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Pharm (Fall 2022) > Seizures (Exam IV) > Flashcards

Seizures (Exam IV) Flashcards

1
Q

How much of the world’s population is affected by seizures?

A

1%

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2
Q

Differentiate seizures and Epilepsy.

A

Epilepsy is a disease. Seizures are a symptom.

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3
Q

What treatments (prior to modern medicine) were used to treat seizures?

A
  • Trephining (Drilling into skull)
  • Cupping
  • Herbal remedies
  • Animal Extracts
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4
Q

Virtually all seizure medications involve the ______ of _______ neurons.

A

Suppression; Ectopic

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5
Q

What are the three main mechanism of action’s of Anti-Epileptic Drugs?

A
  1. Modification of ion conductance (Na⁺ K⁺ Ca⁺⁺)
  2. Enhancing GABA
  3. Inhibiting Glutamate
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6
Q

What are the three types of focal onset seizures?
Which one of these is essentially a generalized seizure?

A
  1. Focal Aware
  2. Focal Impaired Awareness
  3. Focal to bilateral tonic-clonic (same as generalized)
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7
Q

What occurs to muscle tone in atonic/tonic seizures?

A

Extreme muscle tone to no muscle tone

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8
Q

Focal seizures begin in a ___________ of the brain.

A

specific area

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9
Q

What are characteristics of simple focal seizures?

A
  • Minimal spread
  • Unaffected consciousness/awareness
  • EEG may show fairly normal.
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10
Q

What EEG is depicted below?

A

Normal

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11
Q

What EEG is depicted below?

A

Pre-seizure

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12
Q

What EEG is depicted below?

A

Generalized Seizure

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13
Q

What EEG is depicted below?

A

Post-Seizure (Post-Ictal)

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14
Q

What are the three characteristics of Complex Focal seizures?

A
  1. Consciousness/Awareness is affected
  2. May become unresponsive
  3. Usually arises from temporal lobes
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15
Q

What are automatisms?

A

Repetitive motions (lip-smacking, swallowing, scratching , pacing, etc.)

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16
Q

If focal seizures become generalized what state of seizure do they become?

A
  • Generalized Tonic-Clonic
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17
Q

Differentiate Tonic & Clonic phases.

A
  • Tonic = ↑ muscle tone
  • Clonic = rapid movement
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18
Q

If a generalized seizure occurs for greater than 30 minutes it is known as….

A

Status Epilepticus

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19
Q

Generalized seizures, formerly known as ___________, begin over the ________ surface of the brain.

A

Grand mal; entire

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20
Q

Differentiate Tonic and Atonic seizures.
Which will result in a fall?

A
  • Tonic = sudden contraction of muscle
  • Atonic = sudden loss of muscle tone
    Both will result in a fall.
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21
Q

What type of generalized seizure is marked by symptoms like staring into space and waking up with no notice of the seizure?

A

Absence seizure (the artist formerly known as petite mal)

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22
Q

What are generalized clonic seizures?
How do myoclonic seizures differ?

A
  • Seizures marked by the body jerking like its being shocked.
  • Myoclonic seizures involve one muscle group jerking.
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23
Q

Infantile spasm’s, also known as _______ Syndrome, are marked by what?
When do these usually begin?

A

-West’s
- Spasm’s affecting child’s whole body
- These usually begin before 6months of age.

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24
Q

Phenytoin alters conductance of which ion in particular?

A
  • Na⁺
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25
Q

What is the mechanism of action of Phenytoin?

A
  1. Alteration of Ion conductance
  2. ↑ GABA
  3. ↓ Glutamate
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26
Q

What is the more soluble proform of phenytoin?

A

Fosphenytoin

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27
Q

What drug can cause local necrosis if given too much via the IM route?

A

Phenytoin (Dilantin)

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28
Q

What drug would be a great choice for partial and tonic-clonic seizures?

A

Phenytoin (Dilantin)

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29
Q

What drug is dangerous with low albumin levels?
Why?

A
  • Phenytoin (Dilantin)
  • Highly protein bound, if no albumin is available for binding, toxic levels can quickly accumulate.
30
Q

What are therapeutic serum levels of Phenytoin?
What would free levels of Phenytoin ideally be?
What would a toxic serum level of Phenytoin be?
What would a lethal serum level of Phenytoin be?

A
  • 10-20 mcg/ml
  • 1-2.5 mcg/ml
  • 30-50 mcg/ml
  • > 100 mcg/ml
31
Q

What drugs compete for Phenytoin binding?
Which of these is most dangerous if given in conjunction with Phenytoin & why?

A
  • Carbamazepine, sulfonamides, & Valproic Acid
  • Valproic Acid; actively ejects phenytoin off albumin; ↑ serum free phenytoin
32
Q

What might some signs/symptoms of Phenytoin (Dilantin) toxicity be?

A
  • Ocular stuff (Diplopia, Nystagmus, loss of eye tracking)
  • Ataxia
  • Sedation
  • Gingival Hyperplasia
  • Hirsutism
33
Q

Why might folic acid be supplemented in conjunction with Phenytoin?

A

Folic Acid is given w/ phenytoin to combat gingival hyperplasia, hirsutism, & coarsening facial features.

34
Q

What is Carbamazepine’s mechanism of action?

