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SA DX & TX I > Exam 2 - Seizures > Flashcards

Exam 2 - Seizures Flashcards

1
Q

what is the most common neurological problem in small animal medicine?

A

seizures

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2
Q

what is a seizure?

A

hypersynchronous electrical activity of cortical neurons

defects that alter a group of neurons - potential for marked & prolonged depolarization

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3
Q

what are the major inhibitory neurotransmitters?

A

GABA & glycine

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4
Q

what are the major excitatory neurotransmitters?

A

aspartate & glutamate

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5
Q

what are the two general causes of seizures that occur in combination?

A

inadequate neuronal inhibition & excessive neuronal excitation

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6
Q

what is epilepsy?

A

disease characterized by an enduring predisposition to generate epileptic seizures & by the neurobiological, cognitive, psychological, & social consequences of this condition

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7
Q

______ is the event, while ______ is the disease

A

seizure

epilepsy

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8
Q

what is another name for the pre-ictal phase?

A

prodome

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9
Q

what are clinical signs of an animal in the pre-ictal phase?

A

abnormal behavior - may be clingy or may go and hide

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10
Q

what is ictus?

A

the seizure it self

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11
Q

what is seen during the ictal phase?

A

tonic/clonic seizures, non-responsive, urinating, defecating, & salivating

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12
Q

how long does the post-ictal phase last?

A

minutes to days

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13
Q

what clinical signs are seen in an animal during the post-ictal phase?

A

disorientation, blindness, & ataxia

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14
Q

T/F: the longer the seizure, the longer the post-ictal period

A

true

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15
Q

what is the general definition of a tonic-clonic seizure?

A

animal gets stiff (tonic)

then progresses to paddling (clonus)

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16
Q

what is clonus?

A

repetitive/rhythmic activity

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17
Q

before a generalized seizure in a dog, how may an owner describe the clinical signs?

A

dog chokes & turns blue

tonic - muscles of respiration get stiff

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18
Q

what does a generalized seizure look like?

A

class tonic-clonic activity

animal gets stiff & progresses to paddling

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19
Q

what parts of the CNS are affected in generalized seizures? why is this important?

A

both sides of the brain are affected, so the animal will have diffuse general movement & disorientation

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20
Q

how will an animal respond to an outside stimulus during a generalized seizure?

A

they won’t be responsive

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21
Q

T/F: during a generalized seizure, the animal may vomit, urinate, or defecate on themselves

A

true

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22
Q

T/F: any dog breed can get partial or focal seizures

A

true

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23
Q

while clinical signs are variable in partial/focal seizures, what may they include?

A

fly biting, ‘seeing ghosts,’ leg pulling, & head turn prior to generalized seizures

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24
Q

what are partial/focal seizures often secondary to?

A

CNS insult or genetically determined

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25
Q

T/F: partial/focal seizures come from one or more foci, & can spread to involve entire brain

A

true

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26
Q

what is status epilepticus?

A

seizure that lasts longer than 5 minutes or 2 seizures without a complete recovery in between

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27
Q

why is status epilepticus considered a medical emergency?

A

can lead to brain damage - hypoxia & hyperthermia

can lead to organ failure - multi-system failure, DIC, etc.

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28
Q

what is the number one differential for seizures?

A

syncope

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29
Q

how can you diagnose syncope?

A

put an ecg on the patient

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30
Q

what is idiopathic head-bobbing?

A

same direction head-bobbing every time with breed predilection for bulldogs, dobermans, & boxers

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31
Q

regardless of underlying cause, what are the 3 goals of seizure therapy?

A
  1. decrease number of seizures
  2. decrease severity of seizures
  3. increase the normal interictal period
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32
Q

regardless of underlying cause, what are the goals of acute seizure therapy?

A

stop the seizure & look for underlying cause - check bloodwork & look at BG

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33
Q

what are some examples for seizure-like events that are differentials for seizures?

A

narcolepsy, vestibular disease, myasthenia gravis, cerebellar tremors, neck spasms, & behavioral problems

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34
Q

what is the mechanism of action of benzodiazepines in seizure control?

A

lipid soluble drug that enters the brain rapidly

binds to GABA receptors, enhances neuronal hyperpolarization which leads to reduced neuronal activity

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35
Q

how long does an intermittent bolus of a benzodiazepine last?

A

approximately 30 minutes

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36
Q

what is the easy math for giving diazepam (valium) in a seizing animal?

A

0.5mg/kg at 5mg/ml given IV

move the decimal point over one spot

25kg dog gets 2.5 ml

10kg dog gets 1 ml

37
Q

what dose can you give of diazepam if the animal is also on phenobarbital?

A

2mg/kg given rectally

38
Q

T/F: IN midazolam works faster than IV valium

A

true

39
Q

what is the goal of maintenance seizure therapy?

A

aimed at controlling seizures not curing them

-goal of no seizures with minimal side effects
-issue can become quality of life

40
Q

under what conditions should maintenance seizure be started?

A

-when an animal has 2 or more seizures within a 6 month period

-seizures are increasing in frequency, severity, & duration

-status epilepticus or clusters

-severe post-ictal signs

-suspicion of structural lesion based on neuro exam

41
Q

why is client education so important in maintenance therapy in seizure patients?

A

owner compliance is key!!!

risks in stopping drugs abruptly or altering doses on their own & keeping a seizure log

42
Q

when selecting a drug for seizures, what is the definition of effective?

A

for an FDA approved drug to be considered effective - there must be a 50% reduction in seizure frequency

43
Q

what drugs are apart of the 1st generation AEDs?

A

phenobarbital

KBr

benzodiazepines

44
Q

how is phenobarbital metabolized?

A

through the liver

45
Q

what is the success rate of phenobarbital?

A

60-80% effective in idiopathic epilepsy patients

46
Q

what 1st generation AED has a high incidence of side effects?

A

phenobarbital

47
Q

if you are giving phenobarbital, you expect ALP to become high, but why would you be concerned if both ALT/ALP become increased?

A

concerned about hepatotoxicity!!!

48
Q

what is the dosing for phenobarbital?

A

2-3mg/kg BID

49
Q

what are the common side effects seen with phenobarbital?

A

liver problems, PU/PD/PP, inducible enzymes, autoinduction can shorten drug half-life, sedation, & ataxia

50
Q

what is the rare dermatological side effect associated with phenobarbital?

A

superficial necrolytic dermatitis

51
Q

what are some rare side effects of phenobarbital?

A

neutropenia, anemia, & thrombocytopenia

52
Q

what drug is the first choice for cats in many cases for seizure control? why?

A

phenobarbital

fewer side effects seen in general & don’t appear to develop metabolic tolerance from autoinduction enzyme

53
Q

what was the first AED used in people?

A

potassium bromide

54
Q

T/F: potassium bromide is effective as sole therapy drug or an add-on

A

true

55
Q

how is potassium bromide metabolized in the body?

A

through the kidney

56
Q

what is the time to reach steady state for potassium bromide?

A

3 months

57
Q

what is the dosing used for potassium bromide?

A

20-30mg/kg/day

58
Q

what seizure drug can not be used in cats & will kill them?

A

potassium bromide

59
Q

how long can sedation last as a side effect from potassium bromide?

A

up to 3 weeks

60
Q

why should you not use potassium bromide in cats?

A

increased risk of pneumonitis

61
Q

how can you avoid gi side effects of potassium bromide?

A

start with dosing 2x a day

62
Q

what are the common side effects of potassium bromide?

A

PU/PD, sedation, ataxia, pancreatitis, & vomiting

63
Q

what are the 2nd generation AEDs?

A

zonisamide & levetiracetam

64
Q

what is the time to steady state for zonisamide?

A

3 days

65
Q

how is zonisamide metabolized?

A

mixed liver & kidney

66
Q

what are the side effects of zonisamide?

A

sedation, ataxia, rare gi signs, reports of hepatic disease, & reports of renal tubular acidosis

67
Q

what is the dosing used for zonisamide?

A

twice daily dosing

68
Q

what is the time to steady state for levetiracetam?

A

within 1 day

69
Q

what are the side effects seen with levetiracetam?

A

mild sedation, transient decreased appetite

70
Q

what is the dosing used for levetiracetam?

A

20mg/kg - every 8 hours!!! critical owner compliance

71
Q

how is levetiracetam excreted?

A

unchanged through the kidneys

72
Q

T/F: levetiracetam is effective in cats for seizures

A

true

73
Q

what is the downside of using levetiracetam?

A

TID dosing - much more difficult for owner compliance

due to the half life of the drug, dosing needs to be every 8 hours

74
Q

what is keppra XR?

A

long-acting formulation of keppra

75
Q

what is the dosing of keppra XR?

A

30mg/kg BID

76
Q

T/F: once daily dosing of keppra XR may be effective in some dogs

A

true

77
Q

what is the limiting factor of keppra XR? why?

A

size of the patient

can’t cut the tablets in 1/2 because the coating of the pill is what makes it extended release

78
Q

T/F: animals on keppra XR may pass whole pills in their feces

A

true

79
Q

what is pulse therapy used for?

A

effective at breaking the seizure cycle but not the current seizure - will prevent more from happening

80
Q

what drugs can be used for pulse therapy? how can this help owners?

A

chlorazepate - always oral

benzodiazepines

owners can have medication on hand at home

81
Q

what is the dosing used for pulse therapy?

A

TID day 1 (1mg/kg)

BID day 2

once a day on day 3

82
Q

what drugs are your 1st line AEDs?

A

phenobarbital

KBr

zonisamide

keppra

83
Q

what AED has the longest time until steady state?

A

KBr

84
Q

what is the time to steady state for phenobarbital?

A

2 weeks

85
Q

what is the cheapest AED?

A

KBr

86
Q

how should KBR be monitored?

A

check levels every 3 months or if there is a change in seizure control

87
Q

how are levels of zonisamide & keppra monitored?

A

not done as often - check if poor seizure control and if there are significant side effects

88
Q

how are levels of phenobarbital monitored?

A

2 weeks, 3-6 months, & yearly - must also check bile acids

or if there is a change in seizure control

89
Q

how should seizure drugs be monitored?

A

CBC, chemistry panel, & electrolytes - 2 weeks, 1 to 3 months, 6 months, & yearly

SA DX & TX I (59 decks)

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