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PHRM 845 Therapeutics > Exam 3 - Lec 46-47 Seizures Yang > Flashcards

Exam 3 - Lec 46-47 Seizures Yang Flashcards

1
Q

focal onset seizures have what 4 classifications?

A

-aware/impaired awareness
-motor onset/non-motor onset

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2
Q

focal onset seizures may progress to

A

bilateral tonic-clonic (pt will have loss of consciousness)

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3
Q

generalized onset seizures has what 2 classifications?

A

-motor: tonic clonic/other motor
-non-motor (absence seizures)

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4
Q

absence seizures fall into which category?

a. focal onset
b. generalized onset
c. unknown onset

A

b. generalized onset (non-motor)

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5
Q

unknown onset seizures are either motor (tonic clonic/other motor), non-motor, or _________

A

unclassified

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6
Q

what is it called when seizure activity spreads from a focus in one part of the brain?

a. focal seizure
b. focal to bilateral seizure
c. primary generalized seizure

A

a. focal seizure

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7
Q

which seizures propagate via diffuse interconnections between the thalamus and cortex, with the earliest clinical signs show involvement of both brain hemispheres?

a. focal seizures
b. focal to bilateral seizures
c. primary generalized seizure

A

c. primary generalized seizure

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8
Q

what is it called when a focal seizure progresses to secondary generalized seizures via projections to the thalamus?

a. primary generalized seizure
b. focal to bilateral
c. focal to trilateral

A

b. focal to bilateral

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9
Q

“impaired awareness” was previously referred to as _____ ______

A

complex partial

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10
Q

what are automatisms?

A

repetitive motor behaviors which pts have no memory of; common in “impaired awareness” focal seizures

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11
Q

true or false: aura is common in impaired awareness focal seizures

A

true

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12
Q

what is a postictal state?

A

confused/disoriented state after a seizure subsides

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13
Q

which has a slower onset?

a. typical absence seizure
b. atypical absence seizure

A

b. atypical absence seizure

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14
Q

typical absence seizures are also referred to as ?

A

petit-mal

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15
Q

which type of absence seizure is described?

-10-45 sec loss of consciousness
-staring or eye flickering
-begin abruptly
-often repetitive
-pt may not realize it after
-no convulsions, aura, or postictal periods

a. typical
b. atypical

A

a. typical

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16
Q

which is more difficult to control pharmacologically?

a. typical absence
b. atypical absence

A

b. atypical absence

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17
Q

which type of seizure is referred to as grand-mal?

a. typical absence
b. primary generalized tonic-clonic
c. focal to bilateral tonic-clonic

A

b. primary generalized tonic-clonic

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18
Q

what are paroxysmal depolarizing shifts (PDSs)? (from internet)

A

abnormal fluctuations of the neuronal membrane voltage; hallmark of epilepsy disorders; consists of a large depolarization that triggers a burst of APs

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19
Q

paroxysmal depolarizing shifts: depolarization involves the activation of _____ and _____ channels by the NT _________, and voltage gated calcium channels leading to an _____ of Ca2+ ions

A

AMPA; NMDA; glutamate; influx

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20
Q

paroxysmal depolarizing shifts: depolarization is followed by __________ involving activation of _______ receptors (influx of Cl-) and voltage- and calcium-dependent K+ channels leading to an ______ of K+

A

hyperpolarization; GABA; efflux

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21
Q

in paroxysmal depolarizing shifts, which is normally dampened by feed-forward and feedback inhibition - involving GABAnergic neurons - in a typical cortical neuron circuit?

a. repolarization
b. hyperpolarization
c. depolarization

A

c. depolarization (neuronal signaling)

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22
Q

main pathophysiological reason for paroxysmal depolarizing shifts

A

disrupted balance of excitation/inhibitory NTs

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23
Q

Which of the following occurs during the hyperpolarization phase of a PDS?

a. influx of Cl- ions resulting from GABA-A receptor activation
b. influx of K+ through voltage- and calcium-dependent K+ channels
c. activation of NMDA receptors
d. all of the above

A

a. influx of Cl- ions resulting from GABA-A receptor activation

(B is efflux; C is involved in depolarization)

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24
Q

what is the inhibitory NT?

