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Pharmacology > Epilsepy > Flashcards

Epilsepy Flashcards

1
Q

What is a seizure?
What neurotransmitters is it caused by?

A

Sudden uncontrolled electrical disturbance in the brain
Caused by: too much excitatory (glutamate) or not enough inhibitory (gaba)

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2
Q

What are the different types of seizures?

A

Focal
Abscence
Myoclonic
Tonic
Atonic
Tonic-clonic

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3
Q

How does a focal seizure present?

A

Changes in focal vision
Blurred vision

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4
Q

How does an absence seizure present?

A

Blank stares
Daydreaming
Unresponsiveness

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5
Q

How does a tonic seizure present?

A

Falls backwards
Muscle contractions constantly

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6
Q

How does an atonic seizure present?

A

Muscle relaxation
Falls forward

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7
Q

How does a tonic-clonic seizure present?

A

Tonic phase- muscles stiffen
Clonic phase- muscles convulsions

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8
Q

How does a myoclonic seizure present?

A

Short lived
Muscles twitch or twitches

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9
Q

How does a clonic seizure present?

A

Convulsions
Eg rhythmic muscle contractions

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10
Q

How is epilepsy diagnosed?

A

FBC
Electrolytes
Blood glucose
LFT
RFT
Calcium
EEG
Neuro exam
Clinical history exam

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11
Q

What differs epilsepy from other conditions eg cardiovascular collapse?

A

Epileptic episodes are accompanied by postictal state eg confusion, drowsiness, sleepiness, amnesia for hours

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12
Q

What is administered for focal seizures?

A

Carbamazepinen or lamotrigine

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13
Q

What is administered for absence seizures?

A

Ethosuximide

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14
Q

What is administered for all other seizures to a man or non child bearing woman?

A

Sodium valporate

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15
Q

What is administered for all other seizures to a child bearing/breastfeeding woman?

A

Lamotrigine or Levetiracetam

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16
Q

What is the action mechanism of lamotrigine?

A

Blocks voltage gated Na+ channels stopping Na+ influx and therefore depolarisation of glutaminergic neurons reducing excitotoxicity

17
Q

What is the action mechanism of diazepam?

A

Increases Cl- influx by binding to benzodiazepine site on GABA-A at post synaptic neuron leading to hyperpolarisation of excitatory neurones

18
Q

What is the action mechanism of sodium valporate?

A

Inhibits GABA transaminase preventing the breakdown of GABA which increases conc. of GABA at the presynaptic neuron.

19
Q

What is the action mechanism of levetiracetam?

A

Inhibits the synaptic vesicle protein SVA2 and stops vehicle exocytosis. This reduces glutamate secretion and exitotoxicity

20
Q

What is the action mechanism of carbamazepine?

A

Blocks sodium channel by binding to it which stops glutamate exitotoxicity

21
Q

What are the side effects of lamotrigine?

A

Rash
Suicidal thoughts
Steven Jonson syndrome
Drowsiness

22
Q

What are the side effects of sodium valproate

A

Abdominal pain
Diarrhoea
Weight gain
Hair loss
Pancreatitis
Hepatoxicity

23
Q

What are the side effects of diazepam?

A

Drowsiness
Respiratory depression
Haemolytic anaemia
Jaundicd

24
Q

What are the side effects of levetiracetam?

A

Dizziness
Fatigue
Headache

25
Q

What happens if lamotrigine and the oral contraceptive pill are taken together? What can be done to combat this issue?

A

OCO makes an enzyme which metabolises lamotrigine faster, this reduces the effects produced by it. Increase lamotrigine in weeks 1-3 and decrease it in week 4 (due to placebo effect)
Could go on a progesterone only contraceptive eg the implant

26
Q

Why is there a difference between men and child potential bearing women treatments?

A

Sodium valproate can cause neural tube defects, decreased IQ and autism in fetus’

27
Q

How are epileptic seizures treated in A&E?

A

Benzodiazepams- IV lorazepam first followed by diazepam.
Midazolam can also be given buccally if out on the street

28
Q

How do oestrogen and progesterone impact seizures? Why do people with epilepsy need to be monitored more during pregnancy?

A

Progesterone- seizure inhibiting
Oestrogen- seizure promoting
During pregnancy this needs to be monitored in people with epilepsy- lamotrigine levels may be decreased in fear of harming baby which will also add to likelihood of seizures occurring

Pharmacology (8 decks)

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