Pharm 2060B Module 14B

Front 1

what is status epilepticus

Back 1

a single seizure for longer than 30 minutes OR frequent seizures without recovery of awareness in between

Front 2

what is the definition of focal/partial seizures and what are the 2 subcategories?

Back 2

focal/partial seizures arise in one area of the brain

there are simple partial seizures, and complex partial seizures

Front 3

what is the difference between simple partial seizures and complex partial seizures?

Back 3

simple partial seizures involve no loss of consciousness, while complex partial seizures do

Front 4

what is a generalized seizure?

Back 4

these seizures have a bilateral diffuse onset, and come from all areas of the brain at once

Front 5

what are the 5 types of generalized seizure? (atm ta)

Back 5

absence seizure

tonic/clonic seizure

myoclonic seizure

tonic seizure

atonic seizure

Front 6

name 3 symptoms of absence seizures

Back 6

1. loss of consciousness

2. behavioral arrest

3. staring

Front 7

t/f

a) absence seizures occur most in adulthood

b) absence seziures are rarely associated with automatisms

Back 7

a) false. absence seizures occur most in childhood

b) true. random movements are not characteristic of absence seizures

Front 8

what are three events that occur during tonic clonic seizures

Back 8

1. loss of consciousness

2. a tonic period of muscle rigidity

3. a clonic period of involuntary muscle movement

Front 9

t/f patients may become incontinent and have tongue biting in absence seizures

Back 9

false. patients may become incontinent and have tongue biting in tonic/clonic seizures

Front 10

a patient who just had a seizure is drowsy, confused, and is having a lot of headaches. what seizure was it?

Back 10

tonic/clonic

Front 11

what seizure is petit mal?

what seizure is grand mal?

Back 11

petit mal is absence

grand mal is tonic/clonic

Front 12

name 2 hallmarks of myoclonic seizures

Back 12

1. brief, sudden muscle contractions that involve any muscle group

2. no loss of consciousness

Front 13

t/f only the 'mal' seizures have no loss of consciousness

Back 13

false. only the petit and grand mal seizures DO have a loss of consciousness

Front 14

name 2 hallmarks of tonic seizures

Back 14

1. muscle rigitidy

2. impaired, but not lost, consciousness

Front 15

describe atonic seizures

Back 15

1. aka 'drop' seizures, these result from a loss of muscle tone. there is a risk of falling injury.

Front 16

what is a secondary generalized seizure?

Back 16

a seizure that begins at one area of the brain (like a focal seizure) then spreads throughout the brain

Front 17

what is the preliminary focal phase of a secondary generalized seizure referred to?

Back 17

an aura

Front 18

what are the three regions of the frontal lobe that are affected by focal seizures?

Back 18

1. primary motor cortex

2. supplemental motor area (SMA)

3. higher areas of the frontal cortex

Front 19

name some movements that may arise from focal seizure in the primary motor cortex of the frontal lobe

Back 19

very simple motor movements

Front 20

name some movements that may arise from focal seizure in the supplemental motor area of the frontal lobe

Back 20

tonic posturing (rigidity) affecting the entire side of the body

Front 21

name some movements that may arise from focal seizure in the higher areas of the frontal cortex of the frontal lobe

Back 21

very complex behavioral automatisms such asriding a bikeswimminglaughingcrying

Front 22

temporal lobe seizures show a number of effects.

name 4

Back 22

1. emotions

2. psychic symptoms (deja vu)

3. sensory hallucinations (auditory, olfactory, gustatory)

4. visual distortions

Front 23

what are the three regions of the parietal lobe that are affected by focal seizures?

Back 23

1. somatosensory cortex

2. somatosensory association cortex

3. higher order sensory association areas

Front 24

name some effects that may arise from focal seizure in the somatosensory cortex of the parietal lobe

Back 24

paresthesias (numbness) and 'pins and needles'

Front 25

name some effects that may arise from focal seizure in the somatosensory association cortex of the parietal lobe

Back 25

more widespread paresthesias than in the somatosensory cortex

Front 26

name some effects that may arise from focal seizure in the higher sensory association areas of the parietal lobe

Back 26

hallucinations and illusions. very similar to temporal lobe focal seizures

Front 27

what two focal seizures are the most similar?

