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701 > Exam 1: Seizure & Epilepsy > Flashcards

Exam 1: Seizure & Epilepsy Flashcards

1
Q

ILAE classification of common seizures

A
  1. how do they begin (focal/general)
  2. Is the person aware or impaired?
  3. Other features/ behavioral symptoms
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2
Q

Simple partial seizure

A

conscious of seizure occurring
motor, sensory, somatosensory, autonomic, behavioral manifestations

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3
Q

Complex partial seizure

A

impaired consciousness - remains after seizure
behavioral manifestations, hallucinations, same behavior every time

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4
Q

Secondary generalized

A

starts with partial onset but evolves into tonic clinic
often due to tumor, or other anatomical reason

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5
Q

Generalized Absence

A

petit mal
last seconds, generally in childhood
alteration of consciousness

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6
Q

General myoclonic

A

bilateral, involuntary rhythmic jerking of muscles

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7
Q

General Clonic

A

sustained muscle contractions
altering with relaxation

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8
Q

General Tonic

A

Sustained muscle contractions
with stiffening

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9
Q

General tonic-clonic “grand mal”

A

sudden loss of conciousness
rigid, falls to ground, lasts for 1 minute
can evolve to status epilepticus

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10
Q

General atonic

A

Drop attack, mainly in children
sudden loss of postural tone and falls to the ground

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11
Q

Pathophysiology of seizures

A

Abnormal firing of neurons due to ion channels
not enough inhibitory activity of GABA
too much excitatory activity of NMDA

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12
Q

How AED drugs work

A

Increase the inhibitory effects of GABA
Decrease the excitatory effects of NMDA (Na, Ca)

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13
Q

Causes of seizures

A

inherited
acquired
congenital
drug withdrawal
drug induced

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14
Q

Acquired seizures

A

head trauma, brain surgery, Cerebrovascular disease
infections, meningitis, flu, toxoplasmosis, Measles, mumps, syphillis
Metabolic disorders

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15
Q

Drugs withdrawal cause seizure

A

alcohol
benzodiazepines
barbituates
antiepileptics

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16
Q

Drugs that induce seizures

A

certain abx
antidiabetic drugs
anesthetics
antimalarials
antispastics
antidepressants
antipsychotics

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17
Q

Risk factors of breakthrough seizures; or if many at once, for any person

A
  1. sleep deprivation
  2. many missed AED dose
  3. alcohol withdrawal/rec drug misuse
  4. exhaustion
  5. strobe lights
  6. intercurrent infections
  7. metabolic disturbances
  8. uncommon: loud noise, hot bath
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18
Q

Rational polypharmacy

A

Risks:
1. DDI (carbamazepine + VPA = epoxide tox)
2. Drug burden (toxicity)
Rational
1. multiple MOA = synergy (lamotrigine + topiramate)

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19
Q

AED to use in pregnancy

A

Phenobarbital
lamotrigine
ethosuximide
topiramate
Oxcarbamazepine

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20
Q

AED to AVOID in pregnancy

A

phenytoin
valproic acid

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21
Q

Levetiracetam MOA

A

AMPA glutamate receptor non-competitive antagonist

22
Q

Levetiracetam ADR

A

weight gain

23
Q

Levetiracetam DDI

A

enhances CNS depressants

24
Q

Levetiracetam disadvantages

A

Renal - dose adjust

25
Q

Lamotrigine MOA

A

Na block to inhibit stimulatory AA (glutamate/aspartate)

26
Q

Lamotrigine ADR

A

SJS/TEN
Influenza-like syndrome
Somnolense, blurry vision, ataxia, HA, aggression

27
Q

Must titrate AED

A

Lamotrigine
Topiramate

28
Q

Gabapentin MOA

A

GABA analog
inhibit reuptake

29
Q

Gabapentin ADR

A

somnolense
Blurry vision, ataxia
Fatigue, nystagmus

30
Q

Topiramate MOA

A

NA block potentiates GABA

31
Q

Topiramate ADR

A

Expressive aphasia
Psych/cognitive dysfunction
Weight loss
Urolithiasis
BILATERAL paresthesias (not stroke)
sedation, dizziness, fatigue

32
Q

Vigabatrin MOA

A

inhibits GABA metabolizing enzyme like valproic acid

33
Q

Vigabatrin ADR

A

Visual field defects
psychosis and depression
VERY LIMITED USE - infantile spasms

34
Q

Zonisamide MOA

A

Prolongs Na channel Inactivation

35
Q

Zonisamide ADR

A

Loss of appetite, nausea, vomiting
but well absorbed GI

36
Q

Tigabine MOA

A

Inhibits GABA reuptake and increases its level

37
Q

Tigabine ADR

A

Mild memory impariment
Asthenia
Abdominal pain
sedation, dizziness,

38
Q

Valproic acid MOA

A

increases GABA by inhibiting degrading enzymes

39
Q

Valproic acid ADR

A

GI intolerance d/t poor solubility
weight gain (increased appetite)
hepatotoxicity
transient hair loss
NEURAL TUBE DEFECT

40
Q

Valproic acid DDI

A

inhibits metabolism of
CTPP
Carbamazepine
Topiramate
Phenytoin
Phenobarbital

41
Q

VPA also used for

A

GENERAL seizures
MANIA
Migraine Prophy
Mood

42
Q

Phenytoin MOA

A

Na, Ca, influx block
inhibits excitatory aminoacids

43
Q

Phenytoin ADR

A

GINGIVAL HYPERPASIA
hirsutism
HYDRANTOIN SYNDROME (fetal cleft)
megaloblastic anemia
OSTEOMALACIA
[GI upset]
[CNS: sedation, HA, vertigo, nystagmus]
[vein thrombosis]

44
Q

Phenytoin also used for

A

partial, tonic clonic, NOT ABSENCE
V FIB

45
Q

Carbamazepine MOA

A

similar to phenytoin
Na, Ca block

46
Q

Carbamazepine ADR

A

HYPONATREMIA/water intoxication
Congenital malformations
RASH
BLOOD dyscrasias
SELF. INDUCER

47
Q

Drugs with enzyme activity

A

Sodium valproate
Phenytoin
Carbamazepine
Levetiracetam (?)
Tigabine

48
Q

AED with GI upset

A

VPA
Pheny
carba
zonisamide
tigabine

49
Q

Seizure is Medical Emergency If

A
  • Longer than 10 minutes or a 2nd one starts (status epilepticus risk)
  • Difficultly in rousing at 20 min interval
  • Compliants of vision change
  • Vomitting
  • Persistent HA after rest period
  • Unconscious with failure to respond
  • Pupils unequal or excessively dilated
50
Q

FIRST AID for Generalized Tonic-Clonic Seizures

A
  1. Record the time of seizure onset
  2. Stay with the patient until the seizure ends
  3. Have someone call 911
  4. Prevent person from hurting himself or herself. Place something soft under the head, loosen tight clothing, and clear area of sharp or hard objects.
  5. DO NOT
    1. Force any objects into patient’s mouth
    2. Restrain patient’s movements.
    3. Pour liquids into patient’s mouth or offer any food, drink or medication until fully awake
  6. Turn patient on his or her side to allow saliva to drain from mouth
  7. Give artificial respiration if patient does not resume breathing after seizure.
  8. Provide area for patient to rest until fully awakened, accompanied by responsible adult.

701 (16 decks)

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