A
  • Blockade of Na⁺ channels to slow down excitation of neurons.
35
Q

What drug is the drug of choice for focal seizures & Trigeminal Neuralgia?

A

Carbamazepine

36
Q

What is unique about Carbamazepine’s metabolism?

A

Carbamazepine increases the count of CYP450 enzymes thus ↑ its own metabolism as well as other drugs.

37
Q

What drug induces a sodium channel blockade, is used for focal seizures, and whose effect hardly changes with increased dosing?
What might increasing dosages with this drug actually help?

A
  • Lacosamide
  • Generalized seizures
38
Q

What is the oldest currently available anti-seizure drug?
What is this drug’s MOA?
What does toxicity of this drug look like?

A
  • Phenobarbital
  • ↑ GABA
  • Sedation
39
Q

What derivative of Phenobarbital is useful in some tremor disorders?

A

Primidone

40
Q

What types of seizures is Phenobarbital useful for?

A
  • Focal
  • Tonic-Clonic
41
Q

What types of seizures can Phenobarbital worsen?

A
  • Absence
  • Atonic
  • Infantile spasms
42
Q

What is Levetiracetam’s usefulness as an anti-seizure medication?

A
  • Useful as an adjunct to other therapies.
43
Q

What drug is a useful adjunct in focal seizures specifically?

A

Lamotrigine

44
Q

What are GABA analogs useful for?
Give an example of two GABA analogs.

A
  • Pain disorders, neuralgia, CNS suppression in general.
  • Gabapentin, Pregabalin
45
Q

What is the drug of choice for absence seizures?
What is this drug’s MOA?
What occurs with toxicity with this drug?

A
  • Ethosuximide
  • Ca⁺⁺ Channel Inhibition
  • Gastric Distress & Lethargy (↓ toxicity)
46
Q

What is the mechanism of action of Valproic Acid?

A
  • Affects are three modalities of seizure treatment
47
Q

What is the organic structure of a Benzodiazepine?

A
  • Benzene Ring + Diazepine Ring
48
Q

What drug class is really useful for status epilepticus?

A

Benzodiazepines

49
Q

What is the MOA of Benzodiazepines?

A
  • CNS depression through ↑ GABA
50
Q

What is Diazepam (Valium) useful for?
What is it not useful for?

A
  • IV/PR; useful in stopping continuous seizure activity
  • Not effective for chronic therapy
51
Q

What long-acting drug is effective against absence seizures and is only available in an oral form?

A

Clonazepam (Klonopin)

52
Q

What benzodiazepine is more effective than diazepam for status epilepticus in its IV form?

A

Lorazepam (Ativan)

53
Q

Infantile spasms are a ________ disorder (not seizure).

A

Developmental

54
Q

What three facets of treatment are there for infantile spasms?

A
  1. Palliative
  2. Corticotropins (ex. prednisone)
  3. Vigabatrin (GABA analog)
55
Q

How does Vigabatrin work?

A
  • Blocks enzymatic hydrolysis = ↑ GABA
56
Q

What dietary change for children can help with seizure activity? Why?

A
  • Ketogenic Diet
  • ↑ fatty acids slow neuron firing
57
Q

What radical surgery for children can treat seizures originating from one side of the brain?

A

Hemispherectomy

58
Q

What type of seizure condition is life-threatening?
What specific type of seizure is the most common cause?

A
  • Status Epilepticus
  • Generalized Tonic-Clonic
59
Q

What three drugs are usually given first during status epilepticus? Which one of these is longer acting?

A
  • Diazepam & Lorazepam
  • Fosphenytoin (longer acting; 15-20mg/Kg LD)
60
Q

What drug should be given for status epilepticus that is refractory to fosphenytoin?

A

Phenobarbitol (20mg/Kg)

61
Q

What is the most important thing to ensure during the treatment of status epilepticus?
What lab value should be checked as well?

A
  • ABC (airway, breathing, circulation)
  • BG (blood glucose)
62
Q

What percentage of epileptic cases are refractory after 1st & 2nd dose administration?

A

40%

63
Q

What should be known about perioperative care of patients with known seizures on pharmacologic therapy?

A
  • Important to maintain adequate levels of anti-seizure drug during perioperative period.
64
Q

What is the only narcotic that stimulates seizure activity?

A

Meperidine (Demerol)

65
Q

Chronic phenytoin therapy makes patients ______ to neuromuscular blocking drugs. Why is this?
Conversely, active dosing of phenytoin does what when NMBs are administered?

A
  • Resistant; ↓ GABA channels (verify, doesn’t make sense)
  • Active Phenytoin = ↑ NMBs
66
Q

What is the last-ditch effort in treating seizures?

A
  • Craniotomy with resection of epileptic foci.
67
Q

Which two drugs blockade Na⁺ channels to treat seizures?

A
  • Lacosamide
  • Carbamazepine
68
Q

Which drug classes increase GABA as their only MOA in treatment of seizures?

A
  • GABA analogs
  • Benzodiazepines
69
Q

Which two drugs exhibit all known MOA’s for treatment of seizures?

A
  1. Phenytoin
  2. Valproic Acid
70
Q

Which drug exhibits Ca⁺⁺ channel blocking effects in treatment of seizures.

A

Ethosuxamide

Pharm (Fall 2022) (23 decks)

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