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SS - Exam 2 > Seizures 2 > Flashcards

Seizures 2 Flashcards

(52 cards)

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1
Q

Epilepsy

A

Disease of brain - enduring predisposition to generate epileptic seizures. Having at least two unprovoked epileptic seizures >24 hr apart

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2
Q

Structural epilepsy vs idiopathic

A

**age of onset most reliable
Epileptic seizure type (gen or focal)
Normal inter-ictal exam
Single seizure vs cluster/status epilepticus

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3
Q

Concerns for structural epilepsy

A

Age of onset <6m or >6y
Interictal neurological abnormalities
Status
Drug resistance

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4
Q

Idiopathic epilepsy

A

Most common chronic neurological disease in dogs
GP manage approx 10 cases /year
Median age of death is 7 y
Median treatment duration is 2.3 years
Dogs w IE experience cognitive dysfunction at young age

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5
Q

Tier I confidence level IE

A

2 or more unprovoked epileptic seizures >24 apart
6m or 6y
Known breed for IE (boarder collie)
Normal CBC, Biochem, urinalysis
Normal inter-ictal exam (post ictal, anti seizure med)

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6
Q

Tier II confidence level IE

A

Meet tier I
Normal pre and post prandial bile acids
Normal MRI (post ictal changes)
Normal CSF analysis

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7
Q

Tier III confidence level IE

A

Meet tier I & II
EEG abnormalities

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8
Q

Genetics and epilepsy

A

~90% of purebred dogs
#2 concern of dog breeders (following cancer)
Prevalence in normal dog population ~0.75%
- incidence is unknown (new cases at sp time)
- prevalence in at risk breed >2% (overall cases)
Less common in cats

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9
Q

Incidence & heritability

A

Belgian tervuren - 17% prevalence, 0.77 heritability
Irish wolfhound - 18.3 prev, 0.87 heritability

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10
Q

Off spring of epileptic

A

Tervuren - 42% change offspring, 1% if normal parent
Lab retriever - 26% change of offspring
Bernese - 33% change of offspring

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11
Q

Choice of anti seizure drug therapy

A

No evidence based guidelines regarding choice of Anti seizure drugs in dogs

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12
Q

Long acting anti seizure drugs - first line

A

Phenobarbital
KBr
Imepitoin

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13
Q

Long acting anti seizure drug - cluster seizures

A

Levetiracetam

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14
Q

Long acting anti seizure drugs - adjunctive

A

Levetiracetam
Zonisamide
Gabepentin
Felbamate
Topiramate
Pregabalin

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15
Q

Fast acting ASD

A

Diazepam
Midazolam
Propofol

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16
Q

Phenobarbital
- is what type of drug
- mechanism

A

Barbiturate

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17
Q

Benzodiazepines

A

Mechanism of action is through GABAa channels
Bind to benzodiazepines receptors NOT barbiturate
^^ affinity for GABA to GABAa
High blood flow, low volume - lipophilic

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18
Q

Phenobarbital efficacy

A

Effictive in decreasing seizure frequency in approx 60-93% of dogs with IE when plasma concentrations are maintained in therapeutic range (25-35mcg.ml)

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19
Q

Therapeutic range for ASD

A

Min Effective dose - 15mcg/ml
Max tolerated dose = 40mcg/ml
LD - 150mg/kg
Loading dose - 15mg/kg iv
Oral dose - 2.5-3mg/kg

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20
Q

Pharmacokinetics

A

Oral bioavailability - 90%
Peak concentration- 4-8 hrs after admin
T1/2 avg 48 hr - takes 10 days to reach steady state
45% protein bound
75% met by liver
PB and metabolites are mainly renally excreted
CYP450 induction in 30-90 days

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21
Q

Pharmacokinetic drug interactions
Also metabolized by CYP450

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A

Corticosteroids
Cyclosporine
Digoxin
Phenylbutazone
Levothyroxine
Zonisamide
Levetiracetam
Benzodiazepines

22
Q

Side effects of ASDs

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A

Sedation
Ataxia
Polyphagia
PU/PD
Symptoms are transient and can go away w time
Hepatotoxicity** - liver failure is possible

23
Q

Idiosyncratic reactions

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A

Hepatic failure
Hematologic abnormalities
Superficial necrolytic dermatitis
Hypoalubinemia

24
Q

Superficial necrolytic dermatitis

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A

Erosive dermatopathy w multifocal distribution
Footpads are effects w crusty hyperkeratosis
Mucocutanous junctions of mouth, eyes, genitalia, hocks, elbows, pinnae, interdigital areas

25
SND cause and prognsosi
Concurrent hepatic abnormalities and low plasma amino acid concentrations is linked to SND Mean survival time is 12 weeks Common w chronic use to PB
26
SND findings
Ultrasound findings: hypoechoic nodules w trabecular network surrounding nodules Mild/moderate disorganization of lobular architecture from multifocal areas of neutrophilic inflammation & fibrosis
27
Monitoring
2 weeks Check PB steady state, CBC, Biochem 3 months PB levels (enzyme induction), CBC, Biochem 6 months PB levels - monitoring, CBC, Biochem 12 months PB levels - monitoring, CBC, Biochem
28
Monitoring math
Current drug dose/current drug level = New drug dose/desired drug level
29
Monitoring math cross multiply
(current drug dose X desired level) / current drug level = new drug dose
30
primidone
Only FDA approved drug for ASD Much more adverse effects than PB
31
KBr - potassium bromide
Acts on GABA receptors, keeping them open longer to allow more Cl- inside the cell Acts similar to PB
32
Efficacy of KBr
65% of dogs respond well PU/PD is less common but vomiting is much more common than PB Idiosyncratic reactions - personality changes, cough, ^ risk of pancreatitis & megaesophagus, skin problems
33
Pharmacokinetics of KBr
Oral bioavailability is 46% T1/2 is 24-46 days - steady state 5 months Not protein bound KBr is excreted unchanged in urine Undergoes tubular reabsorption in competition w chloride - high dietary chloride con increase the excretion of KBr & shortens half life
34
Pharmacokinetic interactions of KBr
Loop diuretics (furosemide) may enhance KBr elimination by blocking KBr reabsorption through renal tubular chloride channels KBr should be avoided in dogs w renal dysfunction to prevent toxicity secondary to reduced renal elimination Synergistic side effects possible w PB
35
Dosing and monitoring KBr
20-40mg/kg 20 if on PB, 40 if not on PB 625mg/kg loading dose given over 2-5 days Check Br levels in 1m (w loading) or 3-5m (w/out loading) Drug level = 1-3 mg/mL
36
ASD for IE
Start w PB or KBr
37
Use of Imepitoin
FDA approved for anxiety Most used for IE Improvements seen after 11w 76.5% of owners opted to continue Imepitoin
38
Pharmacokinetics of Imepitoin
T1/2 2-6 hours Extensive liver metabolism Excreted mainly via feces Neither reduced kidney function or impaired liver function
39
Interactions at AE of Imepitoin
Benzodiazepines have 200x affinity for binding site
40
Levetiracetam
Binds to SV2A similarly to Keppra
41
Efficacy of Levetiracetam
Depends on cause of seizures 50-60% of patients w refractory epilepsy in reducing seizures For structural epilepsy 52% have >50% reduction 64.8% reduction in cluster seizures
42
Pharmacokinetics of Levetiracetam
100% oral bioavalibity
43
Dosing Levetiracetam
Requires a loading dose of 60mg/kg Maintenance dose = 20-30 mg/kg, extended release 30-40 mg/kg Drug levels = 12-46 mcg/L *good for patients w renal failure
44
Zonisamide
Binds to loading gate - making development of action potential harder
45
Pharmacokinetics of Zonisamide
T1/2 of 15 hrs Almost complete oral absorption Mainly undergoes hepatic metabolism via the CYP450 before being excreted by kidneys
46
Efficacy of Zonisamide
60% have >50% reduction in seizures as mono therapy or adjunctive therapy Insufficient evidence for use in dogs
47
Side effects of Zonisamide
Ataxia, vomiting, sedation Renal tubular acidosis - inhibition of carbonic anhydrase Sulphonamide based anticonvulsant
48
Idiosyncratic reactions
Acute hepatic toxicity Renal failure (in people)
49
Gabapentin
Alpha2 gamma 1 subunit Calcium channel blocker
50
Pharmacokinetics
51
Dosing, safety, efficacy of gabapentin
52
Cat and anti seizure drugs

SS - Exam 2 (18 decks)

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