohol withdrawal and anxiolytics.

19
Q

What are the different administration routes for diazepam?

A

IV -lorazepam
Rectal - diazepam
Buccal or intranasal - midazolam

IM preparations available.

20
Q

How is a diagnosis of epilepsy made and what are the appropriate investigations?

A

Should be made by a specialist - in epilepsy or first fit clinic.
Based largely on history from patients and eyewitness
Videos helpful
EEG - episode capture (more likely when sleep deprived) or abnormal pattern.
Imaging - MRI to rule out vascular or structural abnormalities

21
Q

Many anti-epileptic drugs are sodium channel blockers- what is the mechanism behind this?

A

Block the Na channel in central neurones; slows the rate of recovery neurones from inactive to closed state. This reduces neuronal transmission.

22
Q

How does carbamazepine work and what are the side effects?

A

Sodium channel blocker
Sometimes used for bipolar and chronic pain

Suicidal thought
Joint pain
Bone marrow failure

23
Q

How does phenytoin work and its side effects?

A

Sodium channel blocker - mainly used in status epilepticus or adjunct in generalised seizures.
Has zero order kinetics.

Bone marrow suppression
Hypotension
Arrhythmia (IV use)

24
Q

What is sodium valproate mechanism and its side effects?

A

Mix of GABAa effects and sodium channel blocker - 1st line for generalised epilepsy. Aka epilim,depakote.

  • liver failure
  • pancreatitis
  • lethargy
25
Q

What is lamotrigine and its mechanism of action?

A

Primarily a sodium channel blocker but may affect calcium channels.
Good for focal epilepsy.
Used often when valproate contraindicated in generalised epilepsy.

26
Q

What is levetiracetam (keppra) and its mechanism of action?

A

Synaptic vesicle glycoprotein binder- stops the release of neurotransmitters therefore reducing neuronal activity.

Option for focal and generalised seizures - easy dosing and well tolerated. Safe in pregnancy.

27
Q

What are the common side effects of anti-epileptic drugs?

A 
Tiredness/drowsiness
Nausea and vomiting 
Mood change and suicidal ideation 
Osteoporosis 
Rash including Steven Johnson syndrome
Anaemia, thrombocytopenia or bone marrow failure
28
Q

What are some of the implications of carbamazepine and phenytoin ?

A

May decrease effectiveness of oral contraceptives
Increase likelihood of fetal abnormality
Decrease the effectiveness of some antibiotics

29
Q

Name some of the drugs which induces CYPs

A
  • phenytoin
  • carbamazepine
  • barbiturate
  • rifampicin
  • alcohol
  • sulphonylureas
30
Q

Name some drugs which inhibit CYPs

A
  • omeprazole
  • disulfram
  • erythromycin
  • valproate
  • isoniazid
  • alcohol
  • ciprofloxacin
31
Q

What are anti-epileptic drug implications with family planning?

A

Risk of congenital malformation, with the greatest risk being valproate (10%).
Therefore shouldn’t be prescribed to any woman of child bearing age unless meet conditions of a pregnancy prevention programme.

Lamotrigine and levetiracetam are safest

Pharmacology (22 decks)

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