Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHAR 358 > Seizures > Flashcards

Seizures Flashcards

(64 cards)

Start Studying
1
Q

what is a seizure?

A

a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is epilepsy?

A

disorder of the brain characterised by an enduring predisposition to general epileptic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the current diagnostic definition of epilepsy?

A

patient has minimum of 2 unprovoked seizures 24 hours apart
OR
patients with only 1 unprovoked seizure but at significant risk of seizure recurrence (EEG with epileptiform abnormalities, brain injury, structural brain abnormalities, nocturnal seizures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is an unprovoked seizure?

A

seizure which occurs in the absense of an acute brain event (stroke, head trauma, infection, metabolic/toxic insult)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the risk of seizure recurrence?

A

if 1 non-provoked seizure: 50%
if 2 non-provoked seizures: 60-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the etiology of seizures

A

variable causes, largely unknown
- genetics
- structural lesions in brain
- metabolic disorders
- infectious
- immune
anything that disturbs the normal functioning of the cerebral cortex can cause seizure, and if this abnormality is enduring, it can result in epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the pathophysiology of seizures?

A

increase excitatory synaptic neurotransmission
decrease inhibitory synaptic neurotransmission
alteration of voltage gated ion channels
alteration of intra- or extacellular ion concentrations
hypersynchrony

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are s/sx of a seizure

A

tingling of face, body limb
involuntary muscular contractions of a limb or body part
sweating
awareness of surroundings
fear
recollection of events
aphasia
particular automatisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the 3 primarily types of seizure onset?

A

focal
generalised
unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the difference between focal and generalised seizures?

A

focal seizures originate within networks limited to one hemisphere
generalised originate at some point within and rapidly engage, bilaterally distributed networks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the 2 subdivisions of focal onset seizures?

A

aware and impaired awareness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are some types of generalised seizures?

A

absense
tonic-clonic
myoclonic
atonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what percent of seizures are focal onset?

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how are seizures classified?

A

based on location of origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are epilepsy syndromes?

A

refers to clusters of features that may occur together, including seizure type, EEG findings, imaging findings, age-dependent features, specific comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is status epilepticus?

A

medical emergency
any recurrent or continuous activity lasting 30+ mins in which the patient does not regain baseline mental status
or a cluster of seizures that does not return to baseline for 30+ mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

at what duration of seizure is it treated as impending status epilepticus?

A

any seizure that does not stop within 5 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the acute treatment of status epilepticus?

A

benzodiazepines

adults: lorazepam 1-2 mg SL
pediatrics: midazolam IN or buccal 0.2-0.3 mg/kg/d (max 10 mg)
infants (<3 mo.): rectal diazepam 0.5 mg/kg/dose (max 10 mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are post ictal symptoms?

A

period when the brain recovers from the seizure
- confusion
- depression
- memory problems
- tiredness
- headaches
- anxiety
- repetitive movements
- cognitive problems
- behaviour changes
- language problems

post ictal migraines are very common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what do you do if someone is having a convulsive seizure?

A

time it - longer than 5 mins = call 911
explain what is going, ask to be given space
cushion head and neck with something soft
roll the person to their side to prevent choking
clear the area of dangers
do NOT put anything in the mouth
no NOT restrain
speak gently, be kind during and after the seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what do you do if someone is having a non-convulsive seizure?

A

time it - longer than 5 mins = call 911
explain what is happening
clear the area of dangers
gently guide and protect from hazards
do NOT restrain
speak gently, be kind during and after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are some medications that can lower seizure threshold

A

analgesics: opioids (esp. meperidine, tramadol)

anticancer drugs

antimicrobials: carbapenems, cephalosporins (4th gen), FQs, isoniazid, penicillin

immunosuppressants: azathioprine, cyclosporin, mycophenolate, tacrolimus

psychiatric medications: antipsychotics (esp. clozapine), atomoxetine, bupropion, buspirone, lithium, MAOIs, SSRIs/SNRIs, TCAs

stimulants: amphetamines, methylphenidate

sympathomimetics and decongestants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why are EEGs done for epilepsy diagnosis?

A

used to determine if focal vs. generalised onset and estimate risk of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why is brain imaging done in epilepsy diagnosis?

