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35 Cards in this Set
- Front
- Back
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What is a seizure? |
A symptom of an underlying disorder. A disturbance of electrical activity in the brain that may affect consciousness, motor activity, and sensation. A sudden discharge of excessive electrical energy from nerve cells located within the brain. |
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What is the difference between acute and chronic seizures? |
acute seizure happens a few times, chronic seizures occur more frequently, also known as epilepsy. |
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Convulsions are what? |
A tonic-clonic type of seizure characterized by spasmodic contractions of involuntary muscles. All convulsions are seizures, but not all seizures are convulsions. |
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What causes seizures |
Infectious diseases of the brain, Trauma either physical or chemical, metabolic disorders like fluid and electrolyte disorders, vascular disease like a change in oxygenation and/or perfusion, fever, neoplastic disease, and drug effects or withdrawal of alcohol |
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What is Neoplastic Disease? |
Rapid cell division which results in a tumor, which can push on the brain and cause seizures. |
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What is a generalized seizure? |
A seizure that begins in one area of the brain, hemisphere, and then rapidly spreads to the other area of the brain, the other hemisphere. There are three types of generalized seizures: tonic-clonic, absence, and atonic. |
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What is a tonic-clonic seizure? |
Grand mal seizure. The body becomes stiff, the tonic phase. Then loss of consciousness occurs. This is followed by convulsions which relax and contract, the clonic phase. Urinary and renal incontinence may be associated. Auras may occur. Gradually regains consciousness. If the patient does not remember events, it is called postical state. |
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What is a absence seizure? |
Petit mal. Loss of consciousness, brief, less than a minute. Blank stare, may have eye movement. Occure in children mostly. |
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What is a atonic seizure?
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Drop attacks. Sudden loss of muscle tone. |
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What is a partial seizure? |
A seizure involved in only one area, hemisphere, of the brain. This type of seizure does not spread to the other brain hemisphere. Symptoms depend on where the electrical charge is located at in the brain. There are two types of partial seizures. Simple and complex. |
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What is a simple partial seizure?
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A partial seizure where you do not loss consciousness. |
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What is a complex partial seizure? |
A partial seizure where your consciousness is not impaired. |
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What is Febrile seizure? |
A tonic-clonic activity lasting 1 to 2 minutes, followed by rapid return of consciousness. Usually are self limited. Children with fevers. |
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What is a myoclonic seizure? |
A short, sporadic period of large jerky muscle contractions that last for several minutes. Involves one major muscle group. Falling from a sitting position, or dropping something are signs of this type of seizure. |
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What is status epilepticus? |
A medical emergency type of seizure, the most dangerous type. A state in which seizures rapidly occur again and again without a recovery period. This type of seizure can lead to coma or even death. |
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What is the goal of antiseizure medication? |
Control seizure activity with minimal adverse effects and increase the seizure threshold. |
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What do you need to consider when selecting antisiezure medication? |
seizure type, adverse effects, mono or comination therapy, cost, pregnancy risk, and suicide risk. |
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When substituting one drug for another, what should be done? |
The new drug should be gradually introduced, starting with a relatively low dose. The new drug should be allowed to achieve therapeutic levels before the first drug is discontinued. |
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What should be considered when monitoring a patient who is on an antiseizure drug? |
The effectiveness is dependent on the response of the patient. Periodic measurements of serum drug levels are recommended. The timing is important. Baseline CBC, renal and liver blood studies should be performed before, and during drug therapy. |
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What should be considered when deciding to discontinue therapy? |
Must be seizure free for at least three years. Advantages of discontinuing therapy include avoiding adverse effects, and decreasing cost. Disadvantages of discontinuing therapy include the possibility of a more severe recurrence seizure. Discontinuing should be done gradually, not abruptly. Only one drug should be reduced or discontinued. |
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What would the goal of pharmacotherapy? |
Supress neuronal activity enoug to prevent abnormal or repetitive firing. |
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What are the mechanisms of action for pharmacotherapy? |
Enhance GABA, suppress sodium influx, suppress calcium influx, and glutamate antagonism |
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What are Barbiturates? |
GABAa-receptor agonists Examples include phenobarbital. These are commonly used in partial and generalized seizures. These enhance the effect of GABA. These suppress abnormal neuronal discharge. They are schedule 4. They do not cause sedation, unless overdose has occurred. Children may have a paradoxical response. There is a low margin of safety and a long half-life. Administered orally. Therapeutic effects may not be seen for several weeks. Alcohol increases the effect of barbiturates. |
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What are some vitamin deficiencies associated with barbiturates? |
Vitamin D, and calcium, resulting in bone damage. Vitamin K in nenoates because of mother, increase risk of bleeding. B6 pyridoxine synthesizes hem in hemoglobin, which is used to prevent anemia and immune function. |
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What are benzodiazepines? |
GABAa-receptor agonists. Examples include diazepam. These act on the limbic=motion, and RAS=sleep/wake. These bind to GABA receptor-chloride channels. These supress abnorml neuronal foci. These calm without sedation. These relax skeletal muscle. Oral admin therapeutic effect takes one to two weeks. Tolerance may develop after four weeks of therapy. These are schedule 4. These increase IOP. IV route is used for treatment of status epilepticus, either by diazepam or lorazepam. These are ineffective against absence seizures. These can only be mixed with saline. These affect vitamin d and warfarin metabolism. These are extremely irritating to soft tissues. |
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What is an adverse reaction of benzodiazepine use? |
Respiratory depression. |
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When you overdose on benzodiazepine, what is used? |
flumazenil, or romazicon |
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What does valium do to phenytoin serum levels? |
increases, causing toxicity. |
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What are hydantoin drugs? |
Examples include phenytoin. These desensitize sodium channels. The do NOT block sodium channels. These are effective and do not have abuse potentials. These have antidysrhythmic activity. These have a narrow margin of safety, which means you should observe for toxicity. Used after benzodiazepines for status epilepticus. |
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What are some adverse reactions to hydantoin drugs? |
Steven-Johnson Syndrome=blisters all over the body. Gingival hypertrophy=gums inflammation. HPN and Bradycardia. Hyperglycemia. Agranulocytosis. |
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What is a black box warning for use of hydantoin drugs? |
IV administration rate should not exceed 50mg/min. |
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What are phenytoin-like drugs? |
Examples include valproic acid (Depakene). These have the same effect as pehytoin, but also has effects on GABA and calcium channels. These cause significant weight gain. These increase the serum phenobarbital and pheytoin levels. |
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What is a black box warning for phenytoin-like drugs? |
Do not mix with carbonated beverages. Extremely hepatoxic, and can cause life threatening pancreatitis. |
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What are succinimides? |
Examples include ethosuximide. These suppress seizures by delaying calcium influx into neurons. These raise the neuronal threshold. These are only effective against absence seizures. These increase serum phenytoin levels. |
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What are some adverse effects associated with succinimides? |
May impair mental and physical abilities, bone marrow suppression. |
