Antiepileptic Drugs Context Info

Question 1

Seizure def

Answer 1

transient occurrence of signs/sx due to abnormal excessive or synchronous neuronal activity in the brain “lightening storm”

Question 2

Epilepsy def

Answer 2

enduring predisposition to generate epileptic seizures

Question 3

Epilepsy def requirements

Answer 3

at least one epileptic seizure not caued by another treatable medical condition

Question 4

what are some medical conditions that can cause a seizure?

Answer 4

fever, infection, hypoglycemia, medication (PNC, carbepenems, Bupropion)

Question 5

Diagnostic epilepsy criteria

Answer 5

at least 2 unproved seizures less than 24 hours apart OR one unprovoked seizure and probability of future seizures

Question 6

when is epilepsy considered resolved?

Answer 6

no seizures in 10 years and off meds for 5 years

Question 7

what Is AED treatment decision based off of?

Answer 7

type of seizure
side effect profile
patient preference
cost and dosing

Question 8

when do most seizures occur?

Answer 8

within first 2 years of life, treatment can lower risk of recurrence

Question 9

definition of generalized seizure

Answer 9

both hemispheres from outset

Question 10

6 examples of generalized seizure types

Answer 10

absence, tonic clonic, tonic, clonic, myoclonic, atonic

Question 11

absence seizure

Answer 11

staring out into space seems like they zoned out

Question 12

absence seizure diagnosis

Answer 12

made via sx, EEG sometimes but hard to catch during small testing time frame

Question 13

tonic clonic seizure presentation

Answer 13

classic aka grand mal
loss of consciousness, jerky motion, get them to a safe area
get onto floor and turn on side

Question 14

tonic seizure

Answer 14

all muscles stiffen may drop to floor - high risk injury

Question 15

clonic seizure

Answer 15

sustained jerky contraction of muscles that stop with restraint or repositioning of limbs

Question 16

seizure prodrome

Answer 16

changes in behavior, mood, or feelings that occurs hours or days before seizure

Question 17

aura

Answer 17

a simple partial seizure the sx correlate with what area of the brain is experiencing the abnormal electrical activity

Question 18

itcus

Answer 18

what is seen/felt during abnormal electrical activity, includes all the manifestations and sx occurring during the seizure while abnormal electrographic activity occurs

Question 19

postictal

Answer 19

what is seen/felt until brain recovers to baseline normal function.
Confusion, sleepiness, impaired awareness, paralysis until brain function returns

Question 20

todd’s paralysis

Answer 20

occurs during postictal stage, temporary paralysis after seizure until brain returns to baseline activity

Question 21

Indications to stop AED

Answer 21

seizure free 2-4 yrs, depends on seizure type
complete control within one year of onset
normal neuro exam
normal EEG
withdraw slowly over last 6 mo
onset 2-35 more likely can remove meds eventually

Question 22

GABA causes a large concentration of ____

Answer 22

chloride ions (-) to enter receiving neuron telling the neuron to STOP passing on msg

Question 23

what happens without GABA?

Answer 23

not enough stop signal so electrical activity gets out of controi

Question 24

are sodium channels open or closed in resting state?

Answer 24

closed prior to activation

Question 25

what is the brain's major excitatory NT?

Answer 25

glutamate

Question 26

what are 2 groups of glutamate receptors?

Answer 26

ionotropic and metabotropic

Question 27

ionotropic receptors do what?

Answer 27

fast synaptic transmission and they are glutamate gated cation channels

Question 28

what are 3 subtypes of ionotropic receptors?

Answer 28

AMPA, kainite, and NMDA

Question 29

what do metabotropic receptors do?

Answer 29

slow synaptic transmission, modulation of synaptic activity via G protein coupled regulation of second messengers (cAMP and phospholipase C)

Question 30

what is major inhibitory NT ?

Answer 30

GABA

Question 31

what are 2 GABA receptor types

Answer 31

GABA a and GABA b

Question 32

what gaba receptor is postsynaptic with specific recognition sites linked to Cl- channel?

Answer 32

GABA a

Question 33

what are GABA b receptors like?

Answer 33

presynaptic autoreceptors that reduce NT by lowering calcium influx and coupled to a postsynaptic G protein to increase K+

Question 34

exciatation ions

Answer 34

inward sodium and calcium currents

Question 35

excitation NT

Answer 35

glutamate and aspartate

Question 36

inhibition ions

Answer 36

inward CL and outward K+ currents

Question 37

inhibition NT

Answer 37

GABA

Question 38

8 main AED MOA

Answer 38

``` block repetitive Na channel action GABA enhancers Glutamate modulators T calcium channel blockers N and L CCB H current modulators Blockers of unique binding sites carbonic anhydrase inhibitors ```

Question 39

Sodium channel blocker examples 10

Answer 39

``` phenytoin carbamazepine oxcarbazepine valproate felbamate lamotrigine topiramate zonisamide rufinamide lacosamide ```

Question 40

GABA enhancers 8

Answer 40

``` barbiturates benzodiasepines carbamazepine valproate felbamate topiramate tiagabine vigabatrin ```

Question 41

glutamate modulators 6

Answer 41

``` phenytoin gabapentin lamotrigine topiramate levetiracetam felbamate ```

Question 42

T calcium channel blockers 3

Answer 42

ethosuximide valproate zonisamide

Question 43

N and L CCB 4

Answer 43

lamotrigine topiramate zonisamide valproate

Question 44

H current modulators 2

Answer 44

gabapentin | lamotrigine

Question 45

Blockers of unique binding sites 4

Answer 45

gabapentin levetiracetam pregabalin lacosamide

Question 46

carbonic anhydrase inhibitors

Answer 46

topiramate | zonisamide