Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Pharmacology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

A transient occurence of signs or symptoms due to abnormal electrical activity in the brain, leading to a disturbance of conciousness, bhevaiour, emotion, motor function or sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the major excitatory neurotransmitter in the brain and by which receptor does it act?

A

Glutamate acting on the NMDA receptor

Lets Na+ and Ca2+ in and lets K+ out

More likely to fire action potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the major inhibitory neurotransmitter in the brain and by which receptor does it act by?

A

GABA acting on the GABAA receptor

Cl- channel, hyperpolarises membrane → less likely to fire action potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain the pathology behind seizures

A

A manifestation of abnormal + excessive excitation of neurones within the brain, either due to:

  • Loss of inhibititory GABA
  • Too strong excitation by NMDA/ Glutamate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some of the causes of epilepsy?

A
  • Genetic differences in brain chemistry/receptor structure
  • Exogenous receptor activation (drugs / alcohol)
  • Changes in brain chemistry - drug withdrawl, metabolic changes
  • Damage to brain - strokes, tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some of the signs and symptoms of epilepsy?

A
  • Shaking
  • Generalised seizures- loss of conciousness
  • Changes in muscel tone, tongue biting
  • Tonic-clonic seizures initial hypertonic phase followed by rpaid clonus (shaking)
  • Post-ictal period- minutes- hours
  • May have aura pre-seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definition of epilepsy

A

The tendency toward recurrent seizures unprovoked by a systemic or neurological insult

Need at least 2 unprovoked seizures occuring more than 24 hours apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a reflex seizure?

A

A seizure brought on by a particular stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What kind of things can cause a reflex seizure?

A
  • Photogenic
  • Musicogenic
  • Thinking
  • Eating
  • Hot water immersion
  • Reading
  • Orgasm
  • Movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 broad classifications of seizure?

A
  1. Focal Onset - 1 side of brain, spreads slowly
  2. Generalised Onset- bilateral, spreads rapidly
  3. Unknown Onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are generalised seizures?

A

Originate at some point within the brain and rapidly engage bilaterally distributed networks

Can include cortical and subcortical structures not necessarily the entire cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are focal seizures?

A

Seizures that originate within brain networks limited to one hemisphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is grand mal?

A

Grand mal= generalised seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Petit mal?

A

Petit mal= absence seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is another term for partial seizure?

A

Focal seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a provoked seizure? Give examples

A

A seizure as a result of another medical contition

e.g.

  • Drug use/ withdrawl
  • Alcohol withdrawl
  • Head trauma/ intracranial bleed
  • Metabolic disturbance (hyponatraemia, hypoglycaemia)
  • CNS infection: meningitis and encephalitis
  • Febrile seizures in infants
  • Uncontrolled hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat provoked seizures?

A

Treat the underlying condition

18
Q

What are some differential diagnosis of seizures?

A
  • Syncopal episodes
  • Cardiac issues (reflec anoxic seizures, arrhythmias)
  • Movement disorders e.g. Parkinsons, Huntingtons
  • TIAs
  • Migraines
  • Non epileptic attack disorder (pseudo-seizure)
19
Q

What is the initial management of a seizure?

A

Primary survery A→E assessment

Airway- it it patent, can you do anything about it?

Breathing - sats, oxygen

Circulation- expect HR to be high

Disability- Will hae reduced conciousness in generalised seizures but may be awake in partial

E- may want to get into recovery position if possible

20
Q

At what point should you administer drugs for seizures?

A

Should wait for 5 minutes to see if seizure still going then give seizure terminating drugs

Most seizures will self-terminate without drugs

21
Q

What is status epilepticus?

A

A seizure (any variety) lasting more than 5 minutes , or multiple seizures without complete recovery between them

Status epilepticus is a medical emergency

22
Q

What is the treatment for status epilepticus?

A
  • Wait 5 minutes
  • Benzodiazepines
  • Benzodiazepines again
  • Phenytoin (or maybe Levetiracetam)
  • Thiopentone (must be given by an anaesthatist)
23
Q

Explain how benzodiazepines work

A

Bind to GABAa receptor, increase Cl- conductance and taking neurones membrane potential away from threshold

24
Q

What must you be caredful of when prescribing benzodiazepines?

A
  • Addiction
  • Cardiovascular collapse (if giving too much, too quick)
  • Airway issues
25
Give some other uses of benzodiazepines except for treating seizures?
* Alchol withdrawl * Sleep aid * Anxiolytics
26
Name the drug options of benzodiazepine that can be used in status epilepticus
* **Lorazepam** (i.v.- 1st line choice) * **Diazepam** (rectally- difficult when shaking) * Buccal or intranasal **Midazolam** (hard to get into mouth when biting)
27
What is used to help record electrical activity of the brain?
**Electroencephalography** * Useful but relies on capturing a seizure whilst wearing * Can bring on seizures by sleep depriving patient
28
What is the imaging method of choice when investigating epilepsy?
**MRI** May detect vascular or structural abnormalities to account for epilepsy
29
Name 3 anti-epileptics that are sodium channel blockers
1. Phenytoin 2. Carbamezepine 3. Lamotrigine
30
Explain how sodium channel blockers work as anti-epileptics
* Block Na channels in **central neurones** * This **slows the recovery rate** of neurones from inactive to closed state * Reducing neuronal transmission
31
What are some of the side effects of carbamezepine (Tegretol)
* Suicidal thoughts * Joint pain * Bone marrow suppression
32
What is unique about the metabolism of carbemezepine
Carbemezepine **induces** its own metabolism Induces CYP3A4 which is also the CYP that metabolises it
33
What do you need to bear in bind when prescribing phenytoin?
Phenytoin exhibits **zero order kinetics**- take care when adjusting dose
34
What are some specific side effects of phenytoin?
* Bone marrow suppression * Hypotension * Arrythmias (if give i.v.)
35
What is the mechanism of action of sodium valporate?
Works by a mixture of ways on the GABAA receptor and by increasing GABA synthesis 1st line treatment for **generalised epilepsy**
36
What are some of the side effects of sodium valporate?
* Liver failure * Pancreatitis * Lethargy * **Avoid in pregnancy** -high risk of congenital abnormality. Must make sure females of reproductive age are on a **pregnancy prevention programme**
37
When is Lamotrigine used to treat epilepsy?
* Good for **focal** epilepsy * Often used when sodium valporate is **contraindicated** in generalised epilepsy
38
How does Levetiracetam (Keppra) work?
Novel mechanism, unclear Thought to be a synaptic cleft **glycoprotein binder** that stops the **release of neurotransmitter** into the synapse to reduce neuronal activity
39
What are some of the general side effects of anti-epileptic drugs?
* Tiredness/ drowsiness * Nausea and vomiting * Mood changes and suicidal ideation * Osteoprosis (in older patients) * Rashes e.g. Steven Johnson more likely in carbamezepine or phenytoin * Many cause thrombocytopenia, anaemia or bone marrow failure
40
What is the effect of carbemezepine and phenytoin on other drugs
* Reduces effectiveness of oral contraceptive pill * Reduces effectiveness of some antibiotics
41
What are the safest anti-epileptics to use in pregnancy?
* Lamotrigine * Levetiracetam
42
What is the impact on epilepsy and driving?
* Will lose lisence * Patients responsibility to inform DVLA * Need to be 1 year seizure free before reapplying * Need to be 5 years seizure free off medication if a bus, lorry or coach driver

Clinical Pharmacology (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions