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Y2 - CPT > Letcure 24 - Epilepsy And Antiepileptics > Flashcards

Letcure 24 - Epilepsy And Antiepileptics Flashcards

1
Q

What is the main excitatory neurotransmitter?

A

Glutamate

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2
Q

What is the main receptor which the excitatory neurotransmitter glutamate acts at?

A

NMDA receptor

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3
Q

What is the main inhibitory neurotransmitter in the brain?

A

GABA

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4
Q

What are the receptors which the main inhibitory neurotransmitter GABA acts on in the brain?

A

GABA alpha and beta receptors

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5
Q

What happens when glutamate binds to NMDA receptors?

A

Influx of Na+ and Ca2+ leading to depolarisation

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6
Q

What happens when GABA binds to a GABA receptor?

A

Cl- influx
Causes membrane hyperpolarisation reducing firing

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7
Q

What are seizures?

A

Clinical manifestation of abnormal excessive excitation and synchronisation of a group of neurones within the brain (is sudden and temporary)

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8
Q

What causes seizures?

A

Loss of inhibitory signalling
Unchecked excitatory signalling
Post tetanic potentiation

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9
Q

What are non epileptic seizures called?

A

Dissociative seizures

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10
Q

What are some causes of dissociative (non epileptic seizures)?

A

Drugs
CNS infection
Alcohol
Hypoglycaemia
Pyrexia

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11
Q

What are some causes of non epileptic seizures in kids?

A

Febrile convulsions
Breath-holding attacks
Night terrors
Stereotyped ritualistic behaviour

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12
Q

What is an epileptic seizure?

A

A transient occurrence of signs and or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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13
Q

What is epilepsy?

A

A disorder of the brain characterised by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition

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14
Q

What are the risk factors for epilepsy?

A

Premature
Complicated febrile seizure (can be linked to whooping cough)
Genetic conditions (tuberous Sclerosis, neuorfibromatosis)
Head trauma, infection, tumour
Cererbrovascular disease
Dementia and Neurodegenerative disorders

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15
Q

What is epilepsy simplified?

A

Tendency toward recurrent seizures unprovoked by a systemic or neurological insult

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16
Q

What is an epilepsy syndrome?

A

A condition that is not epilepsy but causes epilepsy like condition

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17
Q

What is an epilepsy syndrome?

A

GLUT 1 deficiency

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18
Q

How do we diagnose epilepsy?

A

Urgent referral following first suspected seizure
Assess risk of second seizure
First aid and saftey. Guidance
Detailed Hx

EEG
Neuroimgaing

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19
Q

What neuroimaging is first line for diagnosing epilepsy?

A

MRI

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20
Q

What are the 2 types of seizures that can be seen in epilepsy?

A

Focal seizures
Generalised seizures

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21
Q

What are focal seizures?

A

Seizures that often have focal impaired awareness

So remain conscious but unaware of what’s happening

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22
Q

What is a tonic-clonic seizure?

A

Where there’s violent jerking

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23
Q

Why do you have to give IV fluids when having tonic-clinic seizures?

A

Hyperhidrosis occurs (excess sweating)

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24
Q

What are the 2 main types of seizure?

