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Pharmacology Final Content > Neuro Pt 1 (Epilepsy & ADHD) > Flashcards

Neuro Pt 1 (Epilepsy & ADHD) Flashcards

1
Q

What is epilepsy?

A

a chronic condition characterized by recurrent seizures

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2
Q

what are the types of epilepsy?

A

primary and secondary

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3
Q

Describe the cause of primary epilepsy

A

idiopathic (cause unknown)

>50% of all cases

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4
Q

Describe the cause of secondary epilepsy

A 
Children: 
- injury at birth
- metabolic disease
Adults:
- TBI
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5
Q

define seizure

A

a finite event resulting from excessive discharge of cerebral neurons, causing transient impairments or loss of consciousness

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6
Q

what is important to note about the symptoms of seizures?

A

they will depend on the location of injury

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7
Q

What are the types of seizures?

A

Partial

Generalized

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8
Q

define a partial seizure

A

occurs in one cerebral hemisphere with no loss of consciousness

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9
Q

define a generalized seizure

A

occurs in both hemispheres and pt will have a loss of consciousness

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10
Q

What are the types of generalized seizures?

A
  • tonic-clonic
  • tonic
  • clonic
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11
Q

what are the characteristics of a generalized tonic-clonic seizure?

A
  • rigid extensor spasm for 10-30s with LOC and stopped respiration
  • pt will poop, pee, or salivate
  • rhythmic flexor spasm for 2-4mins with continued LOC (alertness will slowly return)
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12
Q

what are the characteristics of a generalized tonic seizure?

A

rigid extensor spasm lasting a few seconds

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13
Q

what are the characteristics of a generalized clonic seizure?

A

rhythmic flexor spasm lasting a few seconds

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14
Q

Which type of seizure is most common?

A

Generalized tonic-clonic

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15
Q

describe the role of GABA in a seizure

A
  • the main CNS inhibitory transmitter
  • normally inhibits depolarization of the postsynaptic neuron
  • too little –> seizure
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16
Q

describe the role of Glutamate in a seizure

A
  • main excitatory neurotransmitter

- too much –> seizure

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17
Q

for what reason is CNS inflammation pertinent to seizures?

A

microglia may initiate a cycle of inflammation-induced seizures and seizure-induced inflammation

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18
Q

What are the steps of the excitatory pathway for seizures?

A
  1. Na+ and Ca2+ enter presynaptic neuron
  2. Ca2+ push glutamate vesicle to bind with presynaptic neural wall
  3. Glutamate opens AMPA to allow Na+, and NMDA to allow Ca2+ to enter the postsynaptic neuron
  4. T-type Calcium 2 Channels open to allow more Ca2+ into the postsynaptic neuron (making it more positive and facilitating the AP)
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19
Q

What are the steps of the inhibitory pathway for seizures?

A
  1. Na+ and Ca2+ enter presynaptic neuron
  2. Ca2+ push glutamate vesicle to bind with presynaptic neural wall
  3. GABA opens GABA-A channels to allow Cl- to enter the postsynaptic neuron making it harder for an AP to occur
  4. GAT-1 reuptakes GABA and is degraded by GABA-T
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20
Q

Where do anti-epilepsy excitatory drugs work?

A

inhibit GAT1 and GABA-T

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21
Q

Where do anti-epilepsy inhibitory drugs work?

A
  1. block Na+ and Ca2+ channels
  2. block glutamate release
  3. block glutamate binding
  4. prolong the opening of GABA-A channels
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22
Q

What are the types of treatment for Epilepsy

A

excitatory or inhibitory

  • antiepileptic drugs (AED)
  • antiseizure drugs (ASD)
  • anticonvulsants
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23
Q

What should be known about the 3 types of Epilepsy treatments?

A

They are used interchangeably

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24
Q

What does Epilepsy treatment depend on?

A
  1. Patient specific factors
  2. Type of seizure
  3. Response to previous medications
25
Q

What are the treatment goals for Epilepsy?

A
  1. eliminate seizures
  2. experience no AEs
  3. improve quality of life
26
Q

What are the AEs of antiepileptic drugs?

A
  1. neurotoxicity (SEDATION, ATAXIA, confusion, dizziness, blurred vision)
  2. weight gain/loss
  3. hypothyroidism
  4. rash - stevens-johnson syndrome
27
Q

What are the differences between acute and chronic AEs of antiepileptic drugs?

A

Acute: may be concentration dependent or idiosyncratic
Chronic: due to duration of use

28
Q

Who are the “at risk populations” for AEs related to antiepileptic drugs?

