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19 Cards in this Set
- Front
- Back
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Patient with epilepsy. What is your Ddx and Pdx? |
Pdx: Seizure DDx: Syncope, TIA, stroke, MS |
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What is your management for the patient? |
1. Protect head 2. Turn patient on side 3. |
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What questions would you ask in an event of seizures? |
History - Aura, cyanosis, drooling, tongue biting, incontinence, speak to witness |
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How would you investigate that's man's seizures? |
Most salient: EEG - low false positive, look for epileptiform waves
To look for cause - Labs: EUC, BSL (hypo can start seizures), calcium - CT/MRI: previous head injury, meningitis, previous operation - LP only if meningitis is suspected |
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When would you initiate treatment? |
No need to treat if there is only 1 seizure
Treat: If 2 or more seizures occur after 24 hours |
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How would you treat? |
Single therapy only
Focal/partial seizure: carbamazepine Global seizure: Sodium valproate Uncertain: Sodium valproate |
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How does neuronal depolarisation occur? What are causes normal depolarisation? |
Depolarisation: making the inside of a cell less negative
Caused by: Na+ or Ca2+ entering the cell -> reach threshold -> depolarisation
Neurotransmitter responsible for the opening of ion channels: Glutamate |
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How does neuronal hyper polarisation occur? What causes hyper polarisation? |
Hyperpolarisation: where the interior of the cell becomes more negative
Caused by: K+ exiting cell, or Cl- entering cell
Neurotransmitter responsible for K+ and Cl- channels: GABA |
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What is status epilepticus? |
Seizure activity >5 mins or repeated seizures without recovering |
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How to you treat status epilepticus? |
1. ABCs
2. Followed by a benzodiazepine: a. Midazolam up to 10mg IM/IV/buccal/IN over 2-5 mins b. Diazepam 10-20mg IV or c. Clonazepam 1mg IV
3. Followed by an antiepileptic a. Phenytoin 15-20mg/kg IV or b. Phenobarbitone or c. Sodium valproate |
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What is the MOA for benzodiazepines? What are some side effects? |
MOA: potentiate binding of GABA to receptor --> neuron hyperpolarisation
SE: CNS: drowsiness, cognitive impairment, reduced motoro coordination, anterograde amnesia, memory impairment Psych: Physical dependence |
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What is the MOA for Carbamezapine? What are some side effects? |
Indication: first line for focal seizures
MOA: Na+ channel blocker, prevents repetitive neuronal discharge
SE: Drowsiness, LFT derangement, SJS because of HLA-B*1502 (must test before giving to Asians), agranulocytisis, enzyme inducer (↑LFTs)
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What is the MOA for sodium valproate? What are some side effects? |
Indication: first line for generalised seizures
MOA: Na+ calcium channel blocker, prevents repetitive neuronal discharge
SE: *Teratogen* avoid in pregnancy, liver failure, pancreatitis, weight gain, tremor, hair loss
Practice notes: monitor valproate levels |
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What is the MOA for phenytoin? What are some side effects? |
Indication: Status epilepticus, epilepsy
MOA: Na+ channel blocker, prevent repetitive neuronal discharge
SE: SJS, gum hypertrophy, facial hair, acne, coarsening of facial features, enzyme inducer (↑LFTs)
Practice notes: can start at full dose (only AED that can be used at full dose) |
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What is the MOA for Lamotrigine? What are some side effects? |
MOA: Na+ channel blocker, prevents depolarisation
SE: SJS – must start very slowly |
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What is the MOA for Topiramate? What are some side effects? |
MOA: Na+ channel blocker and GABA potentiator
SE: Glaucoma, Psychosis, suicidal ideation, hallucinations, kidney stones |
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What is the MOA for Levetiracetam (keppra) What are some side effects? |
MOA: Binds to synaptic vesicle protein SV2A -> inhibits nerve conductionacross synapses
SE: Aggression, other behavioural effects: depression, emotional lability, anxiety |
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What is the MOA for Pregabalin? What are some side effects? |
MOA: GABA analogue -> binds to voltage gated Ca channels + increase GABA synthesis
SE: Fatigue, sedation, dizziness |
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What is the MOA for gabapentin? What are some side effects? |
MOA: GABA analogue ->decreases Ca2+ influx at nerve terminals and decreases release of several neurotransmitters
SE: Neutropenia, heartblock |
