M2.7 Flashcards
(79 cards)
1
Q
A family of different RECURRENT SEIZURE disorders that have in common the sudden, excessive, and disorderly discharge of cerebral neurons
A
EPILEPSY
2
Q
- refers to an abnormal, synchronized, electrical depolarization of neurons in the CNS
- may be caused by:
* idiopathic in nature
* CNS infections
* fever
* metabolic defects
* cerebral trauma
A
SEIZURE
3
Q
CLASSIFICATION OF SEIZURE
Etiologic classification
A
Primary - Idiopathic
Secondary - Symptomatic
4
Q
CLASSIFICATION OF SEIZURE
Seizure Pattern Classification
A
Partial
General
5
Q
CATEGORIES OF SEIZURE
affects the HEMISPHERE
A
Partial (focal) Seizures
6
Q
CATEGORIES OF SEIZURE
- Partial that BECOMES generalized
- accompanied by LOSS OF CONSCIOUSNESS
A
Partial with secondary generalization
7
Q
CATEGORIES OF SEIZURE
- affects BOTH hemispheres
- accompanied by LOSS OF CONSCIOUSNESS
A
Primarily generalized seizures
8
Q
CATEGORIES OF SEIZURE
- arise in ONE cerebral hemispheres
- Simple partial seizure
- Complex partial seizure
A
PARTIAL (FOCAL) SEIZURES
9
Q
CATEGORIES OF SEIZURE
PARTIAL (FOCAL) SEIZURE:
* NO alteration of consciousness
A
SIMPLE PARTIAL SEIZURE
10
Q
CATEGORIES OF SEIZURE
PARTIAL (FOCAL) SEZIURE:
* LOSS of consciousness
* chewing movements (lip smacking)
* diarrhea and urination
A
COMPLEX PARTIAL SEIZURE
11
Q
CATEGORIES OF SEIZURE | GENERALIZED SEIZURES
- GRAND MAL EPILEPSY
- full body convulsion
- uncontrolled urination and defacation
- tounge and cheek may be bitten
A
TONIC-CLONIC SEIZURE
12
Q
CATEGORIES OF SEIZURE | GENERALIZED SEIZURES
- PETIT MAL epilepsy
- sudden onset and abrupt cessation
- involves a brief, abrupt, and self-limiting loss of consciousness (BLANK STARE)
- rapid eye blinking
A
ABSENCE SEIZURE
13
Q
CATEGORIES OF SEIZURE | GENERALIZED SEIZURES
- rhythmic, jerking spasms
A
MYOCLONIC SEIZURE
14
Q
CATEGORIES OF SEIZURE | GENERALIZED SEIZURES
- sudden LOSS of ALL MUSCLE TONE
over relaxation of muscle
A
ATONIC SEIZURE
15
Q
CATEGORIES OF SEIZURE | GENERALIZED SEIZURES
- develops in YOUNG children (3 months - 5 years)
- accompanied by HIGH fever
- consist of GTC convulsions of short duration
A
FEBRILE (INFANTILE) SEIZURE
16
Q
CATEGORIES OF SEIZURE
- reccurent episodes of GENERALIZED TONIC-CLONIC seizure WITHOUT regaining consciousness
- seizure that lasts more than 5 minutes
A
STATUS EPILEPTICUS
17
Q
- Epileptic Syndrome and NOT a seizure type
- characterized by MYOCLONIC JERKS of the body with sudden FLEXION or EXTENSION of the body and limbs
A
INFANTILE SPASM
18
Q
ANTISEIZURES OR ANTICONVULSANTS
Glutamate INHIBITOR
A
Phenytoin
Lamotrigine
Phenobarbital
19
Q
ANTISEIZURES OR ANTICONVULSANTS
NMDA-receptor antagonist
A
Felbamate
Valproic acid
20
Q
ANTISEIZURES OR ANTICONVULSANTS
broadest spectrum
A
Valproic acid
21
Q
ANTISEIZURES OR ANTICONVULSANTS
T-type-Calcium channel blocker
A
Ethosuximide
(Valproic acid)
22
Q
ANTISEIZURES OR ANTICONVULSANTS
what MOLECULAR TARGET:
Phenytoin, Fosphenytoin, Carbamazepine….
A
Voltage-gated SODIUM channels
23
Q
ANTISEIZURES OR ANTICONVULSANTS
what MOLECULAR TARGET:
Ethosuxomide
A
Voltage-gated CALCIUM channel (T-type)
24
Q
ANTISEIZURES OR ANTICONVULSANTS
what MOLECULAR TARGET:
Retigabine (ezogabine)
A
Voltage-gated POTASSIUM channels
25
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Phenobarbital**, **Primidone**, **Benzodiazapines**
GABA A receptors
26
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Tiagabine**
GAT-1 GABA transporter
27
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Vigabatrin**
GABA transaminase
28
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Levetiracetam**
SV2A
29
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Gabapentin**, **Pregabalinl**
α2δ
30
# **ANTISEIZURES OR ANTICONVULSANTS**
what MOLECULAR TARGET:
**Perampanel**
AMPA receptor
31
**Calcium channel** type for **BRAIN**
T TYPE
32
**Calcium channel** type for **HEART**
L TYPE
33
# **ANTISEIZURES OR ANTICONVULSANTS**
prodrug for **PHENYTOIN**
FOSPHENYTOIN
34
# **ANTISEIZURES OR ANTICONVULSANTS**
serves largely as a prodrug for **LICARBAZEPINE**
OXCARBAZEPINE
35
# **ANTISEIZURES OR ANTICONVULSANTS**
a prodrug for **S-LICARBAZEPINE**
ESLICARBAZEPINE ACETATE
36
# **ANTISEIZURES OR ANTICONVULSANTS**
prodrug for **GABAPENTIN**
GABAPENTIN ENACARBIL
37
# **ANTISEIZURES OR ANTICONVULSANTS**
* **PROTOTYPE** antiseizure drug
* enzyme **inducer** capable of **auto induction**
* DOC for **PARTIAL seizure**
* DOC for **TRIGEMINAL NERUALGIA** -- one of the most painful condition
* AE: **Ataxia**, **Diplopia**, **NEURAL TUBE DEFECT (spina bifida)**, **Steven Johnson Syndrome**
CARBAMAZEPINE
38
# **ANTISEIZURES OR ANTICONVULSANTS**
DOC for **PARTIAL seizure**
CARBAMAZEPINE
39
# **ANTISEIZURES OR ANTICONVULSANTS**
DOC for **TRIGEMINAL NEURALGIA**
CARBAMAZEPINE
40
# **ANTISEIZURES OR ANTICONVULSANTS | CARBAMAZEPINE**
TERATOGENICITY
Neural tube defect (spina bifida)
41
# **ANTISEIZURES OR ANTICONVULSANTS | CARBAMAZEPINE**
**dose**-related AE
Ataxia
Diplopia
42
# **ANTISEIZURES OR ANTICONVULSANTS**
____ has **fewer** adverse effects and drug interactions that carbamazepines
OXCARBAMAZEPINE
43
# **ANTISEIZURES OR ANTICONVULSANTS**
* enzyme **inducer**
* **1ST LINE** for **FOCAL seizure**
* NEVER give **intramuscularly** (water insoluble)
PHENYTOIN
44
# **ANTISEIZURES OR ANTICONVULSANTS**
**1ST line** for **FOCAL seizure**
PHENYTOIN
45
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
ADVERSE EFFECT:
**most common**
nystagmus
46
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
ADVERSE EFFECTS:
**dose**-related
ataxia
diplopia
47
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
ADVERSE EFFECTS:
**cosmetic change**
gingival hyperplasia - prominent gum
hirsutism - hair overgrowth
48
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
ADVERSE EFFECTS:
**idiosyncratic**
Steven Johnson Syndrome
Blood dyscrasia
49
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
ADVERSE EFFECTS:
**teratogenic**
Fetal hydantoin syndrome
Carniofacial abnormalities
50
# **ANTISEIZURES OR ANTICONVULSANTS | PHENYTOIN**
* **water SOLUBLE** derivative
* can be given **IV** or **IM**
FOSPHENYTOIN
51
# **ANTISEIZURES OR ANTICONVULSANTS**
* has the **BROADEST SPECTRTUM**
* MOA: **increase GABA**, **block Na**, **Ca conductance** (inhibit Na Ca channel)
* **only** anticonvulsant that is enzyme **INHIBITOR**
VALPROIC ACID
52
# **ANTISEIZURES OR ANTICONVULSANTS | VALPROIC ACID**
ADVERSE EFFECTS
Hepatotoxic
Neural tube defect (spina bifida)
53
54
a developmental **birth defect** involving the **neural tube:** **INCOMPLETE CLOSURE** of the **embryonic neural tube** results in an **incompletely formed spinal cord**
SPINA BIFIDA
55
# **ANTISEIZURES OR ANTICONVULSANTS**
* **highly PROTEIN BOUND**
* **SAFE** for **pregnant** and **child**
* DOC for **FEBRILE seizures**
PHENOBARBITAL
56
# **ANTISEIZURES OR ANTICONVULSANTS**
DOC for **FEBRILE seizures**
PHENOBARBITAL
57
# **ANTISEIZURES OR ANTICONVULSANTS | PHENOBARBITAL**
* converted to **phenobrbital**
* **alternative choice** for **adults** who have **partial** and **generalized** seizures
* **2 active metabolites** are **phenobarbital** and **phenylethylmalonamide (PEMA)**
PRIMIDONE
58
# **ANTISEIZURES OR ANTICONVULSANTS**
2 active metabolites of **PRIMIDONE**
Phenobarbital
Phenylethylmalonamide (PEMA)
59
# **ANTISEIZURES OR ANTICONVULSANTS**
* **Ca channel** (T-type) **blocker**
* DOC for **ABSENCE seziure**
* **reducre** the **T-type Ca** currents in **tahalamic neurons**
* AE: **GI** effects, **headache**, **dizziness**, **blood dyscrasias**
ETHOSUXIMIDE
60
# **ANTISEIZURES OR ANTICONVULSANTS**
DOC for **ABSENCE seizure**
ETHOSUXIMIDE
61
# **ANTISEIZURES OR ANTICONVULSANTS**
* **Na channel** **blocker**
* effective as **monotherapy** for **PARTIAL seizures**
* also active againsts **absence** and **myoclonic seizures** in **children**
LAMOTRIGINE
62
# **ANTISEIZURES OR ANTICONVULSANTS**
effective **monotherapy** for **PARTIAL** seizures
LAMOTRIGINE
63
# **ANTISEIZURES OR ANTICONVULSANTS**
* **SELECTIVELY bind** to **synaptic vesicular protein (SV2A)** preventing the **release** of **glutamate** --- does not cause drug interaction
LEVETIRACETAM (KEPPRA)
64
# **ANTISEIZURES OR ANTICONVULSANTS**
* indicated particularly for **PARTIAL seizure**
* **IRREVERSIBLY** inhibits **GABA aminotransferase (GABA-T)** -- the enzyme responsible for the **degradation** of GABA
* typical toxicities: **drowsiness**, **dizziness**, **weight gain**
* **contraindicated** to patients with **MENTAL ILLNESS**
* AE: **dizziness**, **nausea**, **headache**, **diplopia**
VIGABATRIN
65
# **ANTISEIZURES OR ANTICONVULSANTS**
* **blocks NMDA receptors**
* has **weak** effects on **sodium** channels and **little effect** on **GABA**
* **increases PLASMA CONCENTRATION** of **phenytoin** and **valproic acid** concentration but **DECREASES** levels of **carbamazepine**
FELBAMATE
66
# **ANTISEIZURES OR ANTICONVULSANTS | FELBAMATE**
**INCREASES plasma concentration** of ____ and ____
phenytoin & valproic acid
67
# **ANTISEIZURES OR ANTICONVULSANTS | FELBAMATE**
**DECREASES** levels of ____
carbamazepine
68
# **ANTISEIZURES OR ANTICONVULSANTS**
* an **analog** of **GABA**, but **NOT acting** on GABA receptor
* **antiepileptic effect** is **poorly** understood
* effective as an **adjunct** against **PARTIAL** and **GTC** seizures
* AE: **somnolence**, **dizziness**, **ataxia**, **headache**, and **tremor**
GABAPENTIN
69
# **ANTISEIZURES OR ANTICONVULSANTS**
* MOA is **similar** to **carbamazepine** and **phenytoin**
* also potentiates **inhibitory effects** og **GABA** by acting at a different receptor from the BZD or barbiturate site
* AE: **cognitive slowing**, **parathesias**, **somnolence**, **fatigue**, **nervousness**, and **confusion**
TOPIRAMATE
70
# **ANTISEIZURES OR ANTICONVULSANTS**
* MOA: **inhibits GABA uptake**
* AE: **dizziness**, **nervousness**, **tremor**, **depression**, **emotional lability**
TIGABINE
71
# **ANTISEIZURES OR ANTICONVULSANTS**
* A **sulfonamide derivative** effective against **PARTIAL** and **GTC** seizures
* MOA is **unknown**
* AE: **drowsiness**, **cognitive impairment**, **formation of renal stones**
ZONISAMIDE
72
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
* potentiates the **inhibitory effect** of **GABA**
BENZODIAZEPINES
73
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
BENZODIAZEPINES:
**most effective** in **STATUS EPILEPTICUS**
| **OLD DRUG OF CHOICE**
DIAZEPAM
74
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
BENZODIAZEPINES:
also used in **STATUS EPILEPTICUS**
| **NEW DOC**
LORAZEPAM
75
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
BENZODIAZEPINES:
used in **ABSENCE seizure**, **INFANTILE spasm**, **MYOCLONIC seizure**, and **ATONIC seizure**
CLONAZEPAM
76
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
BENZODIAZEPINES:
**adjunt** medication in **COMPLEX partial seizure**
CLORAZEPATE
77
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
BENZODIAZEPINES:
used in **INFANTILE SPAMS** and **MYOCLONIC seizures**
NITRAZEPAM
78
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
* A **diuretic** (for hypertension) that **inhibits CARBONIC ANHYDRASE**
* **diminish** the **depolarizing action** of **bicarbonate** ions moving out of neurons via GABA receptor ion channel
* used for **ALL TYPES of seizures**
ACETAZOLAMIDE
79
# **OTHER DRUGS USED IN THE MNGMT OF EPILEPSY**
* the **FIRST** antiepileptic drug
* MOA is **unknown**
* useful in management of **EPILEPSY** in patients with **PORPHYRIA** -- specific substance for hemoglobin synthesis
* AE: **skin rashes**, **sedation**, **behavioral changes**
BROMIDE
