Pharm 3 Flashcards
epilepsy =
Chronic neurological disorder characterized by recurrent seizures
seizures =
Episodes of sudden, transient disturbances in cerebral excitation
neurons: epilepsy
hyperexcitable, “irritable” neurons
neurons: seizures
Neurons firing in rapidly synchronized bursts
Causes of epilepsy/seizures
VARIES WIDELY
- unknown
- congenital
- birth trauma
- anoxia
- genetic
- infection
- hypoglycemic
- injury
How much of the US population have epilepsy?
about 3%
Effectiveness of meds for seizures (%)
50% - meds effective
25% - meds have substantial control
25% - meds have inadequate control
What are the classifications of seizures?
- generalized
- partial or focal seizures
- unknown
Which seizure type was formerly called “grand mal” and “petit mal”?
generalized
What types of seizures are included in the “generalized” category?
- tonic-clonic
- absence
How much of the brain is involved with generalized seizures?
involves whole brain
Partial or focal seizures: brain involvement
- only involve a part of the brain
- can become generalized
What are unknown seizures?
Anything that doesn’t fit into the categories of generalized or focal/partial
What is status epilepticus?
Continuous seizure for 30 minutes or more
OR
successive seizures without regaining consciousness
What can status epilepticus be brought on by?
- Sudden withdrawal from anti-seizure meds
- cerebral infarct
- drug/alcohol withdrawal
- infection
What does status epilepticus require (immediate)
requires emergency tx
- maintain airway/O2
- Monitor BP/HR
- Assessing for injury, blood gases, toxicology, IV medications
What are the first drugs used for status epilepticus?
typically benzodiazepines
first drugs for status epilepticus: benzos are _____ acting
short
first drugs for status epilepticus: benzos may be used concurrently with or followed by _______ (2)
- phenytoin (Dilantin)
- fosphenytoin (Cerebyx)
If status epilepticus is not resolved after first tx method, what is the next course of action?
- phenobarbital (Solfoton)
- valproic acid (Depakene)
If status epilepticus is still not resolved after first and second tx attempt, wht must be done?
If still not resolved, general anesthetics given, then slow tapering over 12 hours
- midazolam (Versed)
- phenobarbital (Nembutal)
- propofol (Diprivan)
rationale for drug tx even though seizures are usually self-limiting
Uncontrolled recurrent seizures may cause further damage to injured neurons
How can seizures be potentially harmful to other healthy cells?
- Cascade of other harmful proteins and oxidative stress
- Structural and functional changes in neuronal pathways
- Impaired cerebral activity
- Susceptibility to other seizures
When can seizures be fatal?
if cardiac irregularities result in cardiac arrest
