Neuro part 2 Flashcards
what is the patho of bacterial meningitis
infection of the pia matter and arachnoid villi, the subarachnoid space (space between the two), the ventricular system, and the CSF
what would a lumbar puncture show for bacterial meningitis
increased neutrophils, decreased glucose, increased protein
what would a lumbar puncture show for viral meningitis
increased lymphocytes (t), normal glucose, slightly increased protein
what is aseptic meningitis
usually viral encephalitis; generally limited to meninges (not found in CSF), no pus or exudate
are symptoms more severe in bacterial or viral meningitis
bacterial
what is the patho for fungal meningitis
fungi enter nervous sytem and produce granuloma/gelantinous masses in the meninges at the base of the brain –> thrombosis, infarction, hydrocephalus, cranial nerve dysfunction (compression)
who is qualified to get meningitis vaccine
all children at 1 year & in grade 7
high risk children should also get 2 doses of 4cMenB and quadrivalent Men-C-ACYW q3-5years
adults just get quad
what is the criteria for epilepsy
- 2 unprovoked seizures occurring >24h apart
- 1 unprovoked seizures and a probability of further seizures
- a diagnosis of an epilepsy syndrome
how are seizure classified (3 things)
- onset - focal, generalized, or unknown
- aware/unaware
- motor/non-motor
what is epilepsy syndrome
a complex of clinical features, S&S that together define a distinctive recognizable clinical seizure disorder
what is focal onset
starts in cluster of neurons in one hemisphere - manifests as unilateral symptoms, can be aware or non aware
define the following motor manifestations: automatisms, atonic, clonic
Automatisms (more or less coordinated, purposeless, repetitive motor activity)
Atonic (sudden loss of muscle tone; can see someone fall; mainly children)
Clonic (focal rhythmic jerking)
define the following motor manifestations: epileptic spasms, hyperkinetic, myoclonic, tonic
Epileptic spasms (focal flexions or extensions of arms; flexion of trunk)
Hyperkinetic (pedaling, thrashing activity)
Myclonic (irregular, brief, jerking movements, lasts sec-min, person can be aware or momentary loss of consciousness)
Tonic (sustained focal stiffening)
define the following non motor terms: autonomic, behaviour arrest, cognitive
Autonomic (focal autonomic sensations like GI sensations, sense of heat or cold, flushing, pyloerection, palpitations, etc)
Behaviour arrest (cessation of movement & unresponsiveness)
Cognitive (pt reports deficits in language, thinking or assoc higher cortical functions)
define the following non motor terms: emotional, sensory
Emotional (emotional changes incl fear, anxiety, anger, laughing, etc)
Sensory (somatosensory, olfactory, visual, auditory, taste, temp, position sensations)
what is generalized onset
onset involved both hemispheres (focal can become generalized)
do you use awareness to classify generalized seizures?
no - most are unaware, only use motor/non-motor
what do the terms tonic & clonic refer to
tonic = limb/neck stiffening, elevation
clonic = sustained rhythmic jerking of limbs on both sies
what is myoclonic
in isolation or conjunction with tonic or atonic activity, differs from clonus by being briefer and not regularly repetitive
what is myoclonic-tonic-clonic
begin with a few myoclonic jerks followed by tonic-clonic activity
what is tonic-clonic
clonic phase –> regularly decreasing frequency of jerks over course, awareness is lost with stiffening & jerking (tonic), may invoke nonspecific feeling of impending seizure
what is myoclonic-atonic
brief jerking followed by limp drop
what is an epileptic spasm
sudden flexion, extension or mixed of predominantly proximal and truncal muscles (infantile spasms)
what is myoclonic absence
rhythmic 3 second myoclonic movements
how are unknown onset seizures classified
motor or unclassified
what test would you order to evaluate a seizure
health hx,
blood & urine tests (glucose, serum Ca, BUN, urine Na, CrCl)
brain imaging (CT, MRI)
CSF exam
EEG
what is the most common cause of fever in peds
fever (it is benign)
what are 2 important considerations with treatment of epilepsy with AEDs
do not stop abruptly, monitor plasma levels to monitor for toxicity
what is the MOA for phenytoin (dilantin)
selective inhibition of Na channels; suppress action potential to suppress hyperactivity
what is phenytoin used for
all types of seizures except absence seizures (especially effective against clonic tonic)
what are AEs for phenytoin
nystagmus, ataxia, bone marrow suppression, gingival hyperplasia
what are CIs for phenytoin
pregnancy, bradycardia, atrioventricular block
what is the MOA for fosphenytoin
prodrug - converted to phenytoin when metabolized (same MOA)
what is fosphenytoin used for
all seizures except absence, esp effective in tonic-clonic (same of phenytoin)
what is the MOA for carbamazepine (tegretol)
similar to phenytoin, reduces Na currents
what is carbamazepine used for
all seizures except absence
what are AEs of carbamazepine
vertigo, NV, leukopenia, anemia, thrombocytopenia
SEVERE include SJS, toxic epidermal necrolysis, DRESS
what is a CI for carbamazepine
pregnancy (increase risk of spina bifida)
what is MOA for ethosuximide (zarontin)
suppressing Ca influx & suppresses neurons in thalamus
what is ethosuximide used for
absence seizures
what are AEs of ethosuximide
NV, decreased appetite/weight loss, drowsiness, dizziness, lethargy (diminish with continued use)
what is the preferred method for determining dose of ethosuximide
monitor clinical response (NOT plasma drug levels)
what is the MOA of phenobarbital
long-acting barbiturate (scheduel 4 controlled substance), enhances the effect of GABA (an inhibitory neurotransmitter)
what are AEs of phenobarbital
drug interactions, sedation, lethargy, depression (widely replaced by newer drugs)
what is the MOA of primidone (mysoline)
identical to phenobarbital (enhance GABA)
what is the MOA of primidone (mysoline)
structure identical to phenobarbital, MOA similar to phenytoin –> selective Na channel suppression
what is primidisone used for
effective against tonic-clonic, simple particle, and complex partial seizures; NOT effective against absence or active seizures
what are AEs of primidone
sedation, ataxia, dizziness
what is the MOA of valproic acid (depakote)
mostly unknown, thought to enhance GABA
what is valproic acid used for
all seizure types
what are the AEs of valproic acid
can be SEVERE: pancreatitis, severe hepatotoxicity, liver failure, thrombocytopenia, high ammonia levels, teratogenic
what is an important consideration for valproic acid related to children?
should not be used in combo with any other drugs
what is the MOA for levetiracetam (keppra)
unkown :)
what is keppra used for
focal and generalized seizures
what are commons AEs of levetiracetam (keppra)
drowsiness & asthenia
less side effects & drug interactions
what AED should you absolutely never use in pregnancy, even at small doses
valproic acid
what AEDs are dangerous in pregnancy but can be used if benefits outweigh the risks
carbamazepine, phenytoin, phenobarbital
what second prescription should pregnant people have if on an AED
folic acid
how does the ketogenic diet help prevent seizures
MOA not understood, ketones and polyunsaturated fats may play role in anti-seizure effect
what AEDs are good for absence seizures
valproic acid (good for everything); ethosuximide (only good for absence)
