Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics III > Epilepsy - Block 1 > Flashcards

Epilepsy - Block 1 Flashcards

1
Q

What is a seizure?

A

a transient alteration of behavior due to the disordered, synchronous, and rhythmic firing of populations of brain neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is epilepsy?

A

a chronic brain disorder characterized by recurrent (≥ 2) seizures that are unprovoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can cause acute symptomatic sz?

A
  1. Neurologic insult
  2. Metabolic disorder
    * Electrolyte imbalances: Hyponatremia (<115 mmol/L); Hypocalcemia (<5 mmol/L); Hypomagnesemia (<0.8 mg/dL)
    * Hypo- or hyper-glycemia
  3. Medication
  4. Alcohol and toxics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the medications that cause seizures?

A
  1. Beta lactams
  2. Fluroroquinolones
  3. Theophylline
  4. Bupropion
  5. Second gen clozapine
  6. Lithium
  7. Meperidine, morphine, propoxyphene
  8. Tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of epilepsy?

A
  1. Genetic
  2. Structural
  3. Infection
  4. Metabolic
  5. Immune
  6. Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Descibe the age onset of epilepsy?

A

Before age 2: Fever, hereditary or congenital neurologic disorders, birth injuries, and inherited or acquired metabolic disorders
Ages 2 to 14: Idiopathic seizure disorders
Adults: Cerebral trauma, alcohol withdrawal, tumors, strokes, and an unknown cause (in 50%)
Older people: Tumors and strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 facotrs that contribute to the development of epilepsy?

A
  1. Hyperexcitability
  2. Hypersynchronization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the phases of a seizure?

A
  1. Prodromal: hours/days before seizure
  2. Aural: deja vu, jamais vu, odd smells, tastes, dz
  3. Ictal: first sx to end of seizure
  4. Recovery: confusion, lack of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 classes of seizure types?

A
  1. Focal: One side
  2. Generalized: Both sides
  3. Unclassified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are seizures classified?

A
  1. Onset
  2. If focal, must identify aware or impaired if known (if unknown omit). Don’t have to identify this for generalized since impaired awareness is implied
  3. First sign or symptom
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the difference between focal aware and focal impaired awareness sz?

A

FA: simple partial sz
FIA: complex partial sz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Another name for focal to bilateral tonic clonic?

A

partial onset with secondary generalization or secondarily generalized tonic–clonic (GTC) seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is most commonly seen in focal aware sz?

A

Aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common form of generalized motor sz?

A

Tonic clonic (grand mal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the oresentations of generalized nonmotor sz?

A

Absense: Abrupt onset and offset of impaired consciousness
* Duration is about 2 to 30 seconds
* No postictal confusion or lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the tx goal for sz?

A

No seizures, no ADRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should we treat sz?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the tx for sz?

A

Non pharm: Diet, vagus nerve stim, surgery, support groups
Pharm: ASD (1st, 2nd, 3rd)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of diet is used for epilepsy?

A

Ketogenic: high in fats and low carbs and proteins -> acidosis and ketosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the forms of ketogenic diets?

A
  1. Classic (4:1 (90% fat and 10% protein and carbohydrate) with restricted calories and fluids
  2. Modified Atkins (1:1 (65% fat, 25% protein, and 10% carbohydrate)
  3. Low glycemic index (least ADRs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is vagal nerve stimi?

A

Implantable and non-implantable options for refractory and generalized sz
ADR: hoarseness, voice alteration, increased cough, pharyngitis, dyspnea, dyspepsia, and nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do seizures occur?

A
  1. Def of inhibitory GABA
  2. Excess of excitatory NT glutamate
23
Q

What are the MOA of AED meds?

A

reduce abnormal electrical activity by:
1. Increasing GABA
1. Decreasing glutamate
1. Blocking/altering calcium channels – reduces transmission of electrical signal
1. Blocking sodium channels – reduces neuronal firing rate

24
Q

What are the factors to consider for tx?

A
  1. The most tolerable adverse effect profile, considering patient-specific factors including age and gender
  2. ASD can also treat patient’s comorbid conditions (topiramate: neuropathy, Pregabalin, carbamazepine: bipolar disorder)
  3. DDI
25
Q

What are the considerations for women taking AED?

A
  1. menstrual cycle influences on seizure activity
  2. drug interactions betweeN contraceptives and antiepileptic drugs
  3. teratogenicity of antiepileptic drugs
26
Q

Med for generalized onset tonic clonic?

A
  1. Lamotrigiene
  2. Valproic
27
Q

Med for focal sz?

A
  1. Lamotrigine
  2. Carbamazepine
  3. Phenytoin
  4. Levetiracetam
  5. Oxcarbazepine
28
Q

Med of typical absence?

