Seizures Flashcards

1
Q

Define seizure

A

Paroxysmal event characterized by a sudden, transient alteration in brain function. Due to an abnormal, excessive hypersynchronious discharge of CNS neurons

They can have various forms of activity

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2
Q

Define epilepsy

A

2 unprovoked seizures w/ or w/o convulsions separated by at least 24 hours

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3
Q

Epidemiology of Seizures

A

New onset occurs in <1yo and >55yo

largest population is ages 15-64

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4
Q

Etiology of Seizures

A

most are idiopathic
causes can include vascular abnormalities, malformations, trauma, stroke
Tumors, infections, neurodeg diseases are rare causes

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5
Q

The two major groups of seizures are…

A

partial

generalized

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6
Q

Define Partial Seizure

A

partial originates in a local area of the brain

unilateral

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7
Q

Define Generalized seizure

A

involve both hemispheres of the brain

may be primary or secondary generalization of a partial seizure

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8
Q

The two types of partial seizures are…

A

Simple partial

complex partial

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9
Q

Define simple partial seizure

A

no impairment of consciousness

May have motor, sensory, autonomic, or psych symptoms

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10
Q

Define complex partial seizure

A

impairment of consciousness, involves some form of autonomic behavior

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11
Q

Absense Seizures

A
Also known as petite Mal- 
sudden, brief impairment of consciousness without loss of postural control.
blank stare
abrupt, quick
seen primarily in childhood
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12
Q

Tonic Clonic seizures

A
Also known as grand Mal-
sudden loss of consciousness
loss of postural control
tonic clonic phase
postical state can last several hours
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13
Q

Status Epilepticus

A

Life threatening
Any seizure lasting longer than 5 minutes
Can be one long seizure or two consecutive with no pause in between
Most common cause is abrupt cessation of AED

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14
Q

Diagnostics of seizures

A

Neuro exam is usually normal
neuroimaging as part of initial dx should be done

EEG- may be normal between seizures-may use sleep deprivation, photic stimulation, hyperventilation, or prolonged monitoring to instigate a seizure

MRI is preferred, is more sensitive than CT

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15
Q

Criteria of Surgical intervention in seizure management:

A
Most common is temporal lobectomy
Done when seizure focus is localized and is not near a critical part of the brain
# criteria must be met:
Definite dx of epilepsy 
failure of drug therapy
localization of seizure focus
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16
Q

Vagal Nerve Stimulator

A

can be used in all types of seizures
placed in chest, tunneled to vagus nerve in the left neck
current stimulates every 5 minutes
usually used in pt that don’t respond to drug therapy and are not surgical candidates

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17
Q

Risk Factors for repeated seizures:

A

Abnormal EEg
CNS lesion
PArtial seizures
Positive FH

If no RF are present, there is a 101-5 percent risk of a repeated seizure
If one or more RF are present the risk is 100 percent

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18
Q

Michaelis-Menten Metabolism

A

-When the maximum capacity of hepatic enzymes to metabolize the drug is reached within normal dose range
non-linear behavior
-Small changes in doses can result in disproportionately large changes in serum concentration >toxicity
-if too large a dose increase is made, or a breakthrough seizure activity if too large a reduction in dose is made.

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19
Q

Clinical significance of MM metabolism and serum levels:

A

non-linear behavior- too large of a dose > serum toxicity

seum concentration <7mcg- increase 100mg/day
seum concentration 7-12mcg- increase 50mg/day
seum concentration >12mcg increase no more than 30mg

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20
Q

Protein Binding

A

phenytoin and valproate are highly protein bound
normal phenytoin is 88-92% bound, 8-12% unbound
the unbound oration is able to leave the blood and produce :
clinical effect on the CNS
dose related SE in the CNS
distribute to other peripheral sites and be metabolized

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21
Q

Pearls of Protein Binding

A
High risks for decreased protein binding and an increased unbound drug:
kidney failure
hypoalbuminemia
pregnancy
neonates
other meds that are highly protein bound
critical care patients
22
Q

Dilantin/Phenytoin pearls

A

First line for mono therapy for both simple and complex partial and also generalized tonic-clonic
MOA: Na channel inactivation
Follows mm metabolism enzyme kinetics
Hold continuous feeds 1-2 hr before and after admin

23
Q

Dilantin/Phenytoin treatment and serum levels

A

Starting dose is 5mg/kg/d

Normal serum levels 10-20mcg/ml, 1-2.5mcg.ml unbound

24
Q

Cerebyx/Fosphenytoin- pearls

A

Prescribed the same as phenytoin, advantage is the IM administration
75mg of fosphenytoin = 50mg phenytoin

25
Q

Cerebyx/Fosphenytoin- treatment and serum levels

A

same as phenytoin

26
Q

AE/CI of Cerebyx/Fosphenytoin

A

same as phenytoin

27
Q

AE/CI of Dilantin/Phenytoin

A

gingival hyperplasia, hirtuism, rash, ataxia, coarsening o facial features, confusion, Via D def

Black box warning with rapid IV administration
Max loading dose for pt with cards issue is 25mg/min, normal is 50mg/min

28
Q

Carbamazepine/Tegratol pearls

A

Monotherapy of partial or generalized tonic-clonic seizures
First line for simple or complex seizures
MOA: Na channel inactivation
Hepatic elimination

29
Q

define Auto Induction

A

.

