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16 Cards in this Set

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sezure classification
partial - focally, from a single location within one hemisphere.
generalized - deeper subcortical midline structure and progects to both hemispheres.
partial sezures:
simple - minimal spread, normal consciousness and awareness.
complex - the discharge become more spread and almost always involves the limbic system, resulting in impaired conscious level.
generalized seizures:
Grand mal - tonic clonic - begins with a tonic phase of skeletal muscules rigidity (1 min) followed by a clonic phase (2-3 min) of massive jerking movements followed by loss of consciousness. the condition is presided by aura.
petit mal - absence seizure - by an abnormal Ca+ current of thalamic neurons. suddent onset. usually last for 10 sec and may occur up to 100 times a day. consciousness is alterd.
Administration
all orally, but phenytoin and clonazepam are given iv. all follow first order except phenytoin.
drugs that inhibits voltage gated Na+ channels
phenytoin
carbamazepine
lamotrigin
phenobarbital
valoproic acid
topiramat
they bind to inactivated channels and prolog the inactivation state.
prolongation of the GABAergic inhibition
Directly: benzodiazepines (increase frequency)
barbiturates (increase duration)
Indirectly: tiagabin - GABA reuptake inhibition
vigabatrin - GABA aminotransferase inhibitor
gabapentin - GABA a.a analoge
inhibition of the glutamate
Directly:
NMDA - remacerid
AMPA - phenobarbital
topiramat
Indirectly:
phenytoin
carbamazepine
lamotrigine
valporoic acid
felbamate
inhibition of Ca+ current (T current)
ethosuximide
dimethadione
useful against absence seizures
drugs used for partial seizuers
phenytoin
carbamazepine
barbiturates
lamotrigine
vigabatrin
gabapetrin
tiagabine
drugs used for generalized absence seizuers
ethosuximide
valproic acid
oxazolidinediones
lamotrigine
phenytoin
unpredictable pharmacokinetics due to the difference in its metabolism by the cyc p450.
בכמויות גדולות המראה שלו בדם עולה לא באופן פרופורציונלי לקצב האדמינסטרציה מאחר והכבד בסטורציה.
90% מהסם מובל בדם ע"י פרוטאינים ולכן יש לו אינטרקציה עם סמים אחרים.בנוסף הוא מעודד יצירת האינזים המפרק אותו ולכן סמים אחרים שמשתמשים באותו אינזים ע"מ להיתפרק יעובדו בצורה מהירה יותר ויהפכו ללא אקטיבים מוקדם יותר.
mechanism of action - Na+ channel inactivator + inhibits glutamate release.
side effects: nystagmus, diplpia, ataxia, megaloblastic anemia, gingival hyperplasia, teratogenic - palatine cleft
carbamazepine
tricyclic compaund was used for bipolar disorders and mania.
used for partial seizures. first choice for tonic clonic seizures.
induce micrisomal enzymes. have hulf life of 36 hu.
mechanism of action - block Na+ channels and decrease glutamate transmission.
side effects - increase the rate of elimination of pirimidone, phenytoin, ethosuximide, valproic acid.
bone marrow depression, diplopia, ataxia
barbiturates
sedative drugs, mostly used for infants.
phenobarbital - binds to an allosteric regulatory site on the GABA receptor and enhances the GABA receptor.
mephobarbital
methanbital
primidone - converted to phenobarbital, but acts like phenytoin.
lamitrigine
inactivator of Na+ channels + inhibits glutamate release
also used for petit mal due to its Ca+ current inhibition mostly in children.
vigabatrin
irreversible inhibitor of GABA aminotransferase (האנזים האחראי על פירוק ה"גבה")
tiagabine
inhibitor og GABA uptake