A

used to identify structural abnormalities
NOT to observe seizure activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what laboratory studies may be done as part of epilepsy diagnosis?
blood glucose CBC with diff electrolytes (esp. Na) lumbar pucture
26
what are some potential differential diagnoses to rule out with seizures?
syncope TIA panic attack and anxiety narcolepsy with cataplexy transient global amnesia drug intoxication migraine psychogenic or nonelectrical seizures
27
what percent of pts with epilepsy achieve seizure control?
60-70%
28
what is the approach to treatment of epilepsy?
epilepsy diagnosis --> classification +/- syndrome disorder --> creation of patient centered management plan
29
T or F pts with acute seizures due to metabolic, toxic or infectious causes require long term treatment
false may require short term treatment but dont generally require long term treatment
30
what is the general approach for initiating ASM therapy?
start with monotherapy titrate slowly
31
what is the usual dose titration to target dosing of ASM?
start at 1/4 to 1/3 of initial dose and increase q1-2 weeks to minimise s/e
32
what is the approach if somebody was inadequate response to initial ASM therapy?
assess adherence if at a mod dose with few a/e titrate to max dose if breakthrough seizures at max tolerable dose consider switching or augmenting
33
what is the most common reason for treatment failure with ASM?
non adherence
34
what is the benefit of poly ASM therapy?
may have fewer side effects with lower doses of 2 concomitant medications
35
when is polytherapy reserved for in epilepsy?
failed monotherapy with 2-3 drugs
36
T or F all patients with epilepsy require life long treatment
false
37
what are some factors that favour successful d/c of ASM?
seizure free (2 years for children; 2-5 years for adults) normal neurologic exam normalised EEG with treatment history of single type of focal seizure of generalised tonic-clonic seizures
38
how do you d/c ASM?
if non emergency situation: slow and gradual taper - taper over at least 6 weeks seems to be safe if on >1 ASM, each one should be withdrawn separately
39
what is the risk of abrupt d/c of ASM?
can precipitate a seizure
40
which diet may have efficacy in reducing seizure frequency?
keto
41
when is surgery an option for epilepsy?
some patients with refractory focal onset epilepsy resistant to multiple ASMs
42
what is VNS?
vagus nerve stimulation involves a surgical procedure to implant an electrical pulse generator in the chest and attach electrodes to the vagus nerve in the neck pulse generator stimulates the vagus nerve on a regularly scheduled basis
43
what are some nonpharm options in epilepsy?
diet: keto surgery vagus nerve stimulation general measures - adequate sleep/nutrition - decrease stress/anxiety - decrease alcohol - avoid triggers
44
what are some common ADEs associated with ASM?
sedation, dizziness, blurred or double vision, ataxia, difficultly concentration nausea, vomiting
45
which ASM are associated with SJS?
phenytoin carbamazepine lamotrigine lacosamide ?
46
which ASMs should be avoided if you develop a rash on another ASM?
any with aromatic hydrocarbon ring carbamazepine oxcarbamazepine eslicarbazepine phenobarbital primidone phenytoin lamotrigine ? lacosamide
47
why is there cross sensitivity between some ASM?
aromatic hydrocarbon ring
48
which ASM should be avoided in pregnancy?
valproic acid
49
what ASM are potentially preferred in pregnancy?
lamotrigine levetiracetam
50
which ASMs are strong CYP inducers?
phenytoin carbamazepine phenobarbital
51
which ASMs are CYP inhibitors?
valproic acid stiripentol
52
what is the preferred contraceptive method when on ASM?
LNG-IUD or copper IUD or progesterone implant depo COC with >30 mcg EE taken continuously
53
when are drug levels of ASM taken?
once the desired clinical response has bee achieved to assist clinician in determining the magnitude of a dose increase ASM toxicity when seizures persist alteration to PKs change in drug formulation change in clinical response poor compliance suspected
54
how are ASMs usually classified?
1. conventional vs new 2. cellular MOA 3. spectrum of activity
55
what are the "conventional" ASM?
carbamazepine barbiturates BZDs phenytoin valproate
56
which types of seizures are narrow spectrum ASMs used in?
generally effective for focal seizures
57
what are the narrow spectrum ASM?
carbamazepine gabapentin oxcarbamazepine phenytoin phenobarbital pregabalin tiagabine vigabatrin
58
what are the broad spectrum ASM?
brivaracetam felbamate lamotrigine levetiracetem perampanel topiramate rulfinamide valproate zonisamide
59
what are the agents used for focal seizures?
1st line: carbamazepine, lamotrigine 2nd line: levetiracetem, valproate, oxcarbazepine, zonisamide 4th line: gabapentin, topiramate, phenytoin
60
what agents are used in generalised tonic-clonic seizures?
carbamazepine lamotrigine valproate topiramate levetiracetem
61
which agents should be avoided in myoclonic seizures?
carbamazepine gabapentin oxcarbazepine phenytoin pregabalin tiagabine vigabatrin
62
which medications are used for absent seizures?
1st line: ethosuximide, valproate 2nd line: lamotrigine
63
what is the most common MOA of ASM?
sodium channel blockage
64

PHAR 358 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions