SEIZURES

Question 1

myoclonic seizure

Answer 1

shock like contraction of muscles
isolated jerking

Question 2

tonic seizure

Answer 2

in children
rigididy as a result of increased tone in extensor muscles

Question 3

clonic seizure

Answer 3

babies and young children
rapid and repetitive movement

Question 4

atonic seizure

Answer 4

sudden loss of muscle tone
patients fall if standing

Question 5

tonic clonic

Answer 5

tonic phase - rigidity followed by clonic rapid motion

Question 6

seizure definition

Answer 6

paroxysmal disorder of CNS by abnormal cerebral discharges with or without loss of consciousness

Question 7

convulsion

Answer 7

attack manifested by involuntary muscle movements

Question 8

epilepsy

Answer 8

repeated seizures due to damage, irritation, chemical imbalance in brain
- sudden electrical discharge

Question 9

what kind of firing is in seizures

Answer 9

disordered, synchronus, rhythmic
synchronized hyperexcitability

Question 10

seizure classifications

Answer 10

focal onset
generalized onset
unknown onset

Question 11

focal onset location

Answer 11

comes from one place in the brain
being in temporal lobe

Question 12

generalized onset location

Answer 12

all over the brain

Question 13

focal seizures usually due to

Answer 13

lesion, head trauma, infection

Question 14

generalized seizures description

Answer 14

loss of consciousness, both brain hemispheres, idiopathic, usually genetic

Question 15

how do primary generalized seizures propagate

Answer 15

diffuse via interconnections between thalamus and cortex

Question 16

difference in EEG for focal vs. generalized seizure

Answer 16

focal has different waves
generalized all has the same

Question 16

aware focal seizures

Answer 16

no loss of consciousness
auras can occur
limited jerking of single part of body

Question 17

impaired awareness focal seizures

Answer 17

most common
clouding of consciousness
repetitive motor behaviors
POSITICTAL STATE
aura common

Question 18

generalized absence seizure typical

Answer 18

no convulsions, aura, postictal period, brief loss of consciousness
staring or eye flickering

Question 19

generalized absence seizure atypical

Answer 19

slower onset than typical

Question 20

do generalized tonic clonic have aura

Answer 20

no

Question 21

do focal to bilateral have aura

Answer 21

brief aura

Question 22

status epileptics definition and goal

Answer 22

seizure lasting > 30 mins
want to bring seizures within 60 minutes

Question 23

does one seizure make an epilepsy

Answer 23

no

Question 24

when should we stop drug therapy in seizures

Answer 24

gradually stopped who havent had seizures in 2-5 years

Question 25

depolarization involves what

Answer 25

activation AMPA and NMDA by glutamate and Ca channels influx of Ca

Question 26

hyperpolarization involves what

Answer 26

activation GABA receptors and K+ channels influx Cl and efflux K+

Question 27

can we stop epilepsy drugs suddenly

Answer 27

no, higher risk for status epilepticus

Question 28

drugs that increase risk of seizure

Answer 28

alcohol bupriopion theophylline CNS stimulants oral contraceptives depressant withdrawal clozapine

Question 29

MOA anticonvulsants

Answer 29

stabilize and reduce neuronal excitability

Question 30

drugs that decrease sodium influx, prolong inactivation of Na+ channels

Answer 30

carbemazepine oxcarbazepine phenytoin lacosamide lamotrigine valproate

Question 31

drugs that decrease Ca influx

Answer 31

lamotrigine ethosuximide valproate

Question 32

drugs that increase GABA inhibition

Answer 32

barbituates benzodiazepines valproate gabapentin vigabatrin tiagabine

Question 33

excitatory antagonists

Answer 33

felbamate topiramate

Question 34

why are there few drugs targeting K channels

Answer 34

hERG target, bad side effects like arrythmias

Question 35

excitatory pre synaptic targets

Answer 35

Na channels Ca channels

Question 36

excitatory post synaptic targets

Answer 36

NMDA AMPA

Question 37

inhibitory pre synaptic targets

Answer 37

GABA transporter (GAT-1) GABA transaminase (GABA-T)

Question 38

inhibitory post synaptic targets

Answer 38

GABA A and B receptors

Question 39

phenytoin MOA

Answer 39

binds inactive state Na channel not isoform selective- other targets

Question 40

what is fosphenytoin

Answer 40

prodrug phenytoin IV

Question 41

phenytoin kinetics are

Answer 41

non linear, dose dependent

Question 42

phenytoin interactions

Answer 42

displaced from plasma proteins (increase blood level conc) induces P450s (inc. conc of other drugs)

Question 43

side effects phenytoin

Answer 43

arrythmia visual ataxia - loss coordination GI sx hirsutism rash

Question 44

carbemazepine and oxcarbazepine structure

Answer 44

tricyclic

Question 45

carbemazepine and oxcarbazepine MOA

Answer 45

binds and stabilizes inactivated state of Na channels

Question 46

carbemazepine and oxcarbazepine interactions

Answer 46

cyp450, increase its metabolism

Question 47

carbamazepine side effects

Answer 47

blurry vision, ataxia, GI, sedation, rash (Stevens Johnson sydrome),eosinophillia / DRESS

Question 48

lacosamide MOA

Answer 48

enhances inactivation of Na+ channels

Question 49

lacosamide toxicity

Answer 49

dermatological reactions, cardiac risk (PR interval), visual disturbances

Question 50

barbituates drugs

Answer 50

phenobarbitol primidone

Question 51

who is phenobarbital drug of choice in

Answer 51

infants up to 2 months

Question 52

phenobarbital MOA

Answer 52

binds to allosteric site on GABA a a increases DURATION Cl- channel opening

Question 53

phenobarbital toxicities

Answer 53

sedation, dependance (abuse)

Question 54

benzodiazepine drugs

Answer 54

diazepam clonazepam

Question 55

diazepam use

Answer 55

tonic-clonic status epilepticus, rectal gel

Question 56

diazepine MOA

Answer 56

binds allosteric regulatory site on GABA - A receptor, increases FREQUENCY of Cl- channel opening events

Question 57

diazepam toxicity

Answer 57

sedation, physcial dependance, not useful for chronic treatment

Question 58

clonazepam use

Answer 58

acute treatment of epilepsy and absence seizures

Question 59

gabapentin and pregabalin MOA

Answer 59

increase GABA release, decrease Ca influx, reduce glutamate release

Question 60

vigabatrin MOA

Answer 60

irreversible inhibitor of GABA-T, which degrades GABA

Question 61

tigabine MOA

Answer 61

inhibits GAT-1, gaba transporter

Question 62

felbamate MOA

Answer 62

NMDA receptor antagonist

Question 63

felbamate toxicity

Answer 63

severe hepatitis

Question 64

topiramate MOA

Answer 64

AMPA and kainate antagonist

Question 65

ethosuximide MOA

Answer 65

blocks T type Ca channels in thalmic neurons

Question 66

lamotrigine MOA

Answer 66

inhibits Na and Ca channels

Question 67

lamotrigine side effect

Answer 67

skin rash, stevens johnson syndrome

Question 68

valproate MOA

Answer 68

inhibits Na and Ca chanels increases GABA

Question 69

levitiracetam MOA

Answer 69

binds synaptic protein vessel SV2A, interferes with synaptic vessel release and neurotransmission also interferes with Ca entry

Question 70

encephalopathy < 3 mo tx

Answer 70

phenytoin

Question 71

encephalopathy > 3 mo tx

Answer 71

levitracetam