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Pmcol 200 > L16 > Flashcards

L16 Flashcards

1
Q

seizures

A

a transient alteration of behavior
due to abnormally excessive and
synchronous neuronal activity in the brain

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2
Q

epilepsy

A

disorder of brain function
characterized by the periodic and
unpredictable occurrence of seizures.

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3
Q

epilepsy can be (2)

A

symptomatic (occur due to a known event such as head trauma or cancer)

asymptomatic (generally due to poorly defined genetic factors)

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4
Q

Seizures can be (2)

A

provoked (i.e., by chemical agents or electrical stimulation) or unprovoked

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5
Q

t/f everyone who has experienced

seizures have epilepsy.

A

f

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6
Q

condition of epilepsy denotes the
occurrence of spontaneous,
provoked/unprovoked seizures

A

provoked

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7
Q

normally, neurons fire synchronously/asynchronously in the brain

A

asynchronously

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8
Q

spread of electrical activity is maintained by
changes in _____potential following_____ (refractory period) and
______ _____

A

membrane
depolarization
surround inhibition

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9
Q

surround inhibition

A

the physiological
mechanism that focuses neuronal activity in
the central nervous system

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10
Q

the primary afferent fibre whose receptive
field centre is____ to the point of
stimulation will produce____ action
potentials than those on the periphery

A

closest

more

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11
Q

action potentials in the second order neurons
whose receptive fields are toward the___ of the stimulus field are more
strongly____, and therefore produce_____ action potentials, than the cell with its receptive field in the center

A

periphery
inhibited
fewer

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12
Q

Seizures can be divided into three steps:

A

initiation, propagation, and termination

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13
Q

• Seizure Initiation is characterized by two
events:
1) ___-frequency bursts of ____
2) ____ synchronization of a neuronal population
this sustained neuronal depolarization
results in a burst of action potentials driven
by _______ through NMDA receptors

A

1) high-frequency bursts of action potentials
2) hyper synchronization of a neuronal population

calcium influx

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14
Q

propagation of bursting activity normally prevented by

A

intact hyperpolarization and surround inhibition

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15
Q

can overcome barriers of bursting activity by (3)

A

• increasing extracellular potassium which
blunts the hyper polarizing outward potassium
currents
• accumulation of calcium in presynaptic terminals leading to enhanced neurotransmitter release
• depolarization induced activation of the
NMDA receptor, which causes more calcium influx and neuronal activation

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16
Q

what happens when sufficient barriers to bursting activities are overcome - 2

A

this leads to loss of surround inhibition and propagation of seizure activity across the brain

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17
Q

seizures generally resolve

A

spontaneously

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18
Q

potential mechanisms to terminate seizure (4)
- loss of ____ gradients
• depletion of ____
• ____ of neurotransmitters (e.g. glutamate)
• activation of ____ circuits (GABA)

A
  • loss of ionic gradients
    • depletion of ATP
    • depletion of neurotransmitters (e.g. glutamate)
    • activation of inhibitory circuits (GABA)
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19
Q

status epilepticus

is it life threatening?

A

seizure lasting longer than 5 minutes or if you have more than 1 seizure within a 5 minute period

yes

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20
Q

postictal period lasts

A

5-30 minutes after a seizure

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21
Q

postictal period characteristics

A

drowsiness, confusion, depression/anxiety, and sometimes psychosis (including hallucinations and delusions).

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22
Q

there are different types of seizures depending on - 2

A

where in the brain they initiate and how widely they propagate

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23
Q

Seizure classes include - 3

A

focal seizures, generalized seizures, and non- convulsive (absence) seizures

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24
Q

Focal Seizures - ___ manifestations depending on ____ in the brain it originates

A

diverse manifestations depending on where in the brain it originates

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25
Q

simple vs complex focal seizure

A

simple (retain consciousness)

complex (loss of consciousness)

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26
Q

Jacksonian March

A

Jerking activity may start in a specific muscle group and spread to surrounding muscle groups

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27
Q

Automatisms

A

unusual activities that are not consciously created, like smacking the lips.

28
Q

what type of seizures may become generalized over time.

A

Focal seizures

29
Q

Generalized Seizures include - 2

A

tonic-clonic and

myoclonic

30
Q

all Generalized Seizures involve

consciousness

A

loss of consciousness and typically happen without warning

31
Q

tonic-clonic

what clonic’s old name

A

involve sustained contractions (tonic) of muscles throughout the body followed by periods of alternating muscle contraction and relaxation (clonic)

(used to be called grand mal seizures)

32
Q

myoclonic seizures

A

brief (~1s) shock like contraction of muscles that may be localized or generalized

33
Q

Non-Convulsive Seizures involve - 2

A

absence and atonic seizures

34
Q

absence seizures

what happens during these

A

are characterized by an abrupt onset of impaired consciousness.

Can be subtle, with only a slight turn of the head or staring. While there is loss of consciousness, the person does not fall over and may return to normal right after the seizure ends, though there may be a period of postictal disorientation

35
Q

postictal disorientation (formerly called

A

petit mal seizures)

36
Q

atonic seizure

is consciousness maintained, what happens?