A
  • Women
  • Pregnant women
  • Children
  • Elderly
29
Q

Why are women at risk when taking AEDs?

A

changes in hormone levels during the menstrual cycle can change the efficacy of the drugs
- sometimes require supplemental meds at highest risk

30
Q

Why are pregnant women at risk when taking AEDs?

A

stress

hormones

31
Q

Why are children at risk when taking AEDs?

A

hepatic/renal activity changes

- requires increased drug monitoring and dose adjustments

32
Q

Why are the elderly at risk when taking AEDs?

A
  1. change in body mass changes volume distribution and half-life of drug
  2. hypoalbuminemia (increased free drug in plasma)
  3. greater sensitivity to neurocognitive effects
  4. hepatic/renal changes (monitor/dose changes)
  5. polypharmacy –> DDIs
33
Q

What are the therapeutic considerations of AEDs?

A
  1. some are NTI drugs
  2. Watch for sedation, dizziness, and ataxia
  3. Rashes
  4. Bone marrow depression
  5. Vitamin K deficiency
  6. MUST ask about seizure activity and know how to appropriately respond to a seizure
34
Q

What are therapeutic considerations specific to women and AEDs?

A
  1. decreased ovarian function
  2. infertility
  3. PCOD - polycystic ovarian disease
  4. weight gain
35
Q

What is ADHD?

A

a series of behavioral disorders

36
Q

What does ADHD stand for?

A

Attention-Deficit/Hyperactive Disorder

37
Q

What are the subtypes of ADHD?

A
  1. inattentive
  2. hyperactive-impulsive
  3. combined
38
Q

What are the causes of ADHD?

A
  • multifactorial: environment, genetics, biologic factors

- pre/perinatal exposure to cigarettes/alcohol increase risk 2-3x

39
Q

What are the main treatments for ADHD?

A
  1. Stimulants

2. atomoxetine

40
Q

What are the alternative medications for ADHD?

A
  1. alpha-2 adrenergic agonists
  2. Bupropion
  3. Lithium
  4. Antipsychotics
41
Q

What is the general MOA of stimulants?

A

block dopamine and norepinephrine reuptake and increase dopamine and NE release

42
Q

What are the different ways stimulants are taken?

A

IR (immediate release)

XR (extended release)

43
Q

What are the characteristics of IR stimulants?

A
  • 15-30min onset
  • 2-6hr duration
  • multiple daily doses
44
Q

What are the characteristics of XR stimulants?

A
  • 8-12hr duration
45
Q

What should be considered when taking stimulants with food?

A

there is a slower onset and decreased absorption
BUT
it may decrease some AEs

46
Q

What are common AEs of stimulants?

A
  1. decreased apetite/weight loss
  2. stomachache
  3. insomnia
  4. HA
  5. irritability/jitteriness
47
Q

What are some rare AEs of stimulants?

A
  1. dysphoria
  2. zombie-like state
  3. tics/abnormal movements
  4. HTN, HR fluctuations
  5. Hallucinations
  6. Hypopigmentation from the patch
48
Q

What are the stimulant drugs on the drug list?

A
  • Ritalin/Concerta (methylphenidate)

- Adderral (mixed amphetamine salts)

49
Q

What are the BOXED WARNINGS for stimulants?

A
  • CV risk

- abuse potential

50
Q

What class is atomoxetine (Strattera) in?

A

Selective Norepinephrine Reuptake Inhibitors (SNRI)

51
Q

What is the MOA of atomoxetine (Strattera)?

A

selectively inhibits norepinephrine reuptake

52
Q

T/F: atomoxetine (Strattera) takes effect immediately

A

False; 2-4wk onset, 6-12wk before full benefits

53
Q

What are the AEs associated with atomoxetine (Strattera)?

A
  1. more fatigue, sedation, and dizziness than stimulants

BOXED WARNINGS

54
Q

What are the BOXED WARNINGS for SNRIs (atomexatine)?

A

increased risk for suicidal ideation

- must monitor mood changes

55
Q

How are alpha-2 adrenergic agonists used to treat ADHD?

A

as an adjunct tx to decrease disruptive behaviors, control aggression, or increase sleep in youth

56
Q

When is Bupropion appropriate?

A

if a patient has concomitant depression

57
Q

When is Lithium appropriate?

A
  • if a patient has bipolar disorder

- to control aggression or explosive behavior

58
Q

When are antipsychotics used?

A

for refractory cases of severe aggression

59
Q

What are the Therapeutic Concerns regarding ADHD medications?

A
  • monitor vital signs
  • be aware of loss of appetite or insomnia
  • monitor behavior and attention span

Pharmacology Final Content (2 decks)

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