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A-CNS Pharma > Epilipsy > Flashcards

Epilipsy Flashcards

1
Q

بسم الله الرحمن الرحيم
_______________
>= 2 unprovoked seizures within 24 hours apart this is?

A

Epilipsy

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2
Q

Abnormal excessive neuronal electricaly activity in the brain with suden onset and offset
Transinet recurrent neurological symptoms ?

A

Epilipetic seizures

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3
Q

symptoms of epilipsy depends on ?

A

site of origin of the abnormal elctrical activity
if in motor cortex may cause motor seizures and abnormal movements

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4
Q

The most common origin of seizures and abnormal electrical activity is ?

A

Temporal
Frontal

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5
Q

Epilipsy may be ?

A

Focal motor in precentral gyrus
somatosensory in post central gyrus
Visaul
Auditory
Autonmoinc with raising epigastirum in insula

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6
Q

Define convulsion

A

Abnormal involuntary muscle contraction.
Motor seizures

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7
Q

Mention causes of epilipsy

A

Primary Idiopathic may be genetic
_______________________
T3I2VF
Secondary :
Trauma
Tumors
Toxins or drugs ICTI
Inuslin - cocaine - TCAs -Ii
Infection:Meningitis - encephalitis
Vascular: Cerebrovascular disorders+ Stroke
Fever in Children called Febrile Convulsions

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8
Q

Types of epilipsy

A

Patiral simple or complex
Generalized : Absecne -Tonic-clonic -Myoclonic

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9
Q

Mechanism of Epilipsy>

A

Increased Glutamate Tranismission
Decreased GABA transmission
with increased Na & Ca channels activity for depolarization

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10
Q

Mechanism of antirpliptic drugs

A

Drugs working on :
1-Neurotranmsitters
Glutamate decreasing its action : Topiramate
GABA increasing its action :
Phenobarbital-Benzodiazepines
____________________
2-Membrane channels ?
Na channels : Carbamzine+Phenytoin
Ca channel :? Ethosuximdie
______________________

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11
Q

Valporate works on ?

A

Na channels
Ca of T TYPE Post synaptic
with ethoxuisimde
V NMDA of glutamat
Increasing GABA amount with Vigbatrin

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12
Q

Topimerate works on ?

A

Na channels
T AMPA of glutamate
GABA A receptors with benzo and barbit

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13
Q

Lamotrigine works on ?

A

Na channel
Ca channels presynaptic with Gabapentin + Pregaballin

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14
Q

Levetiracetem

A

Vesicular protein Vs2A.

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15
Q

Antiepleiptics working on Na channels are?

A

Phenytoin
carabamazepine
oxcarabamazeipine
______________________
VTL
Valporate
Topiramate
Lamotrigine
Decrasing repetitive firing of neurons

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16
Q

Vigabatrin working on

A

GABA-Transmaminase decreasing catabolism

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17
Q

Effective in absence seizure ?

A

Blokcing T Ca channels decreasing brain ryhtmic activity

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18
Q

Incrasign GAD?

A

Valporate + Gabapentin

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19
Q

Classification of antiepileptics

A

Classicial agents :
VCPE Phe benzoفكبي فيه بنزين في الكتاب واحرقه طبعا
Valporate
Carbamazpine
Phenytoin
Ethosuixmidie
Phenobarbiutate
Benzodiazepines
____________________
Newer agents :-
Tol2 GABA
Topiramate
Lamotrigine
Levetiracetam
Pragabaillin-gabapenitn

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20
Q

Mention Broad spectrum antiepeliptics and GR

A

لا لي فيه لاخفيه ايه رايك في الافيه ؟
La Le V
Lamotrigine
Levetiractam
Valoporate

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21
Q

Mention Broad spectrum antiepeliptics and GR

A

لا لي فيه لاخفيه ايه رايك في الافيه ؟
La Le V
Lamotrigine
Levetiractam
Valoporate
___________________
due to multiple mechanism of actions in brain transmitters and channels so used in partial and generalized epilipsy

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22
Q

Sodium valporate + valporioc acid =

A

Divalporex
converted to valporate ion in GIT For improving GIT tolerance Of valporic acid

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23
Q

how to detect epilpist?

A

EEG

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24
Q

Choices of antieplitptic in types of epipilsy

A

Valporats firs line in all except in Partial is second line
___________________________
Levetiracetam is second line in all except ? Absence seizure
________________________________
First line of Partial is ?Carbamazpine + Lamotrigine while the second line :
Valporate + Oxcarabamzaine + levetiracetam
___________________________
First line Tonic-clonic ?
Valporate - lamotrigine while second :
Levetiracetam -Carabamzpeine+ox
_____________________________
First line Absnces ::?
Ethousimide + Valporate
Second is :
Lemotrigine
___________________
First line in Myoclonic ?
Valporate
Secondline :
Topiramate +
Levetiracetam

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25
Q

IF patient has Tonic clonic + Absence seizure the preferrd antiepilpetic is ?

A

Valporate due to multiple meahncims

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26
Q

Contraindicated antiepileptics in absence and myoclonia seizures

A

CarGaP2
Carbamazepine
Gapapetnite
Pregabalin
Phenytoin
______________
Contr in absence ?
the above 5+ Phenobarbital and Levetiracetam
________________
Cont in myclonic :
the 5 above + Lamotrigine

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27
Q

Due to sedation and tolerance Benzo and phenobarbital are used mainly in ?

A

Acute fits and status epilipticus

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28
Q

Phenobarbital is used in ?

A

Tonic clonic & partial

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29
Q

Clonezpam is used as ? in epilipsy

A

2nd line broad spectrum

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30
Q

Adverse effects of Phenytoin as antiepliptic?

A

Cosmetic + pharmacokinetic disturbances :Cinteic
=Irregular BA
=Saturation kinetic if serum level increased to a level liver cannot control
=CYP inducer: causing drug interactions

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31
Q

Indications of phenytoin
Contraindications ?

A

in partial and Tonic-clonic
In Status epilipticus
_______________
CI : Absecne + Myoclonic and carbazmaepine also CI

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32
Q

Fosphenytoin Characteristics

A

Given IM in oppoiste of Phenytoin
Given IV less irritant
has higher rate of infusion than pheytoin100BA
_______________________
PCB-Less phelibitis
-Less Cardiotoxic hypotension and arrythmia
-Increased BA Faster infusion not ppt
it is the prodrug of phentoion

33
Q

compare between fosphenytoin and phenytoin in tissue side effect?

A

Phenytoin if extravasates may cause purple glove syndorme and tissue necrosis
But
Fosphenytion less tissue side effects

34
Q

Oxcarbaepine compared to carbamazepine is ?

A

Less potent with
less side effects ( enzyme induction and blood dyscriasis )

35
Q

Hypersensitivity appear more in ?

A

Valoporate causing skin rash

36
Q

GIT diusturbances appear more in ?

A

valproate

37
Q

Neurological disutrbances of Phenytoin ,carbamazepine and valproate ?

A

Phenytoin :
Nystagmus - dipolopia -ataxia -drowiness- decrasing learninig in children
____________________________
Carbamazpeine : diplopia -ataxia -doriwsness
____________
Valproate :
Fine hand termores + ataxia
Less sedation

38
Q

Hepatic CYP 450 Affected by anitepliptic show ?

A

Phenytoin enzyme inducer causing increeaing metabolism of other antieplieotics and Vit D causing decreasd Ca in bones casuing Osteomalacia
_+_________________
Carbamazpine enzyme iducer of other anti epiliptics causing induction of metabolism of Warfatin = thrombosis
Oral contraceptives = pregnan
_______________________
Valproate is enzyme inhibitor

39
Q

Megaloblastic anemia can occur by,,,,while lecopenia and Agranulocyotsis by ,,,,,,, ?

A

Phenytoin megalo
Agranulo ? = Carbmazepine

40
Q

Thromboctosis can occur by?

A

Valproate

41
Q

Spina bifida and Neural tube defects occur by ?

A

Valproate

42
Q

Cleft + lip palate + Heart anomalies can occur by ?

A

Phenytoin

43
Q

Adverse effect of phenytoin ?

A

Cosmetic + Unpredictible level
_________________________
Cosmetic :GFH
Gingival Hyperplasia
Coarse features
hirsutism +acne

44
Q

Mention avdverse effects of Valproate

A

HAPO Valproate
Hepatoxic
Alopecia hair loss
Polycystic ovaries
Overwieht with increased appetite

45
Q

Water intoxication with Diltional hyponatermia is due to ?

A

Carabamazepine increasing ADH

46
Q

eTHOSUXMIDE indication + adverses

A

Narrow specrtum for Abscnese
_________________
GIT symtpms
Skin rash
Diziness -Drowsness -headache

47
Q

Steven johnison syndrome caused by?

A

it is fatal hypersensitivty dermaititis by ?
Lamotrigine

48
Q

Never ever give lamotrigine with ? valproate why?

A

Due to valproate enzyme inhibtion causing increased level of lamotrigine pericptating Steven johnoson sundorme

49
Q

adjust Lamotrigine dose if given with Oral contaceptive and Carbamazepine why ?

A

As they are enzyme inductors
casuing its level to be decreased

50
Q

Levetiracetam with renal patients

A

should be adjusted beacuse it is renally excreted

51
Q

Levetiracetam is broad spectun exept ?

A

abscence seizures
________________
It casues mood and behavioral changesa
Aggession agitaiton and depression

52
Q

Gapapetinoids used in focal epilpisy
indications ?
with adverses of
Dizzness dowinsness sedation atxia
Wiegh gain

A

NAR
Neuropathic pain
restless leg syndrome
Antianxiety

53
Q

Mention adverses of Gapapetioids

A

PRA
=Peripheral edema
=Excreted renally only as levetiracetam
=Risk of abuse due to euphoric effect in Nucleus accumbnes
_______________________

54
Q

Mention adverse effects of Topiramate

A

RMHW
1-Renal stones
2-Myopia + glacuoma
3-weight loss
4-hypohidrosis with less sweat causing hyperthermia

55
Q

Topiramate indication

A

Broas spectrum antiepiletoic &Migrane

56
Q

Renal stones occur with ?

