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Module 4 > Seizures > Flashcards

Seizures Flashcards

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1
Q

chronic neuro disorders

A
  1. seizures/ epilepsy
  2. MS
  3. parkinsons
  4. amyotrophic lateral sclerosis
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2
Q

what is happening to the brain during a seizure

A

multiple neurons firing at a faster rate

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3
Q

metabolic disturbances associated w seizures

A

-acidosis
-electrolyte imbalance
-hypoglycemia
-hypoxia
-alcohol withdrawal
-dehydration, water intoxication

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4
Q

extracranial disorders associated w seizures

A

-HTN
-heart, lung, liver, kidney dz
-systemic lupus
-DM
-septicemia (sepsis)

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5
Q

T or F : seizures resulting from systemic or metabolic disturbances (underlying causes that can be treated) are not considered epilepsy

A

True

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6
Q

T or F : cause of most seizures are unknown

A

true

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7
Q

known causes of seizures

A

-stroke, brain tumor, cerebral infection, TBI
-hypoxic birth injury, neurodevelopment disorders, neurodegenerative dz

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8
Q

other causes of seizures

A

-low or high glucose levels
-abnormal electrolytes
-lack of sleep
-alcohol withdrawal

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9
Q

epilepsy

A

dz with continuing predisposition to seizures w consequences

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10
Q

what detects epilepsy?

A

EEG - electroencephalography

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11
Q

what is critical for successful surgical intervention for epilepsy?

A

locating seizure focus

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12
Q

classes of seizures

A

generalized
focal

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13
Q

where is a focal seizure

A

one area of brain - focused (every time)

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14
Q

Where is a generalized seizure?

A

any part of brain, different every time

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15
Q

two types of focal seizures

A

-simple
-complex

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16
Q

generalized seizures

A

-tonic-clonic
-absence
-myoclonic
-atonic
-tonic
-clonic

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17
Q

phases of seizures

A

-prodromal
-aural
-ictal
-postictal phase

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18
Q

prodromal phase

A

sensations/behavioral changes the pt will experience

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19
Q

aural phase

A

sensory warning - similar each time / hear, see, taste something

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20
Q

ictal phase

A

first symptoms of seizure - firing of neurons

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21
Q

post ictal phase

A

recovery after seizure

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22
Q

triggers for seizure

A

EXTREME things
-lights
-stress
-sleep
-sounds
-stopping anti seizure meds
-exercise

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23
Q

tonic clonic seizure is characterized by

A

loss of consciousness and falling

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24
Q

what happens to body in tonic clonic seizure

A

body stiffens (tonic - 10-20 sec) with subsequent jerking of extremities (clonic - 30-40 sec)

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25
Q

symptoms that may occur during tonic clonic seizure

A

cyanosis , salivation, tongue / cheek biting , incontinence

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26
Q

does a pt with a tonic clonic seizure remember ?

A

NO - no memory of seizure

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27
Q

postictal phase of tonic clonic seizure

A

-muscle soreness
-fatigue
-pt may sleep for hours
-may not feel normal for hours-days
-no memory

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28
Q

T or F ; every time pt has a seizure can lead to tissue brain death

A

TRUE

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29
Q

typical absence seizures symptoms

A

no symptoms in BODY

-‘daydreaming’
-unresponsive

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30
Q

how long do absence seizures last

A

abt 10 seconds

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31
Q

atypical absence seizures symptoms

A

‘daydreaming’ with :
-eye blinking
-jerking movements of lips
-repetitive finger movements

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32
Q

how long do atypical absence seizures last

A

abt 30 seconds

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33
Q

atonic seizure involves

A

tonic episode or paroxysmal muscle loss of muscle tone - sudden fall

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34
Q

how long do atonic seizures last

A

15 seconds

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35
Q

what are pts with atonic seizures at risk for?

A

fall risk - head injury

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36
Q

myoclonic seizure symptoms

A

-sudden excessive jerking
-pt can fall
-twitching of extremities
-loss of consciousness,
-multiple times a day , multiple clusters

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37
Q

tonic seizures involves

A

sudden onset of maintained increased muscle tone in extensor muscles

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38
Q

when do tonic seizures often occur

A

sleep

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39
Q

what side(s) of body do tonic seizures affect

A

both

40
Q

how long do tonic seizures last

A

about 20 seconds

41
Q

is consciousness preserved in a tonic seizure

A

usually

42
Q

clonic seizure begins with

A

loss of consciousness and sudden loss of muscle tone

43
Q

what happens after loss of consciousness and loss of muscle tone in a clonic seizure

A

rhythmic limb jerking , may/may not be symmetric

44
Q

are clonic seizures rare

A

yes

45
Q

simple focal seizures - pt remains

A

conscious and alert

46
Q

what does the pt experience during a simple focal seizure

A

unusual feelings or sensations
-sudden unexplainable feelings of joy, anger, sadness, nausea (aural phase)
-may hear, smell, taste, see or feel things that are not real

47
Q

complex focal pts have a

A

loss of consciousness or alteration in awareness

48
Q

what do the eyes do in complex focal seizures

A

may remain open, cannot interact
-may display strange behaviors
-automatisms
-don’t remember activity started before / during seizure

49
Q

psychogenic nonepileptic seizure

A

-imitate seizures but triggered by emotional events - experience same symptoms
-diagnosed by EEG
-hx of emotional, physical abuse or traumatic event

50
Q

status epilepticus is what ?

