Neuro Flashcards
1
Q
what are seizures
A
- abnormal discharges of brain neurons
2
Q
where in the brain can seizures occur
A
- may occur in part (focal) or all (general) of the brain
- partial—one side
- general—both sides
3
Q
what is the difference between a simple and complex seizure
A
- level of consciousness
- simple: no loss of consciousness
- complex: loss of consciousness
4
Q
what is the objective of drug therapy with seizures and how do they work
A
- suppress seizures by maintaining an effective concentration of the drug in the blood and brain cells at all times
- effect ions used in impulses: Cl, Na, Ca
- choose a first-line antiepileptic agent specific to the seizure type
- cannot cure
5
Q
what are phenobarital and benzodiazepines and how do they work
A
- sedative/hypnotic drugs
- imitates the neurotransmitter GABA
- binds to GABA receptor
- opens chloride channel
- chloride rushes into the cell
- impulse stops
- more adverse effects with barbiturates than benzos
- lorazepam (or diazepam) intravenously (IV) = drug of choice in status epilepticus and in alcoholic-related seizures
6
Q
what are hydantoins and how do they work
A
- blocks sodium channels
- prevent sodium from entering brain cells
- message not started
- first-line therapy for partial (both simple and complex) seizures and generalized tonic-clonic seizures.
- teratogenic
- narrow therapeutic index (monitor blood levels).
- metabolized by P450 liver enzymes (CYP2C9)
- drug interactions with - metronidazole (increase phenytoin levels)
7
Q
what are some clinical guideline for patients taking hydantoins
A
- monitor for gingival enlargement
- monitor and emphasize oral hygiene; difficult for patient to adequately maintain oral hygiene because of tissue overgrowth
- place patient on frequent recall appointments to monitor gingival condition
8
Q
what is carbamezipine
A
- controls partial and generalized tonic-clonic seizures
- originally developed for the treatment of trigeminal neuralgia
9
Q
what are adverse effects of carbamazepine
A
- agranulocytosis (decreased white blood cells), platelet decrease, aplastic anemia.
- need medical consult for dental treatment.
- metabolized by CYP3A4 enzymes
- many drug interactions; erythromycin, clarithromycin, ciprofloxicin
10
Q
what are some guidelines for patients taking carbamazepine
A
- avoid erythromycin, clarithromycin (Biaxin), and doxycycline
- monitor for dry mouth
- monitor for blood disorders: infections, spontaneous bleeding (not provoked with an instrument), and poor healing
- look for oral ulcerations, dry mouth, and glossitis
- stress good oral hygiene
11
Q
what are other hydantoins
A
- valproic Acid (Depakene)/ - valproate (Depakote)
- metabolized by CYP2C9
- many adverse side effects.
- lamotrigine (Lamictal)
- used in children
- gabapentin (Neurontin)
- also used in chronic orofacial pain management
- not metabolized in the liver, so no drug interactions
- far safer than other drugs
12
Q
what are succinmides
A
- i.e. ethosuximide
- slow the entry of Ca into the nerve cell
- increases the threshold (cannot re-fire if busy firing)
- side effects: hiccups
13
Q
what is Parkinson’s disease
A
- age-related
- chronic, progressive, degenerative disorder of the CNS
- reduction in the neurotransmitter dopamine
- need balance of ACh and dopamine for control of normal muscle movement
14
Q
what are classic symptoms of Parkinson’s disease
A
- classic symptoms of Parkinsonism
- resting tremor
- muscle rigidity
- poker face
- bradykinesia (muscular movement becomes slow and rigid)
- masked facial expression
- “short step” walk
- postural instability
15
Q
what is the objective for treating Parkinson’s with drugs
A
- increasing the activity of DA (dopaminergic drugs) or decreasing the activity of ACh (anticholinergics)
- dopamine cannot get through the blood-brain barrier and get into the brain,
- give levodopa which then converts to dopamine in the brain
- combine levodopa with carbidopa (Sinemet) to reduce dose & SE of levodopa