A
  1. Valprioc
  2. Ethosuximide
29
Q

Med for atypical absence, myoclonic, atonic?

A
  1. Valproic
  2. Lamotrigine
  3. Topiramate
30
Q

ASD ADRs?

A

All AEDs increase risk of CNS depression
Idiocratic: drug rashes (carbamazepine, phenytoin, phenobarbital, lamotrigine)
Long term: Osteomalacia and porosis (carbamazepine, phenytoin, phenobarbital, oxcarbazepine, felbamate, valproate)

31
Q

What are the 1st gen ASD?

A

Carbamazepine, clonazepam, ethosuximide, phenobarbital, phenytoin, primidone, valproate

32
Q

ADR of first gen?

A

Carbamazepine – BOXED WARNINGS OF BLOOD DYSCRASIAS AND FATAL DERM RXNS; hyponatremia
Phenobarbital - Hyperactivity in children
Phenytoin (chronic) - Gingival hyperplasia and osteoporosis
Valproate - many AEs including thrombocytopenia and well-known teratogenicity

33
Q

What are the 2nd gen?

A

Felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, zonisamide

34
Q

What can prevent OC from working?

A

Oxcarbazepine and topiramate

35
Q

What drug is effected by OC?

A

Lamotrigine

36
Q

What should be avoided in patients with sulfa allergy?

A

Zonisamide

37
Q

ADR of 2nd gen?

A

Lower incidence of CNS ADRs; considered better tolerated with the exception of topiramate and zonisamide
Felbamate – could cause acute liver failure, aplastic anemia
Tiagabine – has been associated with new onset seizures and SE
Lamotrigine – can cause rash but can progress to SJS

38
Q

What are the 3rd gen ASD?

A

Brivaracetam, cannabadiol, cenobamate, clobazam, eslicarbazepine, fenfluramine, lacosamide, perampanel, pregabalin, rufinamide, stiripentol, and vigabatrin

39
Q

What medications are approved for specific epilepsy syndromes?

A

Cannabadiol, clobazam, fenfluramine, rufinamide, stiripentol, and vigabatrin

40
Q

WHat are the ADR of 3rd gen?

A

Perampanel – BOXED WARNING: monitor for life-threatening psych/behavioral changesincluding aggression, hostility, irritability, anger, and homicidal ideation and threats (can occur with and without prior psych history or prior aggressive behavior)
Cenobamate – DRESS with fast titration; QT interval shortening, appendicitis
Fenfluramine – BOXED WARNING: risk of valvular heart disease and PAH
Vigabatrin - Most serious in this gen effects on vision, aggravate seizures, pts with history of psych conditions may develop psychiatric effects

41
Q

Medication for elderly?

A

Due to age, more likely to be on multiple medications (polypharmacy), have hypoalbuminemia and decreased renal/hepatic function, and change in body mass

Lamotrigine

42
Q

Medication for youth?

A

TDM

43
Q

Medication for women?

A

Consider potential for an unplanned as well as planned pregnancy and teratogenicity of ASDs

Epileptic women taking ASDs and OCs are recommended to use other forms of birth control

44
Q

Medications to avoid in pregnancy?

A

Valproate and topiramate

45
Q

Pregnancy and lactation increases clearance of what drugs?

A

lamotrigine, carbamazepine, phenytoin, oxcarbazepine, and levetiracetam

46
Q

What are the teratogenic profiles of ASD?

A
47
Q

How much folic acid is given to pregnant patients?

A

1-4 mg QD

48
Q

What is the most common reason for tx failure?

A

Med adherence

49
Q

What ADRs should we assess?

A

Idiosyncratic - serious rash (ie, SJS, TEN), hematologic dyscrasias, electrolyte abnormalities
Laboratory assessment (complete blood cell (CBC) counts, chemistries, and liver function tests)  baseline and after initiation of ASDs
Long-term effects: Screen for osteoporosis, neuropathy, and gingival hyperplasia (phenytoin)

50
Q

What do we do during a seizure?

A
51
Q

How do we improve QoL?

A
  1. Limit driving
  2. Economic security
  3. Sz diary
  4. Safety
  5. Social isolation
  6. Stigma
52
Q

What are common sz triggers?

A
  1. Sleep deprivation
  2. Flashing lights
  3. Alcohol
  4. Stress
  5. Menstration
  6. Meds
  7. Missed med
53
Q

What are the approaches to tx at follow up?

A

Monotherapy is preffered
* If not seizure free, switch to second ASD as monotherapy
* If not seizure free, dual ASD therapy may be necessary: Adjunctive ASD should be gradually added:

54
Q

When do we dc ASD?

A

Seizures free for many years (2-5yr) + low risk of recurrence = ASD withdrawal may be considered

Therapeutics III (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions