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neurology FA > seizures (and treatment) > Flashcards

seizures (and treatment) Flashcards

1
Q

Seizures?

A

characterized by synchronized, high-frequency neuronal firing. Variety forms

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2
Q

Seizures - types

A
  1. partial (focal)
  2. generalized
  3. partial that secondary generalize
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3
Q

partial vs generalized seizures

A

partial: affect single area of the brain
generalized: diffuse

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4
Q

partial (focal) seizures - most commonly originate in

A

medial temporal lobe

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5
Q

partial (focal) seizures - often preceded by

A

seizure aura

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6
Q

partial (focal) seizures - types

A
  1. simple partial

2. complex partial

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7
Q

simple partial seizures - characteristics

A

CONSCIOUSNESS INTACT

motor, sensory, autonomic, psychic

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8
Q

complex partial seizure - characteristics

A

IMPAIRED CONSCIOUSNESS

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9
Q

simple vs partial seizure according consciousness

A

simple - intact

complex - impaired

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10
Q

generalized seizures - types

A
  1. absence
  2. myoclonic
  3. tonic clonic
  4. tonic
  5. atonic
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11
Q

absence seizure is also called

A

petit mal

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12
Q

absence (petit mal) seizure - characteristics

A

3 hz, no postictal confusion,

blank stare

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13
Q

myoclonic seizure - characteristics

A

quit, repetitive jerks

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14
Q

tonic-clonic seizure is also called

A

grand mal

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15
Q

tonic-clonic (grand mal) seizure - characteristics

A

alternating stiffening and movement

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16
Q

tonic seizure - characteristic

A

stiffening

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17
Q

atonic seizure - characteristics

A 
drop seizures (falls to floor) 
commonly mistaken for fainting
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18
Q

epilepsy - definition

A

a disorder a recurrent seizures

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19
Q

epilepsy with fever?

A

FEBRILE SEIZURES ARE NOT EPILEPSY

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20
Q

status epilepticus?

A

continuous or recurring seizure(s) that may result in brain that variably defined as >10-30 min

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21
Q

status epilepticus - duration

A

> 10-30 min

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22
Q

causes of seizures in children

A
  1. genetic
  2. infection (febrile)
  3. trauma
  4. congenital
  5. metabolic
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23
Q

causes of seizures in adults

A
  1. tumor 2. trauma 3. stroke 4. infection
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24
Q

causes of seizures in elderly

A
  1. stroke 2. tumor 3. trauma 4. metabolic 5. infection
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25
Q

Generilized seizures - types and characteristics

A
  1. absence (petit mal) - 3 hz, no postictal confusion,
    blank stare
  2. myoclonic - quick, repetitive jerks
  3. tonic clonic (grand mal) - alternating stiffening and movement
  4. tonic - stiffening
  5. atonic - drop seizures (falls to floor), commonly mistaken for fainting
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26
Q

generalized epilepsy - mistaken for fainting

A

atonic

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27
Q

seizures - often preceded by aura

A

partial

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28
Q

epilepsy drugs?

A
  1. ethosuximide
  2. benzodiazepines
  3. phenyntoin
  4. carbamazepine
  5. valproic acid
  6. gabapentin
  7. phenobarbital
  8. topiramate
  9. lamotrigine
  10. levetiracetam
  11. tiagabine
  12. vigabatrin
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29
Q

ethosuximide - mechanism of action

A

blocks thalamic T-type Ca2+ channels

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30
Q

ethosuximide blocks ….. T-type Ca2+ channels (area)

A

thalamic

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31
Q

ethosuximide - clinical use

A

1st line for absence

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32
Q

ethosuximide - side effects

A
  1. GI 2. fatigue 3. headache 4. urticaria

5. Stevens-Johnson

33
Q

epilepsy - benzodiazepines - drugs

A
  1. lorazepam

2. diazepam

34
Q

epilepsy - benzodiazepines - clinical use

A
  1. 1st line for acute status epilepticus

2. also for eclampsia seizure

35
Q

eclampsia seizure - 1st line

A

MgS04

36
Q

epilepsy - benzodiazepines - side effects

A
  1. sedation
  2. respiratory depression
  3. tolerance
  4. dependence
37
Q

phenytoin - mechanism

A

Na+ channel inactivation

ZERO kinetic order

38
Q

Fosphenytoin?

A

phenytoin for parental use

39
Q

phenytoin for parental use

A

Fosphenytoin

40
Q

Phenytoin - side effects

A

A. Neurologic 1. nystagmus 2. diplopia 3. ataxia 4. sedation 5. peripheral neuropathy
B. Dermatologic 1. gingival hyperplasia 2. hirsutism
3. Stevens-Johnson syndrome 4. DRESS syndrome
C. Musculosceletal: 1. SLE like syndrome 2. osteopenia
D. Hematologic: Megalobl anemia
E. Reproductive: teratogenesis (fetal hydantoin syndrome)
F. Other: c P-450 induction

41
Q

phenytoin - pharmatokinetic characteristic

A

zero order kinetics

42
Q

phenytoin - clinical use

A
  1. simple seizure
  2. complex seizure
  3. tonic clonic seizure (1st line)
  4. status epilepticus (1st line for prophylaxis)
43
Q

carbamazepine - mechanism

A

Na+ channel inactivation

44
Q

carbamazepine - clinical use

A
  1. simple seizure (1st line)
  2. complex seizure (1st line)
  3. tonic clonic
  4. 1st line for trigeminal neuralgia
45
Q

Carbamazepine - side effects

A
  1. diplopia 2. ataxia 3. blood dyscrasias (agranulocytosis, aplastic anemia) 4. liver toxicity
  2. teratogenesis 6. induction of P-450 7. SIADH
  3. Stevens-Johnson syndrome
46
Q

Valproic acid - mechanism of action

A
  1. Na+ channel inactivation

2. increase GABA concentration by inhibiting GABA transaminase

47
Q

Valproic acid - contraindicated in

A

pregnancy

48
Q

Valproic acid - side effects

A
  1. GI 2. distress 3. rare but fatal hepatotoxicity (messure LFTs) 4. teratogenesis (neural tube defects) 5. tremor 6. weight gain 7. pancreatitis
49
Q

Valproic acid - clinical use

A
  1. simple
  2. complex
  3. tonic-clonic (1st line)
  4. absence
  5. myoclonic
  6. bipolar disorder
  7. migraine prophylaxis
50
Q

gabapentin - mechanism

A
  1. primarily inhibits high voltage activated Ca2+ channels

2. designed as GABA analogs

51
Q

gabapentin - clinical use

A
  1. simple seizures
  2. complex
  3. peripheral neuropathy
  4. postherpetic neuralgia
52
Q

Gabapentin - side effects

A

sedation

ataxia

53
Q

phenobarbital - clinical use

A
  1. simple
  2. complex
  3. tonic clonic
  4. 1st line in neonates
54
Q

phenobarbital - side effects

A

1, sedation 2. tolerance 3. dependence 4. induction of P-450 5. cardiorespiratory depression

55
Q

topiramate - mechanism

A
  1. blocks Na+ channels

2. increase GABA action

56
Q

topiramate - clinical use

A
  1. simple
  2. complex
  3. tonic - clonic
  4. migraine prevention
  5. idiopathic intracranial hypertension (pseudotumor cerebri)
57
Q

topiramate - side effects

A
  1. sedation
  2. mental dulling
  3. kidney stones
  4. weight loss
58
Q

lamotrigine - mechanism

A

blocks voltage gated Na+ channels

59
Q

lamotrigine - side effects

A

Steven Johnson Syndrome

60
Q

lamotigine - how to avoid Steven Johnson Syndrome

A

must be titrated slowly

61
Q

lamotigine - clinical use

A
  1. simple seizure
  2. complex
  3. tonic-clonic
  4. absence
62
Q

levetiracetam - mechanism of action

A

unknown. may modulate GABA and glutamine release

63
Q

levetiracetam - clinical use

A
  1. simple seizure
  2. complex
  3. tonic-clonic
64
Q

tiagabin - mechanism of action

A

increases GABA by inhibiting reuptake

65
Q

tiagabin - clinical use

A
  1. simple seizure

2. complex

66
Q

vigabatrin - mechanism of action

A

increase GABA by IRREVERSIBLY inhibiting GABA tranasmaminase

67
Q

vigabatrin - clinical use

A
  1. simple seizure

2. complex

68
Q

epilepsy drug that induce P-450

A
  1. phenytoin
  2. Carbamazepine
  3. phenobarbital
69
Q

trigeminal neuralgia - 1st line treatment

A

carbamazepine

70
Q

eplepsy drugs with nystagmus

A

phenytoin

71
Q

eplepsy drugs with diplopia

A

phenytoin and carbamazepine

72
Q

eplepsy drugs with sedation

A
  1. benzodiazepines
  2. phenytoin
  3. gabapentin
  4. topiramate
  5. phenobarbital
73
Q

eplepsy drugs with ataxia

A

gabapentin, phenytoin and carbamazepine

74
Q

eplepsy drugs that inhibit Na+ channels

A
  1. phenytoin
  2. carbamazepine
  3. valproic acid
  4. topiramate
  5. lamotrigine
75
Q

eplepsy drugs with Steven Johnson syndrome

A
  1. phenytoin
  2. carbamazepine
  3. Lamotrigine
  4. ethosuximide
76
Q

eplepsy drugs - 1st line for absence

A

ethosuximide

77
Q

eplepsy drugs - status epilepticus 1st line

A

acute - benzodiazepines

prophylaxis - phenytoin

78
Q

1st line treatment for tonoclonic seizures

A
  1. Phenytoin

2. Valproic acid

neurology FA (31 decks)

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