Brainscape's Knowledge GenomeTM

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


See full index

CPT > L21 Antiepileptics > Flashcards

L21 Antiepileptics Flashcards

You may prefer our related Brainscape-certified flashcards:
NASM ® CPT flashcards
1
Q

Seizure

A

Transient disturbance of consciousness, behaviour, emotion, motor function or sensation due to abnormal and excessive electrical activity in the brain

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

Pathology of seizures at glutamate receptors

A 
NMDA receptors:
Cation channels let Na+ and Ca2+ in and K+ out 
Depolarises membrane 
More likely to fire action potentials 
NMDA too strong 
GABA receptors:
Allows Cl- influx
Hyperpolarisation 
Less likely to fire an action potential 
Loss of GABA signals

Imbalance between receptors

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

Causes of seizures (4)

A

Genetic difference - genetic epilepsy syndrome
Drugs or alcohol
Drug withdrawal or metabolic changes
Damage to neuronal networks - stokes or tumours

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

Symptoms and signs of a general seizure

A 
Shaking 
Loss of consciousness 
Hyper or hypotonic 
Tongue biting 
Loss of bladder or bowel control 
Post-ictal period present (after seizure there is reduced consciousness for mins to hours)
Aura before seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs and symptoms of tonic clinic seizures

A 
Shaking 
Initial hypertonic phase 
Followed by rapid clonus (shaking or jerking)
Post ictal period present 
Aura before seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Epilepsy

A

Tendency toward recurrent seizures unprovoked by a systemic or neurological insult

  • diagnosed by expert largely based on history
  • seen in young and over 60s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Epilepsy criteria

A

At least 2 unprovoked (reflex) seizures occurring more than 24 hours apart

Or

One unprovoked (reflex) seizure and a probability of further seizures similar to the general recurrence risk after 2 unprovoked (reflex) seizures

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

Types of reflex seizure (8)

A 
Photogenic - flashing lights
Musicogenic 
Thinking 
Eating 
Hot water emmersion 
Reading 
Orgasm 
Movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classification of seizures

A 
Focal onset (partial seizure)
Generalised onset (grand mal) 
Unknown onset 
Absence seizure (petit mal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Focal onset seizure presentation

A

1 side of the brain
Doesn’t spread rapidly

  • aware or impaired awareness
  • motor onset or non motor onset
  • focal to bilateral tonic - clonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Motor focal onset signs

A 
Automatism 
Atonic 
Clonic 
Spasms
Hyperkinetic 
Myoclonic 
Tonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non motor onset focal

A 
Autonomic 
Cognitive impairment 
Sensory impairment 
Emotional impairment 
Behaviour arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Generalised onset symptoms

A

Bilateral
Rapid spread
Loss of consciousness

Motor:

  • clonic
  • tonic - clonic
  • myoclonic
  • atonic

Non motor

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

Provoked seizure

A

As a result of medical conditions
Treat the seizure and underlying condition
Unlikely to need ongoing anti epileptic drugs

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

Differential diagnosis of seizures (6)

A 
Syncopal episodes 
Cardiac issues - reflex anoxic seizures 
Movement disorders - Parkinson’s or Huntington’s 
TIAs 
Migraines 
Non epileptic attack disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Initial management of seizure

A

A/E assessment
Recovery position
Start a timer or look at clock
Majority of seizures self terminate without the use of drugs in 5 minutes

17
Q

Status epilepticus

A
  • A seizure of any type lasting more than 5 minutes or multiple seizures without a complete recovery between them
  • medical emergency
18
Q

Pharmacological treatment of status epilepticus

A

Wait 5 minutes

  • benzodiazepines
  • benzodiazepines again
  • phenytoin
  • thiopentone or anaesthesia
19
Q

Benzodiazepines mechanism

A

GABAa agonists - increased Cl- influx
End in - apam e.g. lorazepam or diazepam
Increases inhibition

20
Q

Benzodiazepine side effects

A

Addiction
Cardiovascular collapse
Airways issues

21
Q

Other benzodiazepine uses

A

Anxiolytics
Sleep disturbance
Alcohol withdrawal

22
Q

Delivery of benzodiazepines

A 
Intravenous lorazepam 
Rectal diazepam (difficult) 
Buccal or intranasal midazolam
23
Q

Investigations and imaging of seizures

A

Electroencephalograph during episode

Imaging - MRI (generally not required)

24
Q

Anti epileptic drugs

A

Sodium channel blocker:

  • Carbamazepine
  • Phenytoin
  • Valproate

Calcium channel blocker:
Lamotrigine (focal onset)

SV2a - synaptic vesicle glycoprotein binder inhibition:
Levetiracetam

GABA agonist:
Benzodiazepines

25
Q

Sodium channel blockade

A

Blocks Na+ influx in central neurones
Slows recovery of neurones from inactive to closed state
Reduced neuronal transmission

26
Q

Side effects of carbamazepine

A

Suicidal thoughts
Joint pain
Bone marrow failure

27
Q

Phenytoin side effects

A

Zero order kinetics

Side effects:

  • bone marrow suppression
  • hypotension
  • arrhythmias (IV)
28
Q

Sodium valproate side effects

A

Liver failure
Pancreatitis
Lethargy

29
Q

Levetiracem mechanism

A

Stops the release of neurotransmitter release into the synapse and reduces neuronal activity

Safe in pregnancy

30
Q

Side effects of AED (8)

A

REQUIRES CLOSE MONITORING

Tiredness 
Nausea and vomiting 
Suicidal thoughts 
Osteoporosis 
Steven Johnson syndrome 
Anaemia
Thrombocytopenia 
Bone marrow failure
31
Q

Interactions of AEDs

A

Do not drink alcohol whilst taking AEDs

  • carbamazepine and phenytoin are CYP inducers decreasing the effectiveness of the oral contraceptive pill and other antibiotics
  • valproate increases plasma conc of other AEDs
32
Q

CYP inducers

A 
Phenytoin 
Carbamazepine 
Barbiturates 
Rifampicin 
Chronic alcohol 
Sulphonylureas
33
Q

CYP inhibitors

A

Omeprazole
Disulfram
Erythromycin
Valproate

34
Q

Valporate and family planning

A

Valproate should not be given to any women of child bearing age unless they are on the pregnancy prevention scheme

  • hysterectomy
  • impacts
  • high contraception
35
Q

Epilepsy and driving

A

Will lose license and need to be seizure free for 1 year before reapplying

For bus and lorry drivers 5 years seizure free for single seizure and 10 years for multiple seizures

CPT (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions