Test 1: Epilepsy and Alzheimer's Flashcards by Bridgette Zickefoose

Type of Partial seizures

simple

complex

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partial simple seizures characteristics

aura
consciousness not impaired
memory intact

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partial complex seizures characteristics

consciousness impaired
memory impaired
automatism

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Type of generalized seizures

absence
atonic
tonic
myoclonic
tonic clonic

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absence seizure characteristics

brief 2-5 seconds
onset 4-14 years
mild atonia
automatisms

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atonic seizure characteristics

brief <15 seconds

sudden loss of muscle tone

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tonic seizure characteristics

brief <20 seconds

sudden loss of muscle tone, dropping things

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myoclonic seizure characteristics

brief

bilateral jerk of neck, shoulders, legs

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tonic clonic seizure characteristics

loss of consciousness
tongue biting
incontinence

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treatment of status epilepticus

IV benzo
(Fos)phenytoin
phenobarbital

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3 ways to decrease excitatory stimulus in seizures

reduce sustained AP
reduce excitatory NT release
inhibit excitatory receptors

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target to reduce sustained AP generation

Na channels

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target to reduce excitatory NT release

synaptic vesicles
Ca channels
-T-type channels
-alpha2delta1 channels

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target to inhibit excitatory receptors

glutamate receptor

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how to increase inhibitory stimulus in seizures

enhance inhibitory neurotransmission via GABA

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3 targets of AED on GABA to increase inhibitory stimulus

positive allosteric modulation
GABA reuptake inhibiton
inhibit metabolism

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MOA of Na channel inhibiton

bind to and stabilize Na channels that are inactivated

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AED that target synaptic vesicles

Levetiracetam

Brivaracetam

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MOA of Keppra and Briviacet

bind with high affinity to a specific synaptic vesicle protein (SV2A) to inhibit release of neurotransmitter release

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AED that target Ca channel

Gabapentin

Pregabalin

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MOA of Gabapentin, Pregabalin

do not work on GABAr

bind w/ high affinity to alpha2-delta site of voltage-gated Ca channel to reduce release of glutamate and NE

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AED that targets glutamate receptors

Perampanel

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MOA of perampanel

noncompetitive AMPA receptor antagonist

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AED that targets GABA transporter

Tiagabine

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MOA of Tiagabine

inhibits GABA transporter to decrease GABA reuptake into neurons and glial cells=increase inhibitory transmission

AED that targets GABA transaminase

Vigabatrin

MOA of Vigabatrin

inhibit GABA transaminase (inativates GABA) to raise CNS GABA levels

AED that targets GABA-A receptors

Benzodiazepines | Barbiturates

MOA of Benzos

allosterically facilitates activation of the GABA-A receptor

AED for absence seizures

Ethosuximide | Valproic acid

MOA of Ethosuximide and Valproic Acid

inhibit T-type Ca channels

result of enzyme induction

increased metabolism, decreased serum concentration and effects

result of enzyme inhibition

reduced metabolism and accumulation of the affected drugs

4 major inducers

carbamazepine phenytoin phenobarbital primidone

valproate inhibits....

``` lamtrogine phenobarb carbamazepine amitriptyline nortriptyline cisplatin etoposide ```

Carbamazepine induces...

``` Warfarin Psychotropic drugs DHP simvastatin BC ```

BC induced by....

OXC if dose >1200mg/day TPM if dose >200mg/day perampanel

estrogen induces...

Lamotrigine

Warfarin effects w/..... adding inducer withdrawing inducer

increased coagulation risk | increased bleeding risk

Which AED can be affected by antacids

Gabapentin

K channel stabilizer

Ezogabine | Flupirtine

AED treat complex partial

``` ethotoin phenytoin phenacemide carbamazepine lacosamide OXC Gabapentin Perampanel Felbamate Phenobarbital Primidone Vigabatrin Tiagabine Valproate Lamictal Zonisamide Topiramate Clonazepam ```

AED treat Tonic-clonic

``` Ethotoin Phenytoin Carbamazepine OXC Leve Perampanel Felbamate Phenobarbital primidone valproate lamotrigine clonazepam ```

AED treat status epilepticus

Fosphenytoin | Trimethadione

absence seizure treated by which class of AED

T-type Ca channel inhibitors

AED that cause kidney stones

Zonisamide | Topiramate

AED that cause gingival hyperplaisa

phenytoin

AED that cause weight loss

zonisamide | topiramate

AED that cause weight gain

Pregabalin | valproate

AED that causes osteomalacia

phenytoin carbamazepine phenobarbital

AED that cause hyponatremia

carbamazepine | OXC

3 types of dementia

lewy body dementia frontotemporal dementia reversible cause

4 reversible causes of dementia

normal pressure hydrocephalus thyroid dysfunction vitamin b12 deficiency depression

DSM-5 Criteria

1. evidence of significant conitive decline in 1+ domain 2. deficits interfere with ADL 3. deficit do not occur only in context of delirium 4. deficits not better explained by another mental disorder

MMSE score 0

positive for cognitive impaire

MMSE score 1-2

if abnormal CDT then positive for impairment | if normal CDT then negative for impairment

MMSE score 3

negative screen for dementia

Mild Alzheimer's

MMSE 24-20 forgetfulness mild anxiety

Moderate Alzheimer's

``` MMSE 10-19 concentration decline complex skills decline withdrawal delusions anxiety ```

Severe Alzheimer's

``` MMSE <10 unable to recall people or places needs help with ADLs dysphobia apathy ```

Profound Alzheimer's

MMSE 0

tx for anxiety in AD

trazodone buspirone SSRI

tx for depression in AD

trazodone | SSRI

tx for general agitation in AD

redirecting activity | safety proofing

tx for psychotic behaviors in AD

atypical antipsychotics

tx for Aggressive behavior in AD

divalproex/carbamazepine in combo w/atypical antipsychotics | dextromethoropharn-quinidine

4 antipsychotics for AD

aripiprazole olanzapine quetiapine risperidone

Donepezil dose

6 weeks of 5mg/day then 10mg/day

Rivastigimine dose

1.5 mg BID increase by 1.5mg BID q 2 weeks up to 6mg BID

Galantamine dose

4mg BID after 4 weeks increase to 8mg BID then again to 12mg BID

Memantine dose

initial 5mg qd increase dose at minimum 1 week intervals in 5mg increments to 10mg/day as 5mg and 10mg in separate doses