A

GABA

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25
Q

what is the excitatory NT?

A

glutamate

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26
Q

which of the following activates the GABA-A receptor? SELECT ALL THAT APPLY

a. barbiturates
b. benzodiazepines
c. valproate
d. gabapentin
e. vigabatrin
f. tiagabine

A

a. barbiturates
b. benzodiazepines

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27
Q

which of the following increases GABA levels?

a. barbiturates
b. benzodiazepines
c. valproate
d. gabapentin
e. vigabatrin
f. tiagabine

A

c. valproate

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28
Q

which of the following increases GABA release?

a. barbiturates
b. benzodiazepines
c. valproate
d. gabapentin
e. vigabatrin
f. tiagabine

A

d. gabapentin

29
Q

which of the following inhibits GABA transaminase?

a. barbiturates
b. benzodiazepines
c. valproate
d. gabapentin
e. vigabatrin
f. tiagabine

A

e. vigabatrin

30
Q

which of the following inhibits GAT-1?

a. barbiturates
b. benzodiazepines
c. valproate
d. gabapentin
e. vigabatrin
f. tiagabine

A

f. tiagabine

31
Q

which of the following is an antagonist of NMDA receptors?

a. felbamate
b. topiramate
c. phenytoin
d. carbamazepine

A

a. felbamate

32
Q

which of the following is an antagonist of kainate/AMPA receptors?

a. felbamate
b. topiramate

A

b. topiramate

33
Q

phenytoin elimination kinetics are

a. dose-independent, leading to non-linear PK
b. dose-independent, leading to linear PK
c. dose-dependent, leading to non-linear PK
d. dose-dependent, leading to linear PK

A

c. dose-dependent, leading to non-linear PK

34
Q

therapeutic plasma level range for phenytoin

A

7.5-20 ug/mL

35
Q

true or false: phenytoin can be displaced from plasma proteins by other drugs, and can induce CYP P450 enzymes in the liver

A

true

36
Q

what two drugs are iminostilbenes?

A

carbamazepine and oxcarbazepine

37
Q

MOA of carbamezipine

A

binds and stabilizes the inactive state of Na+ channels

38
Q

carbamazepine can cause what serious skin rash?

A

Steven-Johnsons Syndrome/toxic epidermal necrolysis

39
Q

what hypersensitivity reaction is possible with carbamazepine? (not Stevens-Johnson Syndrome)

A

DRESS (drug rxn with eosinophilia and systemic sx)

40
Q

what TWO drugs that we discussed are classified as barbiturates?

a. phenytoin
b. carbamazepine
c. phenobarbital
d. clonazepam
e. primidone
f. gabapentin
g. diazepam

A

c. phenobarbital
e. primidone

41
Q

MOA of phenobarbital

A

binds to allosteric site on GABA-A receptor, inc DURATION of Cl- channel-opening events (and thus enhancing GABA inhibitory signaling)

42
Q

which barbiturate is the drug of choice in infants up to 2 months of age?

a. primidone
b. phenobarbital

A

b. phenobarbital

43
Q

toxicities for phenobarbital (2 of them)

A

-sedation
-physical dependence (potential for abuse)

44
Q

what TWO drugs that we discussed are benzodiazepines?

a. phenytoin
b. carbamazepine
c. phenobarbital
d. clonazepam
e. primidone
f. gabapentin
g. diazepam

A

d. clonazepam
g. diazepam

45
Q

Diazepam is especially useful for which seizure disorder? What is its route of administration for seizure control?