Back 27

temporal lobe and parietal lobe

Front 28

occipital lobe focal seizures are associated with visual hallucinations. are these more or less likely to be of discrete object

Back 28

less likely

Front 29

what focal seizure can cause temporary blindness and reflex nastygmus?

Back 29

occibital lobe focal seizure

Front 30

what are the three classifications of epilepsy etiology? describe them

Back 30

1. symptomatic epilepsy - epilepsy that has been caused by something we know (trauma, stroke)

2. idiopathic epilepsy - we dont know the cause but there is family history

3. cryptogenic epilepsy - we dont know the underlying cause

Front 31

what is the seizure threshold?

Back 31

the balance between exitable and inhibitory forces in the brain

Front 32

name 3 factors that can affect the seizure threshold

Back 32

1. stroke2. head injury3. visual stimuli (flashing lights)

Front 33

what are the 4 mechanisms of action of antiepileptic drugs?

Back 33

1. blocking sodium channels

2. blocking voltage dependent calcium channels

3. glutamate antagonists

4. potentiating actions of GABA

Front 34

how does AED blocking sodium channels decrease seizures?

Back 34

sodium influx is essential for action potential propogation. normally, sodium channel lets some sodium in, then is inactive for a bit, then lets more sodium in. Sodium channel blocking AEDs prolong the inactivation state of this sodium channel

Front 35

what is the most widely used aed? which one of the 4 aeds is it?

Back 35

phenytoin. it is a sodium channel blocker

Front 36

_______ (sodium channel blocker) is useful for all types of seizures except _____ seizures

Back 36

phenytoin is useful for all types of seizures except absence seizures

Front 37

a _____ increase in phenytoin dose produces a _____ increase in plasma concentration. why?

Back 37

a small increase in phenytoin dose produces a large increase in plasma concentration. phenytoin follows non linear kinetics and the metabolic capacity to metabolize phenytoin is limited

Front 38

t/f phenytoin is teratogenic

Back 38

true

Front 39

how do blocking voltage dependent calcium channels work as an AED?

Back 39

calcium is necessary to push neurotransmitters out into the synapse. blocking calcium influx stops this

Front 40

glutamate antagonists block what two receptors to treat epilepsy?

Back 40

NMDA and AMPA

Front 41

why does potentiating GABA prevent seizures?

Back 41

GABA binding to its receptor causes an influx of Cl-, which makes it harder for the cell to depolarize.

Front 42

what are the 4 ways drugs can potentiate gaba? (pretty basic)

Back 42

1. enhance GABA binding to receptor

2. stimulating GABA release

3. inhibiting GABA breakdown

4. inhibiting GABA reuptake

Front 43

diagnosis of depression requires ___ symptoms over __ weeks

Back 43

diagnosis of depression requires 5 symptoms over 2 weeks

Front 44

What are the two major types of depression?

Back 44

exogenous and endogenous

Front 45

What are two signs of exogenous depression? Name 2 symptoms for each

Back 45

1. Pathological grief - symptoms are prolonged grieving with excess guilt

2. adjustment disorder - depression following failure or rejection. common symptoms hypersomnia and hyperphagia

Front 46

exogenous depression is best treated by ____

Back 46

psychotherapy

Front 47

name 3 symptoms of major depression

Back 47

1. lack of response to positive stimuli

2. weight loss

3. insomnia

Front 48

what is the difference between major depression and severe depression?

Back 48

severe depression has suicidal tendencies and psychoses as added symptoms

Front 49

what is the difference between atypical depression and major depression?

Back 49

similar symptoms except atypical depression has the atypical symptoms of hypersomnia and hyperphagia

Front 50

those with atypical depression are usually ______

Back 50

those with atypical depression are usually obese

Front 51

what is the difference between dysythmia and major depression?