A

sudden loss of muscle strength. Usually consciousness is maintained, though the person may fall down

37
Q

The antiseizure drugs are usually used____ to prevent the occurrence of seizures in people with epilepsy

A

chronically

38
Q

antiseizure drugs , on occasion, used in people who do not have epilepsy—to prevent seizures that may occur as part of an ___ ___ such as meningitis or in the early period following either ____ or ___ ___ ___.

A

acute illness
neurosurgery
traumatic brain injury

39
Q

what to do if eizures are occasionally caused by an acute underlying toxic or metabolic disorder, such as hypocalcemia

A

appropriate therapy should be directed toward correcting the specific abnormality.

40
Q

anti-seizure drugs act by either _____ inhibitory (____ergic) neurotransmission or ____ excitatory (____) neurotransmission

A

anti-seizure drugs act by either enhancing inhibitory (GABAergic) neurotransmission or diminishing excitatory (glutatmatergic) neurotransmission

41
Q

drugs enhance or inhibit neurotransmission by (3)

A

1.blocking ionic conductance (particularly
sodium, calcium, and potassium) 2.blocking neurotransmitter release
3. inhibiting/activating the postsynaptic
membrane

42
Q

t/f one drug may have multiple targets that reduce likelihood of seizures

A

t

43
Q

anti-seizure drugs enhance GABAergic inhibitory transmission by

A

targeting various elements on the pre- or post-synaptic inhibitory neuron

44
Q

positive allosteric modulators at the GABAA receptors (drugs)

A

benzodiazepines and barbiturate

45
Q

benzodiazepines effect on GABA r in absence of gaba

A

no effect on the GABA receptor in the absence of GABA,

46
Q

barbiturates effect on GABA r

A

GABA agonists at higher concentrations

47
Q

benzodiazepines increase potency or efficacy

how

A

benzodiazepines increase the frequency at which the GABAA receptor opens (this increases the potency of GABA),

48
Q

barbiturates increase potency or efficacy

how

A

barbiturates increase the duration at which the GABAA receptor is open (this increases the efficacy of GABA)

49
Q

overdose risk for benzo and barb

which one has higher risk

A

risk of overdose possible for both benzodiazepines and barbiturates

(but riskier for barbiturates because of direct gating at the GABA receptor)

50
Q

additive risk when taken with other CNS ____ (like ___ or ___)

A

additive risk when taken with other CNS depressants (like alcohol or opioids)

51
Q

vigabatrin

A

vigabatrin inhibits GABA aminotransaminase (GABA-T), an enzyme involved in degradation of GABA

52
Q

tiagabine

A

tiagabine inhibits the GABA transporter (GAT-1 located in neurons and glia), which prolongs the action of the neurotransmitter.

53
Q

carbamazepine

A

block voltage gated sodium channels in neuronal membranes

54
Q

how do Na channel blocking drugs work

A

conformational change of the inactivation gate

55
Q

Diminution of excitatory neurotransmission - action is rate dependent
what does block cause

A

block increases with increased frequency of neuronal discharge) and results in prolongation of the inactivated state of the sodium channel and the refractory period of the neuron.

56
Q

gabapentin consists of a ____ molecule covalently bound to a ____ ____ ring. It was developed as a ____ active ____ agonist with ___ __ ___ that facilities crossing the BBB

A

gabapentin consists of a GABA molecule covalently bound to a lipophilic cyclohexane ring. It was developed as a centrally active GABA agonist with high lipid solubility that facilities crossing the BBB

57
Q

t/f: gabapentin has little activity at the GABA recepto

A

t

58
Q

what does gabapentin inhibit

A

inhibits voltage gated calcium channels

59
Q

gabapentin binds to the ___subunit of the __ __. Not a ___ block, but disrupts the ____ function of the ⍺2𝜹 subunit

A

gabapentin binds to the ⍺2𝜹 subunit of the calcium channel. Not a direct block, but
disrupts the regulatory function of the ⍺2𝜹 subunit

60
Q

blocking calcium influx reduces _____ release (particularly in ____ neurons)

A

blocking calcium influx reduces neurotransmitter release (particularly in glutamatergic neurons)

61
Q

glutamate receptors eg.

A

AMPA, NMDA

62
Q

perampanel is a

A

non- competitive antagonist at the AMPA receptor

63
Q

anti-seizure drugs are used for short/long periods of time to prevent recurrence of seizures

A

long

64
Q

most drugs exhibit very different/similar pharmacokinetic properties

A

similar

65
Q

antizeizure drugs are cleared mostly by the ___, but have ____ extraction ratios (can be ____ acting). Potential for drug-drug interactions are ___

A

antizeizure drugs are cleared mostly by the liver, but have low extraction ratios (can be long acting). Potential for drug-drug interactions are common

66
Q

most anti-seizure drugs have serious side effect risks associated with

A

depression of central nervous system activity (depression, suicidal thoughts, death).

Pmcol 200 (12 decks)

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