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SS - Exam 2 > Seizures 2 > Flashcards

Seizures 2 Flashcards

1
Q

Epilepsy

A

Disease of brain - enduring predisposition to generate epileptic seizures. Having at least two unprovoked epileptic seizures >24 hr apart

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2
Q

Structural epilepsy vs idiopathic

A

**age of onset most reliable
Epileptic seizure type (gen or focal)
Normal inter-ictal exam
Single seizure vs cluster/status epilepticus

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3
Q

Concerns for structural epilepsy

A

Age of onset <6m or >6y
Interictal neurological abnormalities
Status
Drug resistance

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4
Q

Idiopathic epilepsy

A

Most common chronic neurological disease in dogs
GP manage approx 10 cases /year
Median age of death is 7 y
Median treatment duration is 2.3 years
Dogs w IE experience cognitive dysfunction at young age

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5
Q

Tier I confidence level IE

A

2 or more unprovoked epileptic seizures >24 apart
6m or 6y
Known breed for IE (boarder collie)
Normal CBC, Biochem, urinalysis
Normal inter-ictal exam (post ictal, anti seizure med)

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6
Q

Tier II confidence level IE

A

Meet tier I
Normal pre and post prandial bile acids
Normal MRI (post ictal changes)
Normal CSF analysis

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7
Q

Tier III confidence level IE

A

Meet tier I & II
EEG abnormalities

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8
Q

Genetics and epilepsy

A

~90% of purebred dogs
#2 concern of dog breeders (following cancer)
Prevalence in normal dog population ~0.75%
- incidence is unknown (new cases at sp time)
- prevalence in at risk breed >2% (overall cases)
Less common in cats

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9
Q

Incidence & heritability

A

Belgian tervuren - 17% prevalence, 0.77 heritability
Irish wolfhound - 18.3 prev, 0.87 heritability

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10
Q

Off spring of epileptic

A

Tervuren - 42% change offspring, 1% if normal parent
Lab retriever - 26% change of offspring
Bernese - 33% change of offspring

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11
Q

Choice of anti seizure drug therapy

A

No evidence based guidelines regarding choice of Anti seizure drugs in dogs

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12
Q

Long acting anti seizure drugs - first line

A

Phenobarbital
KBr
Imepitoin

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13
Q

Long acting anti seizure drug - cluster seizures

A

Levetiracetam

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14
Q

Long acting anti seizure drugs - adjunctive

A

Levetiracetam
Zonisamide
Gabepentin
Felbamate
Topiramate
Pregabalin

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15
Q

Fast acting ASD

A

Diazepam
Midazolam
Propofol

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16
Q

Phenobarbital
- is what type of drug
- mechanism

A

Barbiturate

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17
Q

Benzodiazepines

A

Mechanism of action is through GABAa channels
Bind to benzodiazepines receptors NOT barbiturate
^^ affinity for GABA to GABAa
High blood flow, low volume - lipophilic

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18
Q

Phenobarbital efficacy

A

Effictive in decreasing seizure frequency in approx 60-93% of dogs with IE when plasma concentrations are maintained in therapeutic range (25-35mcg.ml)

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19
Q

Therapeutic range for ASD

A

Min Effective dose - 15mcg/ml
Max tolerated dose = 40mcg/ml
LD - 150mg/kg
Loading dose - 15mg/kg iv
Oral dose - 2.5-3mg/kg

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20
Q

Pharmacokinetics

A

Oral bioavailability - 90%
Peak concentration- 4-8 hrs after admin
T1/2 avg 48 hr - takes 10 days to reach steady state
45% protein bound
75% met by liver
PB and metabolites are mainly renally excreted
CYP450 induction in 30-90 days

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21
Q

Pharmacokinetic drug interactions
Also metabolized by CYP450

A

Corticosteroids
Cyclosporine
Digoxin
Phenylbutazone
Levothyroxine
Zonisamide
Levetiracetam
Benzodiazepines

22
Q

Side effects of ASDs

A

Sedation
Ataxia
Polyphagia
PU/PD
Symptoms are transient and can go away w time
Hepatotoxicity** - liver failure is possible

23
Q

Idiosyncratic reactions

A

Hepatic failure
Hematologic abnormalities
Superficial necrolytic dermatitis
Hypoalubinemia

24
Q

Superficial necrolytic dermatitis

A

Erosive dermatopathy w multifocal distribution
Footpads are effects w crusty hyperkeratosis
Mucocutanous junctions of mouth, eyes, genitalia, hocks, elbows, pinnae, interdigital areas

