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Pharmacology > Neuro- Epilepsy/Seizures > Flashcards

Neuro- Epilepsy/Seizures Flashcards

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1
Q

what seizure involves only one portion of one hemisphere and can be sensory OR motor in nature that has no impairment in consciousness

A

simple partial… now called focal seizure

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2
Q

what seizure involves only one portion of one hemisphere and can be sensory OR motor in nature WITH impaired consciousness

A

Complex partial

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3
Q

MC generalized seizure?

A

Grand Mal (tonic-clonic)

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4
Q

Alternating muscle contractions and relaxations + LOC

A

Grand Mal (tonic-clonic)

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5
Q

Brief impairment of consciousness, may present in kids aged 3-5YO
*patient stares into space
*has rapid eye blinking
NO postictal phase

A

absence

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6
Q

List the generalized seizures

*which has no postictal phase

A
  1. grand mal tonic clonic
  2. absence–no PI phase
  3. Myoclonic
  4. Atonic
  5. Clonic
  6. Tonic
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7
Q

Muscle contractions confined to one part of the body

A

myoclonic seizure

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8
Q

Sudden loss of muscle tone or “drop attacks”

A

atonic seizure

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9
Q

Short episodes of muscle contractions, may resemble myoclonic, but with consciousness more impaired

A

Clonic

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10
Q

Increased tone in extension muscles —-lasts less than 60 seconds

A

Tonic

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11
Q

General MOA of anti-seizure medications (3)

A
  1. Blocks voltage gated NA or CA channels
  2. Enhances GABAergic impulses
  3. Interferes with excitatory glutamate transmission
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12
Q

Define anticonvulsant

-produces_____?

A

helps terminates convulsive seizures

-produces significant degree of SEDATION

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13
Q

Define anti-epileptic

-decreases____?

A

used PROPHYLACTICALLY to reduce or prevent epileptic seizures
-decreases excitability of brain cells

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14
Q

T/F: Antiseixure medications suppress seizures but do not cure or prevent epilepsy

A

TRUE

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15
Q

define drug characteristics to include when picking AED

A
  • cost

- drug interactions

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16
Q

choice of AED tx is based on:

A
  1. classification of seizures
  2. PT specific variables (age, comorbidites, lifestlye, personal preference)
  3. characteristics of drug
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17
Q 
FOCAL epilepsy (simple, complex) : general drug NON ELDERLY PT regime 
1st 
2nd
3rd
4th
A

1st: Lamotrigine, Levetiracetam or Topiramate
2nd: Carbamazepine or Lacosamide or Pregabalin or Zonisamide
3rd: Divalproex, Gabapentin, Oxcarbazepine, Phenytoin
4th: vagal stimulator

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18
Q 
FOCAL epilepsy (simple, complex) : general drug FOR ELDERLY PT regime 
1st 
2nd
3rd
4th
A

1st: Lamotrigine
2nd: Gabapentin
3rd: Carbamazepine
4th: vagal stimulator

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19
Q

TX regime for absence seizure:
1st
2nd
3rd

A

1st: Ethosuximide
2nd: Valporic acid (depakote)
3rd: Lamotrigine (Lamictal)

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20
Q

TX regime for SE:
1st
2nd
3rd

A

1st: IV BENZOS—- Lorazepam** or Diazepam
2nd: IV Phenytoin or Fosphenytoin IM
3rd: IV Phenobarbital

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21
Q

Epileptic Tonic-Clonic seizure in PEDS PT… what is a good 1st line

A

Lamotrigine? or Topiramate?

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22
Q

1st line tx for myoclonus

A

Valporic acid *****

clonazepam

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23
Q

1st line tx for febrile seizure

A

Phenobarbital

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24
Q

MOA for benzodiazepines

A

Increase inhibitory effects of GABA—they bind to GABA receptors and therefore reduce firing rate

