Seizures, AEDs, Myasthenia gravis

Question 1

Acts on Na channels

Answer 1

CBZ PHT OXC LMT

Question 2

Acts on Ca

Answer 2

ESM

Question 3

Acts on K

Answer 3

LVT OXC

Question 4

Ihibitory tranmission

Answer 4

BZP PB VGB TGB

Question 5

Excitatory

Answer 5

TPM FBM

VPA PB LVT

Question 6

SV2A receptor modulator; has possible action on all except Na

Answer 6

Levetiracetam

Question 7

Short half-lives

Answer 7

LVT 6-8
Pregabalin 5-7
CBZ 6-12

Question 8

Long half life

Answer 8

Phenobarbitaaaal 17-124

Question 9

High protein binding

Answer 9

VPA 85-95%
PHT 70-95
CBZ 75-80

Question 10

Renal elimination

Answer 10

Levetiracetam
Topiramate
pREgabalin
Oxcarbazepine (both renal and hepatic)
ZNS
LCS

the rest, hepatic: CBZ VPA PB PHT LMT

Question 11

Other uses:

overweight pxs

Answer 11

Topiramate

Question 12

Other uses:

underweight

Answer 12

VPA

Question 13

Other uses: migraine

Answer 13

TPM, VPA

weight gain/loss can give you a headache

Question 14

Other uses: mood disorder

Answer 14

VPA, laMOtrigine, CArBAmazepine

Question 15

Side effect: agranulocytosis

Answer 15

CARBamazepine (aGRAINulocytosis)

Question 16

Other uses: polypharmacy

Answer 16

LVT, GBP

Question 17

Risk of malformations (least to most)

Answer 17

VPA - victoryy
PB
Clonazepam
TPM
PHT, CBZ
LVT
OXC
LMT
Gabapentin

Question 18

Factors for d/c AED

Answer 18

Seizure free for at least 2 years (implies >60% successful withdrawal)

others:
control achievable at low dose
no prev unsuccessful attempt
normal EEG, neuro exam
benign disorder
Primaru generalized seizure except JME

Question 19

Definition of status epilepticus

Answer 19

1. lasts 30 min or longer
2. cluster of seizures in which px does not return to baseline mental status
3. OPERATIONAL DEFN: seizure occuring >5min from onset

Question 20

Treat as Status epilepticus after 5 min of seizure?

Answer 20

YES

Question 21

Most common cause of SE

Answer 21

sudden d/c of AEDs

Question 22

Other term for focal seizure with no alteration in consciousness that is in SE?

Answer 22

epilepsia partialis continua

Question 23

Immediate suppression of convulsion

Answer 23

Lorazepam (Ativan) or Diazepam (Valium) 2-4 mg/min IV to a total dose of 10-15 mg with BP monitoring

Question 24

Initiation or reloading of anticonvulsants

Answer 24

Phenytoin 15-20 mg/kg IV at 25-50 mg/min

Question 25

General anesthetic doses for persistent status epilepticus

Answer 25

Midazolam 0.2 mg/kg LD then infusion at 0.1-0.4 mg/kg/h OR propofol 2 mg/kg/h

Question 26

Further treatment/Add-ons

Answer 26

VPA or PB 10 mg/min to total dose of 20 mg/kg IV OR CBZ or LVT by NGT if there is gastric and bowel activity ? neuromuscular paralysis with cont EEG moitoring Pentobarbital 10mg.kg.h Inhaled anesthetic (isoflurane)

Question 27

Myasthenia gravis | Class I

Answer 27

Any ocular muscle weakness

Question 28

Myasthenia gravis | Class V

Answer 28

Requiring intubation with or without ventilation

Question 29

Myasthenia gravis | Class II, III, IV

Answer 29

Mild, Mod, Severe

Question 30

Myasthenia gravis | Class I-V A

Answer 30

Predominantly LIMB, AXIAL or both

Question 31

Myasthenia gravis | Class I-V B

Answer 31

Predominantly oropharyngeal or respiratory

Question 32

3 Hz spikes

Answer 32

Absence seizures

Question 33

DOC: | children with partial-onset sz

Answer 33

OXC 2. ___ 3. CBZ, PHT

Question 34

DOC: | adults with partial-onset sz

Answer 34

CBZ, PHT 2. VPA

Question 35

DOC: | elderly with partial-onset sz

Answer 35

Lamotrigine (mood) Gabapentin (neuropathic pain) elderly people may have these comorbs! 2. ___ 3. CBZ

Question 36

DOC: | children with GTCZ

Answer 36

A. _ B. _ C. CBZ, PHT, VPA, PB, TPM

Question 37

DOC: | adult with GTCZ

Answer 37

A. _ B. _ C. CBZ, PHT / VPA / OXC, PB / LMT, TPM

Question 38

DOC: | Children with absence

Answer 38

Ethosuximide, VPA, LMT

Question 39

DOC: | Benign epilepsy with centro temporal spikes (BECTS)

Answer 39

CBZ, VPA

Question 40

DOC: | Juvenile Myoclonic Epilepsy

Answer 40

NONE

Question 41

DOC: | myoclonic sz

Answer 41

VPA | Clonazepam

Question 42

``` DOC: mixed sseizure (myoc and tonic clonic) ```

Answer 42

VPA, Felbamate | PHT

Question 43

MOA: VPA

Answer 43

enhances GABA effects; reduces frequency of firing

Question 44

Simple partial /Focal wl no alteration in consciousness affects which limb

Answer 44

contralateral to lesion recall Jacksonian seizure

Question 45

Complex partial or Focal with alteration will not remember episode

Answer 45

TRUE. Plus (+) automatism