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A-CNS Pharma > Epilipsy > Flashcards

Epilipsy Flashcards

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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
IF patient has Tonic clonic + Absence seizure the preferrd antiepilpetic is ?
Valporate due to multiple meahncims
26
Contraindicated antiepileptics in absence and myoclonia seizures
CarGaP2 Carbamazepine Gapapetnite Pregabalin Phenytoin ______________ Contr in absence ? the above 5+ Phenobarbital and Levetiracetam ________________ Cont in myclonic : the 5 above + Lamotrigine
27
Due to sedation and tolerance Benzo and phenobarbital are used mainly in ?
Acute fits and status epilipticus
28
Phenobarbital is used in ?
Tonic clonic & partial
29
Clonezpam is used as ? in epilipsy
2nd line broad spectrum
30
Adverse effects of Phenytoin as antiepliptic?
Cosmetic + pharmacokinetic disturbances :Cinteic =Irregular BA =Saturation kinetic if serum level increased to a level liver cannot control =CYP inducer: causing drug interactions
31
Indications of phenytoin Contraindications ?
in partial and Tonic-clonic In Status epilipticus _______________ CI : Absecne + Myoclonic and carbazmaepine also CI
32
Fosphenytoin Characteristics
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
compare between fosphenytoin and phenytoin in tissue side effect?
Phenytoin if extravasates may cause purple glove syndorme and tissue necrosis But Fosphenytion less tissue side effects
34
Oxcarbaepine compared to carbamazepine is ?
Less potent with less side effects ( enzyme induction and blood dyscriasis )
35
Hypersensitivity appear more in ?
Valoporate causing skin rash
36
GIT diusturbances appear more in ?
valproate
37
Neurological disutrbances of Phenytoin ,carbamazepine and valproate ?
Phenytoin : Nystagmus - dipolopia -ataxia -drowiness- decrasing learninig in children ____________________________ Carbamazpeine : diplopia -ataxia -doriwsness ____________ Valproate : Fine hand termores + ataxia Less sedation
38
Hepatic CYP 450 Affected by anitepliptic show ?
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
Megaloblastic anemia can occur by,,,,while lecopenia and Agranulocyotsis by ,,,,,,, ?
Phenytoin megalo Agranulo ? = Carbmazepine
40
Thromboctosis can occur by?
Valproate
41
Spina bifida and Neural tube defects occur by ?
Valproate
42
Cleft + lip palate + Heart anomalies can occur by ?
Phenytoin
43
Adverse effect of phenytoin ?
Cosmetic + Unpredictible level _________________________ Cosmetic :GFH Gingival Hyperplasia Coarse features hirsutism +acne
44
Mention avdverse effects of Valproate
HAPO Valproate Hepatoxic Alopecia hair loss Polycystic ovaries Overwieht with increased appetite
45
Water intoxication with Diltional hyponatermia is due to ?
Carabamazepine increasing ADH
46
eTHOSUXMIDE indication + adverses
Narrow specrtum for Abscnese _________________ GIT symtpms Skin rash Diziness -Drowsness -headache
47
Steven johnison syndrome caused by?
it is fatal hypersensitivty dermaititis by ? Lamotrigine
48
Never ever give lamotrigine with ? valproate why?
Due to valproate enzyme inhibtion causing increased level of lamotrigine pericptating Steven johnoson sundorme
49
adjust Lamotrigine dose if given with Oral contaceptive and Carbamazepine why ?
As they are enzyme inductors casuing its level to be decreased
50
Levetiracetam with renal patients
should be adjusted beacuse it is renally excreted
51
Levetiracetam is broad spectun exept ?
abscence seizures ________________ It casues mood and behavioral changesa Aggession agitaiton and depression
52
Gapapetinoids used in focal epilpisy indications ? with adverses of Dizzness dowinsness sedation atxia Wiegh gain
NAR Neuropathic pain restless leg syndrome Antianxiety
53
Mention adverses of Gapapetioids
PRA =Peripheral edema =Excreted renally only as levetiracetam =Risk of abuse due to euphoric effect in Nucleus accumbnes _______________________
54
Mention adverse effects of Topiramate
RMHW 1-Renal stones 2-Myopia + glacuoma 3-weight loss 4-hypohidrosis with less sweat causing hyperthermia
55
Topiramate indication
Broas spectrum antiepiletoic &Migrane
56
Renal stones occur with ?
taz Topiramate Acetazolamide = CAI Zonisamide
57
dose adjustment of antipeplitoics should be done in elderly why ?
=Decreased clearance : Carbamazepine and Lamotrigine =Decreased protein binding : phenytoin and Valproic acid
58
Drug perferred in elderly ?
Carbamazpine Levetiracetam Lamotrigine Gabapentin CL bagL
59
anitepilptics with no enzyme interactions
Levetiracetam Gapapetint and Pregabalin maily renal excretion
60
Monotherapy is perferred _______________________ Long treatment 2 years gradual withdrawal over 6 months to avoid status epilipticus _____________________ serum level monitoring ________________________
61
Mention use of antiepliptics
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
pREGNANCY Recommendations
-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
Prgancny increasing epilipsy
due to increasing metabolism of antiepiliptics with Hemodilution adjust dose ! increase the dose guided with plasma level
64
Prolonged or repeated tonic clonic seizures
Convulsive status epilipticus time is BRAIN
65
How to detect convulsice status epilipticus ?
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
Withdraw of antiepliptic may lead to ?
Status epilipticus
67
Why status epilipticus ?
TMSAHW Withdraewal of antiepilieptic Trauma Metabolic Stroke Hypoxia Alcohol or drug abuse HMST WITH ALCHOLO
68
wHY STATUS EPILIPTICUS IS FATAL ?
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
Main cause of Death from status epilipticus is ?
Lactic Acidosis
70
Mangemt of status epilitucs
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
الحمدلله رب العالمين
72
Simple partial seziure cc by?
The patient is conscoius Motor or sensort visual pscychi changes
73
Which seizure cc by aure ? describe
Complex partial seizure ____________ Visual olfactory sensory hallucination Senes of fear unusual abdominal sensations ___________________
74
The seizures has automatism in ?
Complex partial seizure as repeated involunarry movements last for 2-5 minutes
75
The seizures has automatism in ?
Complex partial seizure as repeated involuntary movements
76
postictal means and appears in ?
Confusion with amneisa except the aura in complex partial seizure
77
Absenece sieure CC by ? called petiti mal no postictal
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
Describe tonic clonic sieures
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
Myoclonic
Genralized seizure with Affecte muscle or group of muscle doing alternating contraction and relaxation Jerking or twithcing of muscle

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