A

tonic-clonic status epilepticus; administered as rectal gel

46
Q

diazepam MOA

A

binds to allosteric site on GABA-A receptor, inc FREQUENCY of Cl- channel-opening events (and thus enhancing GABA inhibitory signaling)

47
Q

true or false: diazepam is useful for chronic tx of seizures

A

false (due to tolerance)

48
Q

which drug is useful for acute tx of epilepsy and absence seizures?

a. diazepam
b. clonazepam

A

b. clonazepam

49
Q

vigabatrin MOA

A

irrev inhibitor of GABA transaminase (GABA-T), the enzyme that degrades GABA

50
Q

vigabatrin is used as ________ therapy for _____ pts with seizures

A

adjunct; refractory

51
Q

true or false: tiagabine is used as first line therapy for seizures

A

false (adjunct)

52
Q

tiagabine MOA

A

inhibits GABA- transporter (GAT-1)

53
Q

which is a shared toxicity of vigabatrin and tiagabine? SELECT ALL THAT APPLY

a. sedation
b. weight gain
c. depression
d. ataxia
e. psychosis
f. tremor
g. visual field defects

A

a. sedation
c. depression

54
Q

which of the following drugs can cause visual field defects?

a. vigabatrin
b. tiagabine

A

a. vigabatrin

55
Q

which of the following drugs can cause ataxia?

a. vigabatrin
b. tiagabine

A

b. tiagabine

56
Q

do tiagabine and vigabatrin target a presynaptic or post-synaptic target?

A

presynaptic (GAT-1 and GABA-T)

57
Q

do phenobarbital and benzodiazepines target a presynaptic or postsynaptic target?

A

postsynaptic (GABA-A receptors)

58
Q

what is the main toxicity of felbamate?

A

severe hepatitis

59
Q

which is used as a 3rd line drug for refractory cases (especially for focal seizures)?

a. felbamate
b. topiramate
c. gabapentin

A

a. felbamate

60
Q

which drug’s MOA is to block T-type calcium channels (low-threshold current) in thalamic neurons?

a. phenytoin
b. carbamazepine
c. ethosuximide
d. felbamate
e. topiramate

A

c. ethosuximide

(these channels are involved in generating the rhythmic discharge of an absence attack)

61
Q

ethosuximide is only used to treat which type of seizure?

A

absence

62
Q

Which of the following statements is TRUE?

a. Tiagabine inhibits GABA transaminase.
b. Gabapentin increases Cl- influx in postsynaptic neurons.
c. Topiramate is an NMDA receptor antagonist.
d. Phenytoin is stabilized by the co-administration of carbamazepine.

A

b. Gabapentin increases Cl- influx in postsynaptic neurons.

(A targets GABA transporter; C is an AMPA receptor antagonist; D can work by itself to block Na channel)

63
Q

gabapentin and pregabalin MOA (2 things; this slide did not have a star on it)

A

-inc GABA release
-dec presynaptic Ca2+ influx, thereby reducing glutamate release

64
Q

levetiracetam MOA (3 things to know)

A

-binds the synaptic vesicular protein SV2A and interferes with synaptic vesicle release and neurotransmission
-interferes with calcium entry through calcium channels and with intraneuronal calcium signaling
-candidate for tx of status epilepticus cases that are refractory

65
Q

what drug is an analog levetiracetam, but has a higher affinity for SV2A?

A

brivaracetam (Briviact)

66
Q

molecular targets at the excitatory synapse: what is the common target of ethosuximide, lamotrigine, levetiracetam, and valproate?

a. Na+ channels
b. Ca2+ channels
c. NMDA receptors
d. AMPA receptors

A

b. Ca2+ channels (valproate also does a)

67
Q

molecular targets at the excitatory synapse: what is the common target of phenytoin, carbamazepine, lacosamide, lamotrigine, and valproate?

a. Na+ channels
b. Ca2+ channels
c. NMDA receptors
d. AMPA receptors

A

a. Na+ channels (valproate also does b)

68
Q

valproate inhibits what two channels?

A

Na+ and Ca2+

69
Q

Slide 36 is a picture and has a star on it, make sure to look at it

A

Ok

PHRM 845 Therapeutics (34 decks)

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