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Pharmacology - Fall > Lecture 9 - Epilepsy > Flashcards

Lecture 9 - Epilepsy Flashcards

1
Q

What is epilepsy?

A

Chronic disease characterized by recurrent seizures

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2
Q

What is a seizure?

A

Sudden, brief disruption of normal neuron functioning

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3
Q

What are some causes of epilepsy?

A
  • Stroke
  • Brain tumour
  • Brain infection
  • Past head injury
  • Metabolic problems
  • Genetic factors
  • Other neurological conditions
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4
Q

What are some causes of seizures?

A
  • High fever, especially in infants
  • Drug use, alcohol withdrawal
  • Near-drowning or lack of O2
  • Metabolic disturbances
  • Head trauma
  • Brain tumour or infection, stroke
  • Complication of diabetes or pregnancy
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5
Q

What is a partial seizure?

A

Initiated in neurons in a localized area of one cerebral hemisphere

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6
Q

What are the 3 types of partial seizures?

A

1) Simple - no loss of consciousness
2) Complex - impaired consciousness often w/ automatisms
3) Secondary generalized - seizure spreads to activate both hemispheres

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7
Q

What is a generalized seizure?

A

Simultaneous activation of both cerebral hemispheres

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8
Q

What are the 2 types of generalized seizures?

A

1) Tonic-clonic - loss of consciousness, extension then jerking of body
2) Absence - impaired consciousness, sometimes w/ automatisms

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9
Q

What typically precedes a seizure?

A

Aura

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10
Q

What is an electroencephalogram?

A

Record of electrical activity of brain by placing electrodes on scalp

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11
Q

What will the EEG of a partial seizure look like?

A

Abnormal activity in left frontal and left temporal lobes

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12
Q

What will the EEG of a tonic-clonic seizure look like?

A

Abnormal activity in all brain regions

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13
Q

What will the EEG of a generalized absence seizure look like?

A

Abnormal slow wave electricity activity in all brain regions

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14
Q

What is a common symptom of complex partial seizures?

A

“Picking lint”

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15
Q

What are the symptoms of a partial seizure w/ secondary generalization?

A
  • Begins w/ jerking which spreads and patient passes out

- Whole body starts to jerk

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16
Q

What are the symptoms of a tonic-clonic seizure?

A
  • Muscle jerking, whole body is involved

- Lasts 1-3 minutes; afterwards px may be confused, have a headache, and want to sleep

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17
Q

What are symptoms of a generalized absence seizure?

A
  • Typically in children
  • Absence of aura
  • Loss or impairment of consciousness (“blanks out”)
  • 5-15 second lapses of consciousness, sometimes mistaken for daydreaming
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18
Q

What do anti-epileptic drugs do?

A
  • Decrease frequency and/or severity of seizures in pxs w/ epilepsy
  • Treats symptoms, not underlying cause
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19
Q

What is the goal of therapy for epilepsy?

A

Maximize quality of life by eliminating seizures or diminishing seizure frequency while minimizing adverse drug effects

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20
Q

What are mechanisms of action for AEDs?

A
  • Use dependent blockade of voltage gated Na channels (decrease rate of Na channel opening)
  • Inhibit excitatory (glutamate) neurotransmission
  • Increase inhibitory (GABA) neurotransmission
  • Block voltage gated Ca channels
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21
Q

What is the difference btwn normal neurons and neurons that are susceptible to seizure activity?

A
  • Normal neurons have a balance of excitation and inhibition

- Neurons susceptible to seizure activity show increased excitation or decreased inhibition

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22
Q

Which drugs can be used to treat all types of partial seizures?

A
  • Carbamazepine
  • Phenytoin
  • Valproate
23
Q

Which drugs can be used to treat tonic-clonic seizures?

A
  • Carbamazepine
  • Phenytoin
  • Valproate
24
Q

Which drug can be used to treat generalized absence seizures?

A

Ethosuximide

25
Q

Which drugs can be used to treat generalized tonic-clonic and absence, or atypical generalized seizures?

A

Valproate

26
Q

What does carbamazepine do?

A

Inhibits voltage-gated Na+ channels

27
Q

Carbamazepine can enhance the effects of ____

A

Other AEDs including phenytoin and valproate

28
Q

What are some dose related adverse effects of carbamazepine?

A

Double vision and ataxia

29
Q

What does phenytoin do?

A

Blocks voltage-gated Na channels

30
Q

Metabolism of phenytoin is ____ dependent

A

Dose

31
Q

What does phenytoin induce?

A

CYP 3A4, thus increases metabolism of many drugs

32
Q

What enhances the metabolism of phenytoin?

A

Phenobarbital and carbamazepine

33
Q

Which side effects of phenytoin require a dosage adjustment?

A

Double vision and ataxia

34
Q

What do phenobarbital and primidone do?

A

Enhance inhibitory effects of GABA

35
Q

What metabolizes primidone?

A

Phenobarbital

36
Q

What are some dose related side effects of phenobarbital and primidone?

A
  • Drowsiness
  • Ataxia
  • Respiratory depression
  • Decreased motor skills
37
Q

What does gabapentin do?

A

Increases release of GABA from neurons (appears to decrease GABA metabolism)

38
Q

When is topiramate used?

A

Approved for adjunctive therapy, also appears beneficial for monotherapy in partial and tonic-clonic seizures

39
Q

What does topiramate do?

A

Inhibits voltage sensitive Na channels, increases GABA effects, and inhibits glutamate receptors

40
Q

What affects the metabolism of topiramate?

A

Other AEDs

41
Q

When is lamotrigine used?

A
  • Adjunctive therapy

- Also appears effective for monotherapy for partial and absence seizures

42
Q

What does lamotrigine do?

A

Blocks voltage-gated Na channels

43
Q

What affects the metabolism of lamotrigine?

A

Other AEDs

44
Q

What does ethosuximide do?

A

Blocks voltage activated Ca channels

45
Q

What is an important adverse effect of ethosuximide?

A

May increase tonic-clonic seizures

46
Q

When is clonazepam used?

A

Generalized absence seizures

47
Q

What does clonazepam do?

A

Enhances inhibitory effects of GABA

48
Q

When is valproate used?

A

Generalized tonic-clonic, absence, or mixed seizures

49
Q

What does valproate do?

A

Inhibits voltage-gated Na and Ca channels and enhances GABA

50
Q

What does valproate inhibit

A

Metabolism of other drugs, including AEDs

51
Q

Is valproate safe in pregnancy?

A

No, risk of spina bifida

52
Q

What are some other uses of AEDs?

A
  • Bipolar disorder (carbamazepine and valproate)
  • Anxiety disorders
  • Alcohol abuse
  • Spasticity
  • Migraine, cluster headaches
  • Neuropathic pain (especially gabapentin)
53
Q

What is used to stop status epilepticus?

A

IV diazepam or lorazepam (lorazepam is preferred)

54
Q

Why are AEDs gradually increased to therapeutic concentrations and withdrawn gradually?

A

To decrease risk of adverse effects; to decrease risk of inducing seizure

Pharmacology - Fall (15 decks)

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