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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
Alternatives for Tonic Clonic
Levetiracetam, Topiramate, Phenobarb
26
Phenobarbital indications? SEs Long half life
* SPS, CPS, GTCS * Sedation, possible learning impairment, hyperactivity, osteoporosis * Withdrawal associated NOT WELL TOLERATED
27
Diagnosis of seizures?
Patient history: Frequency/duration of episodes, time of day, precipitating factors, Aura present?, Ictal activity, Postictal Evaluations: Physical, neurological, lab - EEG - Diagnostic imaging
28
First line agents for partial seizures? Cats Pee for a Very Long time when Lunging at Orcids
- Carbamazepine, Phenytoin, Lamotrigine, Valproic acid, Levetiracetam, Oxcarb
29
Classification of Seizures 2 subtypes?
Partial or Focal Generalized
30
Once someone has a seizure they are?
More likely to have another
31
Topiramate
Adjunctive for partial seizures Dose dependent CNS effects, sedation, ataxia, cognition
32
First line for tonic clonic Phen finds Carbs VERY Offputting Lately
Phenytoin, carbamazepine, valpro, lamotrigine, Ox carb.
33
Phenytoin metabolism Range?
Michaelis menten elimination 10-20 mcg/ml
34
Precipitation of Seizures
- Sleep deprivation - Sensory stimuli - Emotional stress - Hormonal changes - Fever - Lack of food - Trauma - Drugs
35
Sub-types of generalized seizures
- Absence - Myclonic - Tonic-clonic- major seizure type - Tonic - Atonic
36
Underlying etiology with seizures?
- CNS disorder - Cerebral palsy - Mental retardation
37
Gabapentin Indications
Questionable efficacy mostly used for neuropathy rather than seizures But for CPS and SPS
38
What are the major causes of seizures?
- 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
SEs of carbamazepine? Indicated for mood disorders, trigeminalmyalgia
Ataxia, blurred vision, lethargy, nausea - Leukopenia, thrombocytopenia, rash, fluid retention, osteoporosis - Aplastic anemia:monitor CBC can cause death.
40
Felbamate
restricted use because there were 16 deaths when first used causes insomnia Monitor for liver enzymes in the first year
41
General absence seizures first line and alternative
- Lamotrigine, Valproic acid - Ethosuximide
42
Titrate dose to achieve adequate response
- Start low and go slow - Assess patient according to seizure control and SEs - Use total and free blood concentrations as a guideline
43
Primidone Indications Metabolism
* SPS, CPS, GTCS * Hepatic conversion to phenobarbital
44
Tiagabine
Some pts it was increasing seizures cognition Shitty drug

662 (24 decks)

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