- What is the main CNS inhibitory neurotransmitter? - What is the main CNS excitatory neurotransmitter? - How do these neurotransmitters relate to seizure activity?

- GABA - Glutamine - To little GABA or too much Glutamine will cause too much excitation, causing neurons to be active when they shouldn't be. - GABA-inhibitory - Glutamine-excitatory

- A partial seizure is localized in one ______ ________ - Partial seizures can either be _______ or ______ partial seizure. Whats the difference?

- cerebral hemishpere - simple or complex - The difference is that a simple partial seizure is a primary sensory component without LOC. In a complex partial seizure LOC may occur.

Tonic-clonic - Tonic phase: rigid ______ spasm 10-30 seconds, _______ stops, defication/micturition/salivation may occur - Clonic phase: rhythmic _____ spasm 2-4 minutes, continued LOC, alertness slowly occurs Tonic and clonic seizures are the same as the phases for the tonic-clonic seizure except for what?

- extensor, respiration - flexor -dont have others phases and only last a few seconds

Absence seizure - Most common in ______ - Less _______ but more _______ than tonic-clonic. Involves a breif ____

- children - dramatic, frequent - LOC, amnesia of event

Atonic seizures - Also known as __________ - Seddun reduction in muscle tone resulting in ________ of head/limb. Lasts about ___-____

- drop attacks - dropping, 10-30 seconds

Neurology Part 1 Flashcards by Chance Lee Cauble

EPILEPSY

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In short, what is epilepsy?

Primary vs secondary epilepsy?

-Recurrent seizures, neurons are synchronously active when they shouldn’t be
-Primary- unknown cause, accounts for >50% of cases (idiopathic)
Secondary- in children: injury at birth,metabolic diseas
in adults: TBI

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What is the main CNS inhibitory neurotransmitter?
What is the main CNS excitatory neurotransmitter?
How do these neurotransmitters relate to seizure activity?

GABA
Glutamine
To little GABA or too much Glutamine will cause too much excitation, causing neurons to be active when they shouldn’t be.
- GABA-inhibitory
- Glutamine-excitatory

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What are the two types of epilepsy?

Partial seizure

Generalized seizure

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A partial seizure is localized in one ______ ________

- Partial seizures can either be _______ or ______ partial seizure. Whats the difference?

cerebral hemishpere
simple or complex
The difference is that a simple partial seizure is a primary sensory component without LOC. In a complex partial seizure LOC may occur.

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What cerebral hemisphere is involved in a generalized seizure?

-Both, LOC

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What are the 6 types of seizures?

Which is the most common?

Tonic-clonic
Tonic
Clonic
Absence
Atonic
Myoclonic

-Tonic-clonic

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Tonic-clonic

Tonic phase: rigid ______ spasm * 10-30 seconds, _______ stops, defication/micturition/salivation may occur
Clonic phase: rhythmic _____ spasm * 2-4 minutes, continued LOC, alertness slowly occurs

Tonic and clonic seizures are the same as the phases for the tonic-clonic seizure except for what?

extensor, respiration
flexor

-dont have others phases and only last a few seconds

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Absence seizure

Most common in ______
Less _______ but more _______ than tonic-clonic. Involves a breif ____

children
dramatic, frequent
LOC, amnesia of event

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Atonic seizures

Also known as __________
Seddun reduction in muscle tone resulting in ________ of head/limb. Lasts about ___-____

drop attacks

- dropping, 10-30 seconds

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Myoclonic

-Single or multiple brief _________ of face, trunk, or extremities. Lasts for _______

contractions

- few seconds

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What are the treatment options?

Daily medication (anticonvulsants)
Surgery
Nerve stimulation: stimulate vagus nerve
Ketogenic diet

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What are the antieleptic medications referred to as?

- What does drug selection depend on?

-AED, ASD, or anticonvulsants

-Patient specific factors-age, pregnant, etc.
Type of seizures
Response to previous meds

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Medications are split into what?

What is good about the 3rd generation medications?

1st, 2nd, and 3rd generation

- possible less side effects

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What is the MOA of the medications for epilepsy?

not fully understood

- either decreases excitatory or increases inhibatory signaling

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People with epilepsy tend to have fast or long lasting activation of ________ receptors (NMDA) or a dysfunction in ______ receptors. This neuron is then considered __________ which may cause seizures.

Glutamate
GABA
hyperexcitable

-can also be caused by a decrease in GABA or an increase in Glutamate

5 MOA for medications for epilepsy:

) Block __, ___ entry
) Block _______ release
) Block ________ binding
) Block ____ and ______
) Prolong opening of ______ channels

Na+, Ca2+
glutamate
glutamate
GAT1 and GABA-T
GABA-A

What are the acute vs chronic AE of epilepsy medication?

Acute- may be concentration dependent or idiosyncratic

Chronic- due to duration of use

What are the AE associated with epilepsy medications?
Which of these AE is associated with all epilepsy medication?
What is a rare AE associated with these drugs?

Neurotoxicity
- sedation, ataxia, confusion, dizziness, blurred vision
Weight gain (a few cause weight loss)
Hypothyroidism
Rash
Idiosyncratic: mild to severe hypersensitivity reactions; may have more severe Stevens-Johnson Syndrome rash
neurotoxicity
aplastic anemia

What is key with epilepsy drugs?

Monitoring because many are NTI and they also have MANY DDI

What are the at risk populations and why?

Elderly

changes in body mass can change volume of distribution and med half life
hypoalbuminemia- can increase free drug in plasma if drug is typically highly protein bound
greater sensitivity to neuro effects
polypharmacy- DDI interactions

Children
-hepatic/renal activity changes during childhood means an increase in drug monitoring and dose adjustments

Women
-fluctuating -estrogen/progesterone may change risk of seizures throughout the menstrual cycle

Pregnant Women

increased risk of seizures and increased risk of maternal and fetal complications
risk vs benefit

Therapeutic Concerns with Epileptic Drugs:

The primary AE of this class of drugs (______,______,_____) have direct impacts on patients participation in PT.
If patient is referred to PT for gait instability, what could this be due to?

sedation, dizziness, ataxia

- could be the medication

ADHD

What are the three subtypes of ADHD?

Inattentive type
Hyperactive-impulsive type
Combined type

- The etiology (cause) of ADHD is ________: environmental, genetic, biologic - Pre and perinatal exposure to cigarettes/alcohol increases risk _-_x

- multifactorial | - 2-3x

In order to be diagnosed with ADHD, they have to be classified into _ of the 3 settings.

2 of the 3

Neurochemical and Anatomic Anomalies of ADHD: - Mostly unclear- no particulat sole defect in the ______ associated with ADHD - MRI studies have shown _____________, it is unknown where this causes ADHD or is a result of ADHD - There is a ________ dysfunction in adults with ADHD - Appears that motor (__________) and cognitive (________) result from dysfunction of different cortical sites

- brain - decreased brain volume - dopamine - hyperactivity, inattention

What are the 2 main treatments for for ADHD? | Stimulants act on both _______ and _________ while atomoxetine only acts on _________

- Stimulants, Atomoxetine | - norepinephrine and dopamine, norepinephrine

Methylphenidate (________) and Mixed Amphetamine Salts (__________) - What class of drugs are these? - What is the MOA? - What is IR and XR? - What happens if theye are taken with food?

-Ritalin, Adderral -Stimulant -Methylphenidate: blocks dopamine and norepinephrine reruptake Amphetamine: block dopamine and norepinephrine reuptake; ALSO increase dopamine and NE release -IR= immediate release; onset of 15-30 minutes, lasts 2-6hrs ER= extended release, lasts 8-12 hrs -Slower onset and decreased absorption buy may decrease AE

What are the common AE associated with stimulant medications __________ (Ritalin) and _______________ (Adderral)?

-methylphenidate, mixed amphetamine salts - decreased appetite/weight loss - stomachache - insomnia - HA - irritability/jitteriness

What are the uncommon to rare AE associated with methylphenidate (_______) and mixed amphetamine salts (__________)?

-Ritalin, Adderral - dysphoria - "spacey"/ zombie like status - tics - HTN, HR fluctuations - hallucinations - skin discoloration with methyphenidate patch

What are the boxed warnings associated with some stimulants?

- CV risk | - Abuse potential

atomoxetine (_________) - What is its MOA? - Is it more effective than stimulants and does it have a decreased abuse potential? - Is atomoxetine used as a monotherapy? - What is the onset time and when do we see the full benefit? - How are the AE different than stimulants? - What is an important boxed warning with this drug?

- Strattera - selective NE reuptake inhibitor - less effective than stimulants but has less abuse potential - Yes, but can be used with a stimulant - 2-4 weeks for onset and full benefit at 6-12 weeks - Generally similar but more fatigue, sedation, and dizziness - increrased risk of suicidal ideation in children/adolescents

-What other drug class is also used for ADHD? -What is the MOA? -Are these more of less effective than stimulants? -Are they used as a monotherapy? What are the most common AE? What happens when either med is abruptly stopped?

- alpha2 adrenergic agonists (guanfacine, clonidine) - mimic NE which improves working memory and behavioral inhibition - less effective but less potential for abuse - Yes, but also used with stimulants - dose-dependent sedation, hypotension, constipation - rebound hypertension

What are 3 other drugs used for ADHD?

- bupropion - lithium - antipsychotics

Therapeutic Concerns with ADHD Drugs: - Monitor _________ (especially in ______) - stimulant therapy can increase __ and __ - Be aware of loss of ________ and _________ - Monitor behavior and attention span

- vital signs (especially in adults) - HR,BP - appetite, insomnia