A

continuous seizure activity when seizures recur in rapid succession without return to consciousness between seizures

51
Q

status epilepticus is a seizure lasting longer than

A

5 min
2 + seizure in close succession without return to consciousness (no postictal phase)

52
Q

is status epilepticus an emergency?

A

yes

53
Q

what can status epilepticus result in?

A

brain damage, death

54
Q

complications of seizures

A

-depression
-social
-discrimination
-driving

55
Q

primary drugs for treatment of tonic-clonic and focal onset seizures

A

-phenytoin
-carbamazepine
-valproic acid

56
Q

who is more at risk for SE?

A

comorbidities

57
Q

how to AED work?

A

-supress Na, Ca influx
-promote K efflux
-block receptors for glutamate
-potentiation of GABA

58
Q

what do plasma drug levels help us do?

A

-determine dosage
-pt adherence
-determine cause of lost seizure control
-identify cause of toxicity

59
Q

what is seizure disorder mainly treated with ?

A

anti epileptic drugs (AED)

60
Q

is a cure possible for seizures?

A

no - just reduce seizures and symptoms

61
Q

what can happen if you abruptly stop AED?

A

status epilepticus

62
Q

most widely / first used AED is what?

A

phenytoin

63
Q

MOA of phenytoin

A

causes selective inhibition of Na channels (slows recovery from inactive to active state)

64
Q

adverse effects of phenytoin

A

-CNS: nystagmus, sedation, ataxia, diplopia, cognitive impairment
-gingival hyperplasia (oral care!!) !!!!!!!!!!!
-morbilliform (measles like) rash
-teratogen
-cardiac dysthymias and hypotension

65
Q

phenytoin decreases the effects of

A

oral contraceptives, warfarin, glucocorticoids

66
Q

what does pt need to take if taking phenytoin levels

A

2+ forms of BC

67
Q

phenytoin increases dilantin levels

A

diazepam, isoniazid, cimetidine, alcohol, valproic acid

68
Q

how do we administer phenytoin

A

with food

69
Q

old AED - carbamazepine
MOA

A

same as phenytoin but minimal effects on cognitive function

70
Q

old AED - carbamazepine
adverse effects

A

bone marrow suppression - anemia, leukopenia, leukcytopenia

71
Q

old AED - valproic acid is the 1st line for

A

all partial and generalized seizures

72
Q

old AED - valproic acid MOA

A

same as phenytoin and carbamazepine - suppress Na influx

73
Q

old AED - valproic acid adverse effects

A

hepatotoxicity, pancreatitis

74
Q

old AED - phenobarbital can cause

A

physical dependence

75
Q

old AED - phenobarbital decreases the effects of

A

warfarin and BC

76
Q

old AED - phenobarbital adverse effects

A

drowsiness, interferes with metabolism of Vit D and K

77
Q

old AED - phenobarbital toxicity

A

nystagmus and ataxia

78
Q

newer AED - oxcarbazepine MOA

A

block voltage sensitive Na channels

79
Q

newer AED - oxcarbazepine management of what seizures?

A

partial

80
Q

newer AED - oxcarbazepine can be given with

A

other meds

81
Q

newer AED - lamotrigine MOA

A

blocks Na and Ca channels

82
Q

newer AED - lamotrigine can cause

A

-life-threatening rash
-risk for suicide

83
Q

newer AED - gabapentin adjunct therapy for

A

partial seizures

84
Q

newer AED - gabapentin can also be given for

A

neuropathic pain

85
Q

newer AED - pregabalin useful for

A

neuropathic pain , neuralgia

86
Q

newer AED - pregabalin adjunct therapy for

A

partial seizures

87
Q

newer AED - pregabalin can cause

A

life threatening angioedema

88
Q

newer AED levetiracetam does not interact with

A

other AEDs

89
Q

newer AED - topiramate broad spectrum

A

antiseizure agent

90
Q

management of status epilepticus 1st line

A

lorazepam , effect lasts up to 72 hrs , NEED IV SITE - check every shift

90
Q

management of status epilepticus 2nd line

A

diazepam - short duration, 5-10mg IV every 5-10 min (not exceed 30mg)

91
Q

management of status epilepticus 3rd

A

phenytoin

92
Q

management of status epilepticus 4th

A

fosphenytoin - less irritating

93
Q

pts with what types of seizures are candidates for surgery?

A

focal / defined site

94
Q

how long should pt stay on AED after surgery?

A

2+ years

95
Q

SEIZURE acronym

A

S- suction or turn pt to side
E- ensure safety
I- initiate O2 therapy
Z- zero restraints
U- undo tight clothing
R- record sezire or look at what is happening to pt
E- evaluate seizure

96
Q
A

Module 4 (23 decks)

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