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701 > Exam 1: Seizure & Epilepsy > Flashcards

Exam 1: Seizure & Epilepsy Flashcards

(50 cards)

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1
Q

ILAE classification of common seizures

A
  1. how do they begin (focal/general)
  2. Is the person aware or impaired?
  3. Other features/ behavioral symptoms
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2
Q

Simple partial seizure

A

conscious of seizure occurring
motor, sensory, somatosensory, autonomic, behavioral manifestations

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3
Q

Complex partial seizure

A

impaired consciousness - remains after seizure
behavioral manifestations, hallucinations, same behavior every time

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4
Q

Secondary generalized

A

starts with partial onset but evolves into tonic clinic
often due to tumor, or other anatomical reason

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5
Q

Generalized Absence

A

petit mal
last seconds, generally in childhood
alteration of consciousness

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6
Q

General myoclonic

A

bilateral, involuntary rhythmic jerking of muscles

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7
Q

General Clonic

A

sustained muscle contractions
altering with relaxation

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8
Q

General Tonic

A

Sustained muscle contractions
with stiffening

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9
Q

General tonic-clonic “grand mal”

A

sudden loss of conciousness
rigid, falls to ground, lasts for 1 minute
can evolve to status epilepticus

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10
Q

General atonic

A

Drop attack, mainly in children
sudden loss of postural tone and falls to the ground

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11
Q

Pathophysiology of seizures

A

Abnormal firing of neurons due to ion channels
not enough inhibitory activity of GABA
too much excitatory activity of NMDA

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12
Q

How AED drugs work

A

Increase the inhibitory effects of GABA
Decrease the excitatory effects of NMDA (Na, Ca)

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13
Q

Causes of seizures

A

inherited
acquired
congenital
drug withdrawal
drug induced

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14
Q

Acquired seizures

A

head trauma, brain surgery, Cerebrovascular disease
infections, meningitis, flu, toxoplasmosis, Measles, mumps, syphillis
Metabolic disorders

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15
Q

Drugs withdrawal cause seizure

A

alcohol
benzodiazepines
barbituates
antiepileptics

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16
Q

Drugs that induce seizures

A

certain abx
antidiabetic drugs
anesthetics
antimalarials
antispastics
antidepressants
antipsychotics

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17
Q

Risk factors of breakthrough seizures; or if many at once, for any person

A
  1. sleep deprivation
  2. many missed AED dose
  3. alcohol withdrawal/rec drug misuse
  4. exhaustion
  5. strobe lights
  6. intercurrent infections
  7. metabolic disturbances
  8. uncommon: loud noise, hot bath
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18
Q

Rational polypharmacy

A

Risks:
1. DDI (carbamazepine + VPA = epoxide tox)
2. Drug burden (toxicity)
Rational
1. multiple MOA = synergy (lamotrigine + topiramate)

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19
Q

AED to use in pregnancy

A

Phenobarbital
lamotrigine
ethosuximide
topiramate
Oxcarbamazepine

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20
Q

AED to AVOID in pregnancy

A

phenytoin
valproic acid

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21
Q

Levetiracetam MOA

Study These Flashcards
A

AMPA glutamate receptor non-competitive antagonist

22
Q

Levetiracetam ADR

23
Q

Levetiracetam DDI

Study These Flashcards
A

enhances CNS depressants

24
Q

Levetiracetam disadvantages

Study These Flashcards
A

Renal - dose adjust

25
Lamotrigine MOA
Na block to inhibit stimulatory AA (glutamate/aspartate)
26
Lamotrigine ADR
SJS/TEN Influenza-like syndrome Somnolense, blurry vision, ataxia, HA, aggression
27
Must titrate AED
Lamotrigine Topiramate
28
Gabapentin MOA
GABA analog inhibit reuptake
29
Gabapentin ADR
somnolense Blurry vision, ataxia Fatigue, nystagmus
30
Topiramate MOA
NA block potentiates GABA
31
Topiramate ADR
Expressive aphasia Psych/cognitive dysfunction Weight loss Urolithiasis BILATERAL paresthesias (not stroke) sedation, dizziness, fatigue
32
Vigabatrin MOA
inhibits GABA metabolizing enzyme like valproic acid
33
Vigabatrin ADR
Visual field defects psychosis and depression VERY LIMITED USE - infantile spasms
34
Zonisamide MOA
Prolongs Na channel Inactivation
35
Zonisamide ADR
Loss of appetite, nausea, vomiting but well absorbed GI
36
Tigabine MOA
Inhibits GABA reuptake and increases its level
37
Tigabine ADR
Mild memory impariment Asthenia Abdominal pain sedation, dizziness,
38
Valproic acid MOA
increases GABA by inhibiting degrading enzymes
39
Valproic acid ADR
GI intolerance d/t poor solubility weight gain (increased appetite) hepatotoxicity transient hair loss NEURAL TUBE DEFECT
40
Valproic acid DDI
inhibits metabolism of CTPP Carbamazepine Topiramate Phenytoin Phenobarbital
41
VPA also used for
GENERAL seizures MANIA Migraine Prophy Mood
42
Phenytoin MOA
Na, Ca, influx block inhibits excitatory aminoacids
43
Phenytoin ADR
GINGIVAL HYPERPASIA hirsutism HYDRANTOIN SYNDROME (fetal cleft) megaloblastic anemia OSTEOMALACIA [GI upset] [CNS: sedation, HA, vertigo, nystagmus] [vein thrombosis]
44
Phenytoin also used for
partial, tonic clonic, NOT ABSENCE V FIB
45
Carbamazepine MOA
similar to phenytoin Na, Ca block
46
Carbamazepine ADR
HYPONATREMIA/water intoxication Congenital malformations RASH BLOOD dyscrasias SELF. INDUCER
47
Drugs with enzyme activity
Sodium valproate Phenytoin Carbamazepine Levetiracetam (?) Tigabine
48
AED with GI upset
VPA Pheny carba zonisamide tigabine
49
Seizure is Medical Emergency If
- Longer than 10 minutes or a 2nd one starts (status epilepticus risk) - Difficultly in rousing at 20 min interval - Compliants of vision change - Vomitting - Persistent HA after rest period - Unconscious with failure to respond - Pupils unequal or excessively dilated
50
FIRST AID for Generalized Tonic-Clonic Seizures
1. Record the time of seizure onset 2. Stay with the patient until the seizure ends 3. Have someone call 911 4. Prevent person from hurting himself or herself. Place something soft under the head, loosen tight clothing, and clear area of sharp or hard objects. 5. DO NOT 1. Force any objects into patient's mouth 2. Restrain patient's movements. 3. Pour liquids into patient's mouth or offer any food, drink or medication until fully awake 6. Turn patient on his or her side to allow saliva to drain from mouth 7. Give artificial respiration if patient does not resume breathing after seizure. 8. Provide area for patient to rest until fully awakened, accompanied by responsible adult.

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