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662 > Seizures > Flashcards

Seizures Flashcards

1
Q

Principles of therapy for seizures

A
  • Select the most appropriate drug from seizure pattern from EEG
    • Absence can be increased by CBZ, Oxcarb, PB, PRimidone, PHT, gabapentin, pregablin
    • Optimize first drug then add second drug if control is unsatisfactory
    • Awareness of comorbidities
    • reinforce compliance
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2
Q

Tonic-clonic (Grand-mal)

A
  • Unresponsive and falls at onset
  • Tonic phase- muscle spasms/shrill cry
  • Clonic - Bilateral jerking movements
  • Postical
    • Muscle flaccidity, responsiveness gradually returns, amnesia of seizures, incontinence
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3
Q

Warnings for seizure meds

A

-suicidal behavior and ideation Antiepileptic drugs

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4
Q

Who is effected by seizures?

A

Minority higher

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5
Q

What is the most common seizure type?

A

CPS

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6
Q

Complex Partial Seizures

A
  • Responsiveness is impaired
  • Focal discharge
  • May present:
    • No other features
    • Similar to simple partial
    • Automatisms
  • Briefly postical
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7
Q

Subtypes of partial or focal seizures

A
  • -Secondary generalized
    • Start out as simple or complex but moves on to generalized.
    • Simple
    • Complex
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8
Q

Atonic (Drop attacks)

A
  • Sudden loss of muscle tone - Head - Limb
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9
Q

Active metabolite of carbamazepine?

A

10,11 epoxide

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10
Q

Goal of treatment for seizures

A
  • Control or reduce frequency (many pts can be controlled) - Manage meds SEs and d-d interactions - Provide best QOL for pts.
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11
Q

Simple Partial Seizures

A
  • No impaired responsiveness
  • Focal discharges
  • Motor, sensory or psychic manifestation
    • Motor
    • Sensory symptoms
  • Aura
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12
Q

Autoinduction resolves _____ but?

A

3-4 wks, But if you titrate you avoid it.

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13
Q

Epilepsy is classifies if someone has ___ or more epileptic seizures

A

>=2 unprovoked

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14
Q

Valproic Acid/ Divalproex NA

Indications

Half life

Formulations

A
  • Broad: Absence, SPS, CPS, CTCS, Myoclonic and atonic seizures
  • Depakene: VPA:TID
  • Depakote BID
  • SEs: N/V, weight gain, tremor, hematologic (dose dependent)
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15
Q

SEs of phenytoin

A

Dose related: Nystagmus, ataxia, cognitice impairment, lethargy - Nondose: Gingival hyperplasia, coarse face, osteoporosis, acne, hirsutism, deficiency in folate, rash

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16
Q

Alternate agents for Partial seizures?

Today Gabe Picked up a Zibra Phinally

A
  • Topiramate, Zonisamide, Gabapentin, pregabalin, phenobarb
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17
Q

Ethosuximide Indications

SEs

A
  • Absence seizures, not first line, sometimes may be added
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18
Q

What are the indications for Carbamazepine?

A

SPS, CPS, GTCS

19
Q

Myoclonic

A

Muscular contraction of the face, trunk or extremities

20
Q

Lamotrigine

Indications

Metabolism

SEs

A
  • SPS, CPS, absence, myoclonic, GTCS
  • Primarily hepatic
  • Possibly life threatening rashes (steven-johns), ataxia, sedation, dizziness
  • Broad spectrum
  • Start low go slow
  • Mood stabalizing
21
Q

Phenytoin indication can loading dose

A

SPS, CPS, GTCS

22
Q

Alternative for myoclonic?

A
  • Levetiracetam, topirimate, clonazepam
23
Q

First line for myoclonic

A
  • valproic acid, lamotrigine
24
Q

General dosing guidelines for phenytoin?

A
  • If ss= <7 mcg/mL increase by 100mg/day
  • ss- 7-12 mcg/mL increase 50-60 mg/day
  • SS > 12 mcg/mL increase by 30 mcg/day
25
Q

Alternatives for Tonic Clonic

A

Levetiracetam, Topiramate, Phenobarb

26
Q

Phenobarbital indications?

SEs

Long half life

A
  • SPS, CPS, GTCS
  • Sedation, possible learning impairment, hyperactivity, osteoporosis
  • Withdrawal associated

NOT WELL TOLERATED

27
Q

Diagnosis of seizures?

A

Patient history: Frequency/duration of episodes, time of day, precipitating factors, Aura present?, Ictal activity, Postictal Evaluations: Physical, neurological, lab - EEG - Diagnostic imaging

28
Q

First line agents for partial seizures?

Cats Pee for a Very Long time when Lunging at Orcids

A
  • Carbamazepine, Phenytoin, Lamotrigine, Valproic acid, Levetiracetam, Oxcarb
29
Q

Classification of Seizures 2 subtypes?

A

Partial or Focal Generalized

30
Q

Once someone has a seizure they are?

A

More likely to have another

31
Q

Topiramate

A

Adjunctive for partial seizures

Dose dependent CNS effects, sedation, ataxia, cognition

32
Q

First line for tonic clonic

Phen finds Carbs VERY Offputting Lately

A

Phenytoin, carbamazepine, valpro, lamotrigine, Ox carb.

33
Q

Phenytoin metabolism Range?

A

Michaelis menten elimination 10-20 mcg/ml

34
Q

Precipitation of Seizures

A
  • Sleep deprivation - Sensory stimuli - Emotional stress - Hormonal changes - Fever - Lack of food - Trauma - Drugs
35
Q

Sub-types of generalized seizures

A
  • Absence - Myclonic - Tonic-clonic- major seizure type - Tonic - Atonic
36
Q

Underlying etiology with seizures?

A
  • CNS disorder - Cerebral palsy - Mental retardation
37
Q

Gabapentin Indications

A

Questionable efficacy mostly used for neuropathy rather than seizures

But for CPS and SPS

38
Q

What are the major causes of seizures?

A
  • Trauma-MVA, birth injury - Drug withdrawal, alcohol, barbs, BZDs, anticonvulsants, antidepressants (older) - Toxins- lead poisoning, arsenic, insecticides - Cerebrovascular: Stroke, Tumors - Infection- fever, AIDS, meningitis, encephalitis - Metabolic disturbances-hypoglycemia, electrolytes - Hereditary - Drugs- Antihistamines, antidepressants (TCAs), amphetamines, theophylline, tramadol, illicit drugs, imipenime
39
Q

SEs of carbamazepine? Indicated for mood disorders, trigeminalmyalgia

A

Ataxia, blurred vision, lethargy, nausea - Leukopenia, thrombocytopenia, rash, fluid retention, osteoporosis - Aplastic anemia:monitor CBC can cause death.

40
Q

Felbamate

A

restricted use because there were 16 deaths when first used

causes insomnia

Monitor for liver enzymes in the first year

41
Q

General absence seizures first line and alternative

A
  • Lamotrigine, Valproic acid - Ethosuximide
42
Q

Titrate dose to achieve adequate response

A
  • Start low and go slow - Assess patient according to seizure control and SEs - Use total and free blood concentrations as a guideline
43
Q

Primidone Indications

Metabolism

A
  • SPS, CPS, GTCS
  • Hepatic conversion to phenobarbital
44
Q

Tiagabine

A

Some pts it was increasing seizures

cognition

Shitty drug

662 (24 decks)

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