A

Focal onset
Generalised onset

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25
What are the types of focal onset seizures?
Aware, impaired awareness Can be motor onset and nonmotor onset
26
What are the types of generalised onset seizures?
Motor seizures (tonic-cloning) Non motor (absence)
27
What are the 3 main types of seizures?
Generalised seizures Absence seizures Focal seizure
28
What is prodrome?
Early signs or symptoms a seizure may be coming hours to days before
29
What is aura?
A warning,focal awareness seizure leading to secondary generalised
30
What is the meaning of ictal?
During a seizure
31
What is interictal?
Between seizures in reference t EEG
32
What is post ictal?
Begins as seizure subsides last minutes to hours Confusion, lack of consciousness, fatigue, headache, anxiety, frustration, embarrassment, muscle aching or pain
33
What is sudden unexplained death in epilepsy?
Sudden Death that occurs in patients with epilepsy that not linked to seizures
34
What is the mechanism of action of carbamazepine?
Blockage of Na+ channels leading to reduced Ca2+ influx leading to reduced glutamate release (excitatory)
35
What is carbamazepine used to treat?
Epilepsy Trigeminal neuralgia
36
What are the adverse drug reactions of Carbamazepine?
Dizziness Skin rash (Steven Johnson syndrome) Eosinophilia Leukopenia Hyponatraemia
37
What are the contraindications to carbamazepine?
Teratogenic (neural tube defects) Bone marrow depression AV conduction issues HLA-B 1502 allele
38
What are the drug-drug interactions of carbamazepine?
Is a CYP3A4 inducer (dec effect of COCP) and inc Warfarin metabolism (reduced effect of warfarin) CYP3A4 inhibitors affect it: clarithryomycin, diltiazem increasing the concentration of carbamazepine It induces its own metabolism reducing its half life needed a dose increased
39
What is the mechanism of action of phenytoin?
Blocks Na+ channels, preventing Ca2+ influx and reducing glutamate release exactly the Same as carbamazepine
40
What is phenytoin used for?
2nd line in status epilepticus
41
Why is dosing with phenytoin very important?
Has zero order elimination kinetics so rate of elimination is constant Therapeutic window is narrow and small change in dose can drastically change plasma conc
42
What are the adverse reactions of phenytoin?
Lots Dizziness Skin rash (Steven Johnson syndrome) Visual disturbance Gingival hyperplasia Arrhythmia
43
What are the contraindications to phenytoin?
Is teratogenic often cuasing facial and digital defects Acute porphyria’s Bone marrow depression
44
What are the drug drug interactions phenytoin?
Is a CYP inducer so decreases the plasma conc of drugs like COCP, Abx and other antiepileptics
45
What is the mechanism of action of sodium valproate?
Multiple sites including Na+ channels Increases GABA synthesis and transcription of channel coding genes
46
What is sodium valproate used for?
Epilepsy
47
What are the adverse effects of sodium valproate?
Hepatotoxicity Appetite stimulant Alopecia Thrombocytopenia
48
What are the contraindications of sodium valproate?
Teratogenic (causes major malformation in pregancy) Avoided in pregnancy unless pregnancy programme in place
49
What are the drug drug interactions of sodium valproate?
It increases the conc of Lamotrigine, phenytoin and sodium valproate Hepatotoxicity
50
Why do you need a family planing pregancy prevention programme for women’s taking Anti epileptics?
Teratogenic
51
What anti epileptic drug should only ever be given in women of child bearing age if a pregnancy prevention programme is in place/
Sodium valproate
52
What is the pregancy prevention programme?
At least one highly effective contraception method or two complimentary forms including barrier method
53
What is the method of action of lamotrigine?
Na+and Ca2+ channel blocker selectively blocking neurones Selective for dendrites of pyramidal neurones
54
What are the adverse effects of lamotrigine?
Aggression Agitation Hypersensitivity
55
What are the contraindications of lamotrigine?
Phase 2 metabolism makes it have a long half life
56
What are the drug-drug interactions of lamotrigine?
Sodium valproate increases conc of lamotrigine Phenytoin and oral contraceptives decreases conc of lamotrigine
57
What is the mechanism of action of levetiracetam?
Inhibts synaptic vesicle protein 2A so decreases synchronised burst firing without affecting neuronal excitability
58
What is levetiracetam used for?
Focal seizures including secondary generalisation Safer options for PREGNANCY
59
What are the adverse effects of levetiracetam?
Anxiety Drowsiness Dizziness All common to all anti epileptics
60
What are the contraindications to levetiracetam?
QT prolonging risk factors
61
What are the drug drug interactions of levetiracetam?
CNS depressants which is the same with other anti epileptics
62
How do you decide to initiate and titrate doses of antiepileptics?
Start at low dose and mono therapy is desirable Aim to be seizure free balanced with acceptable side efffect profile
63
What are the benzodiazepine drugs?
Diazepam Lorazepam Midazolam
64
What is the mechanism of action of the benzodiazepines? (Diazepam, lorazepam and midazolam)
Bind to Allosteric site at GABA receptors enchancing hte activity of GABA to hyperpolarising membranes via Cl- influx
65
How does the duration of action of midazolam differ to diazepam?
Midazolam = short acting Diazepam = longer acting
66
Which benzodiazepine is best in hepatic dysfunction?
Lorazepam
67
What are the adverse effects of benzodiazepines?
Ataxia Depression Drowsiness Hypotension Muscle weakness Sleep disorders
68
What are the contraindications of benzodiazepines?
Cause resp depression at high doses
69
What are the drug-drug interactions of benzodiazepines?
Other CNS depressants
70
What is the first line drug in convulsive status epilepticus?
IV lorazepam Buccal midazolam if cant get a line in Or per rectal diazepam
71
What is convulsive status epilepticus?
Epileptic seizure lasting 5 minutes or more or multiple seizures without recovery in between A MEDICAL EMERGENCY
72
What is the steps of treatment for status epilepticus?
Benzodiazepine first line (IV LORAZEPAM) Immediately prepare 2nd dose of benzodiazepine Give 2nd dose after 5-10mins If that doesn’t work give 2nd line levetiracetam, phenytoin or sodium valproate If doesn’t work give a different second line agent to what you gave If doesn’t work then give barbiturates or general anaesthesia Always get help. And treat metabolic derangement like glucose and electrolytes
73
What is important when prescribing antiepileptics?
Always stick to the same specific brand or generics cuz they may differ slightly Specific brand and generic may be same but there may be differences between generics

Y2 - CPT (30 decks)

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