A

taz
Topiramate
Acetazolamide = CAI
Zonisamide

57
Q

dose adjustment of antipeplitoics should be done in elderly why ?

A

=Decreased clearance : Carbamazepine and Lamotrigine
=Decreased protein binding : phenytoin and Valproic acid

58
Q

Drug perferred in elderly ?

A

Carbamazpine
Levetiracetam
Lamotrigine
Gabapentin
CL bagL

59
Q

anitepilptics with no enzyme interactions

A

Levetiracetam
Gapapetint and Pregabalin
maily renal excretion

60
Q

Monotherapy is perferred
_______________________
Long treatment 2 years
gradual withdrawal over 6 months to avoid status epilipticus
_____________________
serum level monitoring
________________________

A
61
Q

Mention use of antiepliptics

A

Epilipsy WOW!? ^_^
____________________
-Mood stabilizer in bipolar
CVL :Carbamazepine -valproate-Lamotrigine
______________________
-Neuropathic pain : Carbamazpine + gabapentin +pregabalin
______________________
-Migarane : valproate + Topiramate
vault valt
_______________________
Arrythmia as phenytoin class ib for ventricualr-Digitalis -torsade arrythmia
AM2N

62
Q

pREGNANCY Recommendations

A

-Folic acid 5 mg/day before and after prenancy decrsanig teratogenic
-Monotherapy
-Decrasing AEDs to lowes doeses
-Women 2-5 years withous seizures then gradual withdrwawl over 6 months
-Cannot withdraw?
replace AEDs with
Carbamazeoine -lamotrigine -levetiracetam
Vit K 10 mg in third 1/3 decreasing newborn pospartum hge

63
Q

Prgancny increasing epilipsy

A

due to increasing metabolism of antiepiliptics with
Hemodilution
adjust dose ! increase the dose
guided with plasma level

64
Q

Prolonged or repeated tonic clonic seizures

A

Convulsive status epilipticus
time is BRAIN

65
Q

How to detect convulsice status epilipticus ?

A

Active toinc clonic sezure with duration of 5 minutes
of more
Tonic clonic seizure repeated after 30 or less mintuts
Withous recovering consciousness from first seizure

66
Q

Withdraw of antiepliptic may lead to ?

A

Status epilipticus

67
Q

Why status epilipticus ?

A

TMSAHW
Withdraewal of antiepilieptic
Trauma
Metabolic
Stroke
Hypoxia
Alcohol or drug abuse
HMST WITH ALCHOLO

68
Q

wHY STATUS EPILIPTICUS IS FATAL ?

A

2hrb lab
1-HYPERTHERMIA
2-Brain damage due to hypoxia and metabolic dis
3-Pulmonary edema
4-Heart arryht
5-renal failure with myoglobinuria and dehydration
6-Lactic acidosis ! main causie of death

69
Q

Main cause of Death from status epilipticus is ?

A

Lactic Acidosis

70
Q

Mangemt of status epilitucs

A

first step ABCDE
aspiration -breathing-circulation-dextrose-electrolytes
_______________________
Second step :-
BZD midazolam IM
diazepam IV RECTAL
Lorazepam IV
Fosphenytoin or pheytoin or !
Phenobarbital 2ndry
IV anitepipetics Valproate -levetiracetam
IV or inhalation anstheisa
______________

71
Q

الحمدلله رب العالمين

A
72
Q

Simple partial seziure cc by?

A

The patient is conscoius
Motor or sensort visual pscychi changes

73
Q

Which seizure cc by aure ? describe

A

Complex partial seizure
____________
Visual olfactory sensory hallucination
Senes of fear
unusual abdominal sensations
___________________

74
Q

The seizures has automatism in ?

A

Complex partial seizure as
repeated involunarry movements last for 2-5 minutes

75
Q

The seizures has automatism in ?

A

Complex partial seizure as
repeated involuntary movements

76
Q

postictal means and appears in ?

A

Confusion with amneisa except the aura
in complex partial seizure

77
Q

Absenece sieure CC by ? called petiti mal
no postictal

A

Loss of consicuosness as it is genrealized seizures the child stares to space blankly eyes rolling up for few second for 50 -100 times /perday after the seizure the patients if fully alert

78
Q

Describe tonic clonic sieures

A

Genralized with loss of consousness
__________
Tonic : Arching of back and extension of limbs
Epiliptic cry +pallor and cyanosis
_____________________
Clonic : Jerks +
up Rolling open eye
Biting tongue + frothing from mouth
Urine incontinence
____________________
Postiictal ? Confusiion with gradual regain of consiucouness

79
Q

Myoclonic

A

Genralized seizure with Affecte muscle or group of muscle doing alternating contraction and relaxation

Jerking or twithcing of muscle

A-CNS Pharma (11 decks)

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