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25
when are benzos usually used in tx of seizures
emergent setting or acute tx due to tolerance
26
List the intermediate acting benzos
Lorazepam---ativan (first line in SE)
27
List the long acting benzos
diazepam (valium) and clonazepam (klonopin)
28
Do benzos cause sedation?
YES!
29
reversal agent for benzo OD
Flumazenil reveres the sedation property in OD
30
SE of class of anti-seizure meds
``` N/V sedation ataxia Rash ***HYPONATREMIA **** wt gain or loss teratogenetic osteoporosis ```
31
which drugs can worsen absence seizure?
Gabapentin | Carbamazepine
32
MOA for cabamazepine
- Prolongs inactivation of NA+ channels (blocks NA) - decreases the neuronal influx of sodium ions - prevents high freq and repetitive firing of neurons
33
Phenytoin side effects
``` P: P-450 drug interactions H: Hirstuism (excess facial hair growht in women) E: enlarged gums--gingival hyperplasia N: nystagmus Y: yellow discoloration of skin T: teratogenic O: osteomalacia I: interfere with folate/B12 absorption N: Neuropathies--vertigo and ataxia ```
34
Carbamazepine side effects | *mnemonic
H--hyponatremia**** (esp eldery) and hepatotixc E--eosinophillia A---agranulocytosis, ataxia, aplastic anemia D---Diplopia, dizziness S---SJS, Splenomegaly
35
SE for Valproate (valproic acid)
``` V----vomiting A--alopecia L---liver toxicity P---Pancreatitis/Pancytopenia R---retention of fats (wt gain) O----oedema (periphereal) A---Anorexia T---Tremor E---Enzyme inhibitor---P450 drug interactions ```
36
Indications for Carbamazepine
partial--simple and complex gen tonic-clonic mania Bipolar disorder (2nd line) Trigeminal neuralgia **** (frist line)
37
What is the tx for trigeminal neuralgia 1st line
Carbamazepine
38
Can you prescribe carbamazepine in pregnancy?
no
39
which AED drugs cause hyponetremia
Carbamazepine (esp in eldery)
40
Phenobarbital drug clas?
barbituate and hypnotic
41
T/F: all barbituates are anticonvulsants and have epilpetic properties
FALSE | *****yes true that all barbituates are anticonvulsants but not ALL are antiepilpetic *only a few are
42
MOA phenobarb
increases inhibitory effect of GABA | Decrs release of glutamate
43
Indications for phenobarb
FIRST LINE TX IN FEBRILE SZ - status ep after phenytoin administration - partial (simplex and complex) - gen TC
44
SE for phenobarb
``` Depression****** osteoporosis ***** irritability ****** sedation hypnosis ```
45
which drug is part of Hydantoins?
Phenytoin
46
what is an advantage to using phenytoin as an AED?
little sedation!!! | no CNS depression
47
MOA for phenytoin
Prolongs inactivation pd of NA channels
48
indicatoins for phenytoin
IV in acute situations----second line SE *** | -focal and generalized sz
49
routes of adminstration for Phenytoin
IV**** | DO NOT GIVE IM
50
Do you need to monitor drug levels for phenytoin
yes
51
SE of phenytoin
``` Gingival hyperplasia rash--erythema multiforme and SJS hirtuism dizziness ataxia diplopia postural imbalance teratogenic ```
52
Phenytoin and Fosphenytoin--which cann be admin IM?
Fosphenytoin only | **second line too for SE if cant get IV
53
Valproic Acid MOA
- blocks NA - Enhances GABA + NMDA - Blocks CA ***provides broad spectrum of anti-seizure activity
54
INDS for Valproic acid
Bipolar - absence sz - gen TC sz - partial sz * *first line for myoclonic
55
valproic acid is 1st line tx in what sz
myoclonus
56
SE for valproic acid
**pancreatitis **hepatotoxicity n/v/d tremor teratogenic
57
which AED can cause pancreatitis?
Valproic acid
58
which AEDs are teratogenic
phenytoin valproic acid carbamazepine
59
Lamotrigine MOA
Inactivates NA and CA
60
INDS for lamotrigine
wide variety of seizures | Bipolar
61
SE lamotrigine
``` dizzines ataxia sleepiness allergic rash HA visual disutrbances rare cases SJS ```
62
What do we do if we add Divalpproex to our tx with Lamotrigine
We must reduce the dose of Lamotrigine
63
what can occur if you titrate Lamotrigine too fast?
Rash can develop----can progress to LT anaphylaxsis
64
Levetiracetam (keppra) used when??
as adjunct therapy in tx of: - partial - myoclonic - generalized TC *kids and adults*
65
SE of Levetriacetam
``` Sleepiness dizziness HA tiredness nervousnss mood alteration ```
66
what is a good adjunct tx to add for partial, myoclonic or gen TC seizures?
Levetriacetam
67
Topiramate INDS
TC and partial SZs | *prevention of migraines
68
Which AED mediaction can also help in TX of mirgraines?
Topiramate
69
SE of Topiramate
``` sleepiness dizziness tiredness mental confuseion RENAL STONES*** ```
70
which drug can cause renal stones
Topiramate | Zonisamide
71
Zonisamide IND
Gen TC and partial | myclonus
72
SE for Zonisamide
minor cns disturbances sleepiness rashes renal stones
73
Felbamate MOA
broad spectrum * na block * CA block * glutamate block * enhance GABA
74
SE for Felbamate
* **aplastic anemia | * **liver failure
75
IND for Felbamate
Refractory epilepsies
76
which drug can cause aplastic anemia
Felbamate
77
Gabapentin MOA
*ANALOG OF GABA* blocks CA decreases glutamate
78
Gabapentin SE
**FEW*** -HA dizziness tiredness adjust dose for PT with renal dx...
79
What is a good AED for elderly
gabapentin
80
INDS for gabapentin
focal sz | post-herpectic neuralgia for PAIN
81
what drug do we give for fibromyalgia
Pregabalin
82
Lacosamdie IND
*add on tx with other drugs (adjunct) for partial seizures in PT >17 YO
83
MOA for Lacosamide
blocks NA
84
what is a good adjunct tx for partial seizures in PT 17+
Lacosamide
85
SE for Lacosamide
blury vision dizzines ataxia electrical issues with heart can occur too

Pharmacology (28 decks)

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