25
Q

SND cause and prognsosi

A

Concurrent hepatic abnormalities and low plasma amino acid concentrations is linked to SND
Mean survival time is 12 weeks
Common w chronic use to PB

26
Q

SND findings

A

Ultrasound findings: hypoechoic nodules w trabecular network surrounding nodules
Mild/moderate disorganization of lobular architecture from multifocal areas of neutrophilic inflammation & fibrosis

27
Q

Monitoring

A

2 weeks
Check PB steady state, CBC, Biochem
3 months
PB levels (enzyme induction), CBC, Biochem
6 months
PB levels - monitoring, CBC, Biochem
12 months
PB levels - monitoring, CBC, Biochem

28
Q

Monitoring math

A

Current drug dose/current drug level =
New drug dose/desired drug level

29
Q

Monitoring math cross multiply

A

(current drug dose X desired level) / current drug level = new drug dose

30
Q

primidone

A

Only FDA approved drug for ASD
Much more adverse effects than PB

31
Q

KBr - potassium bromide

A

Acts on GABA receptors, keeping them open longer to allow more Cl- inside the cell
Acts similar to PB

32
Q

Efficacy of KBr

A

65% of dogs respond well
PU/PD is less common but vomiting is much more common than PB
Idiosyncratic reactions
- personality changes, cough, ^ risk of pancreatitis & megaesophagus, skin problems

33
Q

Pharmacokinetics of KBr

A

Oral bioavailability is 46%
T1/2 is 24-46 days - steady state 5 months
Not protein bound
KBr is excreted unchanged in urine
Undergoes tubular reabsorption in competition w chloride - high dietary chloride con increase the excretion of KBr & shortens half life

34
Q

Pharmacokinetic interactions of KBr

A

Loop diuretics (furosemide) may enhance KBr elimination by blocking KBr reabsorption through renal tubular chloride channels
KBr should be avoided in dogs w renal dysfunction to prevent toxicity secondary to reduced renal elimination
Synergistic side effects possible w PB

35
Q

Dosing and monitoring KBr

A

20-40mg/kg
20 if on PB, 40 if not on PB
625mg/kg loading dose given over 2-5 days
Check Br levels in 1m (w loading) or 3-5m (w/out loading)
Drug level = 1-3 mg/mL

36
Q

ASD for IE

A

Start w PB or KBr

37
Q

Use of Imepitoin

A

FDA approved for anxiety
Most used for IE
Improvements seen after 11w
76.5% of owners opted to continue Imepitoin

38
Q

Pharmacokinetics of Imepitoin

A

T1/2 2-6 hours
Extensive liver metabolism
Excreted mainly via feces
Neither reduced kidney function or impaired liver function

39
Q

Interactions at AE of Imepitoin

A

Benzodiazepines have 200x affinity for binding site

40
Q

Levetiracetam

A

Binds to SV2A similarly to Keppra

41
Q

Efficacy of Levetiracetam

A

Depends on cause of seizures
50-60% of patients w refractory epilepsy in reducing seizures
For structural epilepsy 52% have >50% reduction
64.8% reduction in cluster seizures

42
Q

Pharmacokinetics of Levetiracetam

A

100% oral bioavalibity

43
Q

Dosing Levetiracetam

A

Requires a loading dose of 60mg/kg
Maintenance dose = 20-30 mg/kg, extended release 30-40 mg/kg
Drug levels = 12-46 mcg/L
*good for patients w renal failure

44
Q

Zonisamide

A

Binds to loading gate - making development of action potential harder

45
Q

Pharmacokinetics of Zonisamide

A

T1/2 of 15 hrs
Almost complete oral absorption
Mainly undergoes hepatic metabolism via the CYP450 before being excreted by kidneys

46
Q

Efficacy of Zonisamide

A

60% have >50% reduction in seizures as mono therapy or adjunctive therapy
Insufficient evidence for use in dogs

47
Q

Side effects of Zonisamide

A

Ataxia, vomiting, sedation
Renal tubular acidosis - inhibition of carbonic anhydrase
Sulphonamide based anticonvulsant

48
Q

Idiosyncratic reactions

A

Acute hepatic toxicity
Renal failure (in people)

49
Q

Gabapentin

A

Alpha2 gamma 1 subunit
Calcium channel blocker

50
Q

Pharmacokinetics

A
51
Q

Dosing, safety, efficacy of gabapentin

A
52
Q

Cat and anti seizure drugs

A

SS - Exam 2 (18 decks)

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