30
Q

AE/CI Carbamazepine/Tegratol

A

TCA, MAOI, bone marrow suppression

diplopia, drowsiness, N, aplastic anemia, leukopenia rashes, SIADH, GI upset

31
Q

Oxcarbazepine/Trileptal treatment

A
Monotherapy or adjunct with partial seizures
MOA:Na channel inactivation 
Renal excretion
300mg bid Maintenance of 600-2400mg/day
no serum concentration range
32
Q

AE/CI Oxcarbazepine/Trileptal

A

don’t use if sensitive to carbamazepine

dizziness, somnolence, hyponatremia, diplopia

33
Q

Valproic Acid/Dicalproex/Depakote treatment

A

mono therapy and adjunctive for partial, generalized TC, absence seizures
MOA: Na channel inactivation

15mg/kg/d max is 60mg/kg/d

CI hepatic disease
AE weight gain pancreatitis, nausea tremor, behavioral changes

34
Q

Phenobarbital

A

Barbituate
mono therapy for generalized TC and partial seizures
MOA: NA channel inactivation

CI severe liver disease, advanced Respiratory disease
AE; dependence sedation, memory issues, behavior issues

35
Q

Gabapentin

A

uncommonly used in epilepsy
used as adjunct only for partial seizures
900mg-3600 bid/tid

weight gain fatigue dizziness

36
Q

Pregablin/Lyrica

A

adjunct only for partial seizures
150mg BID, MAX 600mg
CI angio edema, HF, HTN, DM\can cause peripheral edema

37
Q

LAmotrigine/Lamictal

A

25mg/d slow titration every 2 weeks, max 800mg day

If rash developed DC immediately.

38
Q

Levetiracetam

A

adjust for partial or generalized TC

500mg BID, MAX 3000mg day

39
Q

Toprimate/Topamax

A

mono therapy or adjunct in partial or generalized TC
25-50mg bid, maintenance 100-400/d bid/tid
AE: ataxia, dizziness, acute glaucoma, met acidosis, weight loss

40
Q

Lacosaminde/Vimpat

A

50mg bid, titrate weekly maintenance 200-400mg/d
CI liver disease
AE tremor, diplopia arrhythmia

41
Q

Clonazepam/Klonopin

A

Benzo
adjunct for myoclonic, atonic, generalized TC
preventions of absence seizures
1.5mg/d increasing q3/d MAX of 20mg day

CI severe liver disease

42
Q

Lorazepam/Ativan

A
Benzo
Used in IV status epilepticus
4mg slow IV bolus, repeats q 13-30 min 
CI hepatic impairment, renal, CNS depression 
AE tachycardia
43
Q

Comorbid conditions

A

Asthma
HA- meds the preven tHA topiratme, valproate
Meds that can worsen HA

44
Q

Depression

A

Keppra, phenytoin exacerbate depression

Lamotrigine, carbamazepine, oxycarbazine are good with depression

45
Q

Switching drugs

A

new drug is tapered to effective dose, then DC drug is tampered down. Pt is at a higher risk of seizure during this time

46
Q

Stopping therapy

A
No seizure for 2-4 years
complete seizure control by 1yr onset
Onset of seizure >2yo and < 35yo
Normal Egg and near exam 
Tappered over 3 mos
47
Q

Stopping therapy

A
No seizure for 2-4 years
complete seizure control by 1yr onset
Onset of seizure >2yo and < 35yo
Normal Egg and near exam 
Tappered down over 3 mos
48
Q

Pediatrics

A

Metabolic rates are higher Control seizure ASAp due to brain development
AED doses are increased rapidly
mg/kg dosing
serum concentrations ar eisend extensively

49
Q

Pregnancy

A
use monotherpay if possible
lowest dose possible
Monitor serum at pregnancy and then monthly 
admin Vit K during 8th month
Monitor post partum serum, adjust dosing
50
Q

Pregnancy CI and AE

A

Barbiturates and Phenytoin congenital heart defects, cleft palate
Carbamazepine- spina bifida
Valproic Acid- spina bifida and highest risk of fetal malformations of all AED

51
Q

Postical state is defined as …

A

.