Chapter 14 - Antiepileptic Drugs Flashcards Preview

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Flashcards in Chapter 14 - Antiepileptic Drugs Deck (36)
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1

What is epilepsy caused by?

excessive electrical activity of neurons in cerebral cortex

2

What is a seizure?

brief episode of abnormal electrical activity in nerve cells of brain -> may/may not lead to convulsion

3

What is a convulsion?

more severe seizure involuntary spasmodic contractions of any/all voluntary muscles in body, including skeletal, facial, and ocular

4

What is epilepsy?

chronic, recurrent pattern of seizures

5

Primary Epilepsy Another name and what cause

Idiopathic Epilepsy Cause cannot be determined more than 50% of cases

6

Secondary Epilepsy Another name and what cause

Symptomatic Epilepsy Distinct cause identified: trauma, infection, cerebrovascular disorder Infants/children: r/t developmental defects, metabolic disease/injury at birth Adults: acquired brain disorder is major cause

7

What are grand mal seizures now known as?

Generalized onset seizures

8

What is happening in generalized-onset seizures?

neuronal activity originating simultaneously in both hemispheres

9

What are the subtypes of generalized onset seizures?

1. Tonic-clonic

2. tonic

3. clonic

4. atonic (drop attacks)

5. myoclonic

6. absence and infantile spasms

10

Who is generalized onset seizures most often seen in?

children

11

How will a generalized onset seizure present itself to you?

1. loss of consciousness

2. no postical confusion

3. may have rhythmic movements

4. no convulsion

12

What are the 3 types of partial-onset seizures?

1. Simple (used to be "petit mal seizures")

2. Complex

3. secondary generalized tonic-clonic seizure

13

Characteristics of Simple Partial-onset seizures

brief loss of awareness (blank stare), no LOC

hallucinations

autonomic nervous system responses

personality changes

motor symptoms are commonly at face, arms, and leg

14

What are the classifications of seizures?

1. Partial seizures 

-simple 

-complex

2. Generalized seizures

3. Unclassified seizures

15

Characteristics of Complex Partial-onset Seizures 

impaired consciousness

memory impairment

behavioral effect

aura, chewing, swallowing, unreal feelings

tonic, clonic, or tonic-clonic seizures

16

Characteristics of Secondary Generalized Tonic-Clonic Seizure

Partial onset seizures that progress

Occurs in up to 40% of pts

Postictal confusion

17

What is an Unclassified Seizure?

Seizures that do not fit into any other category

18

What can status epilepticus lead to?

hypotension, hypoxia, and cardiac dysrhythmias

which can all lead to brain damage and death

19

What is status epilepticus?

multiple seizures occurring without recovery between

20

What can febrile seizures progress to?

Status epilepticus

21

What drugs are used to treat status epilepticus?

1. diazepam

2. fosphenytoin

3. lorazepam (off label use)

4. phenobarbital

5. phenytoin

Page 221, Table 14-3 has all the doses, onsets, etc.

22

What are Antiepileptic Drugs (AEDs) also known as?

anticonvulsants

23

What are the goals of therapy using AEDs?

control/prevent seizures while maintaining reasonable quality of life

minimize adverse effects/drug-induced toxicity

24

How long does AED therapy last? When can the pt discontinue?

therapy is usually lifelong

Pts who are seizure-free for 1-2 years may be able to discontinue

25

_______ drug therapy started before _______ drug therapy

single drug therapy started before multiple drug therapy

26

Titrate antiepileptic drugs to the lowest effective level. True or false?

True

27

MOA of AEDs

Exact MOA is unknown.

AEDs are thought to alter movement of Na, K, and Ca ions across nerve cells in the brain

1. Increase the threshold of activity (reduce nerve's ability to be stimulated)

2. Limit the spread: suppress transmission of impulses from one nerve to the next

3. Decrease the speed of nerve conduction within a neuron

28

Overall effect of MOA and AEDs

Neurons stabilized

Neuron hyperexcitability decreased

Excessive nerve impulse spread decreased

29

Indications of AEDs

prevention/control of seizure activity

long-term maintenance therapy for chronic, recurring seizures

acute treatment of convulsions and status epilepticus

other uses

30

Adverse effects of AEDs

 

Numerous - vary per drug

often necessitate change in meds

Phenytoin: long-term may cause gingival hyperplasia, acne, hirsutism, and dilantin facies

black box warning (2008): suicidal thoughts/behavior is twice the risk