Back 51

dysythmia symptoms are not as severe, also symptoms are more noticable to family and friends than they are to the patient

Front 52

which of the endogenous depressive disorders would you treat with psychotherapy?

Back 52

disythmia

Front 53

what are the last 3 endogenous depressive disorders?

Back 53

SADpostpartum depressionbipolar disorder

Front 54

what is the monoamine hypothesis for depression?

Back 54

depression results from an altering of

monoamine release, receptor sensitivity, or altering of post synaptic function

Front 55

what are the two ways antidepressant drugs mediate their effect?

Back 55

inhibitng monoamine reuptake

inhibiting monoamine metabolism

Front 56

what are the 4 classes of drugs used to treat antidepressants?

Back 56

tricyclic antidepressants

SSRIs

SNRIs (selective norepinephrine/serotonin reuptake inhibitors)

MAO Is (monoamine oxidase inhibitors)

Front 57

what is the tricyclic antidepressant mechanism of action?

what type of endogenous depression do they help treat?

Back 57

inhibit the reuptake of both serotonin and norepinephrine

they help treat major depression

Front 58

name 3 adverse FX of tricyclic antidepressants

Back 58

1. weight gain

2. sedation

3. decreased seizure threshold

Front 59

what are the most commonly used antidepressant and what type of depression are they most commonly used for?

Back 59

SSRIs they have the same mech of action as tricyclic antidepressants except they only inhibit serotonin reuptake. they are mostly used for major depression

Front 60

what is the main adverse effect of SSRI use and what is it?

Back 60

serotonin syndrome. excess serotonin transmission can cause agitation, confusion, anxiety

Front 61

what is the main advantage to SNRIs?

How are they different from TCA?

Back 61

a) they have a rapid onset of action

b) they dont have a 3 ring structure

Front 62

what is the mechanism of action of MAO I

Back 62

MAO is an enzyme that inactivates monoamine neurotransmitters. MAO I stops that from happening

Front 63

what does MAO A do?

What does MAO B do?

Back 63

MAO a metabolizes serotonin and norepinephrine

MAO B metabolizes dopamine

Front 64

t/f MAO inhibitors used to treat depression are selective

Back 64

false. they are non selective, so they can also help with parkinsons treatments as well

Front 65

MAO inhibitors are useful in the treatment of what forms of depression?

Back 65

atypical and dysythmia

Front 66

how do mao inhibitors mediate their effects?

Back 66

by inhibiting metabolism of serotonin and norepinephrine in the synapse

Front 67

name 2 adverse effects of MAO inhibitors

Back 67

1. CNS excitation

2. hypertensive crisis if taken with tyramine containing foods

Front 68

what is biploar disorder characterized by?

Back 68

recurrent fluctuations between episodes of mania and depression

Front 69

what three major groups of drugs are used to treat bipolar disorder?

Back 69

1. mood stabilizers

2. antipsychotics

3. antidepressants

Front 70

what are the three effects of mood stabilizers (bipolar)

Back 70

1. relieve symptoms during manic or depressive episodes

2. prevent reocurrence of episodes

3. do not worsen symptoms or change rate of cycling

Front 71

what are the two drugs used as mood stabilizers?

Back 71

lithium and valproic acid

Front 72

why is giving lithium and a diuretic bad?

Back 72

it actuallly increases lithium concentrations. diuretic could increase GI upset and tremors

Front 73

what are antipsychotics used for specifically for bipolar disorder?

Back 73

to help stabilize mood during manic episodes

Front 74

t/f antipsychotic drugs benefit bipolar patients even when they dont have psychotic symptoms

Back 74

true

Front 75

what are used to treat bipolar patients, conventional or atypical antipsychotics?

Back 75

atypical. this is because they wont cause extrapyrimidal symptoms

Front 76

when treating bipolar episodes, antidepressants are usually combined with a _____. why?

Back 76

antidepressants are usually combined with a mood stabilizer because it is thought that antidepressants on their own can cause mania

Front 77

t/f those with depression usually have bipolar

Back 77

false. those with depression probably have anxiety

Front 78

which anxiety disorder is often confused for heart attack?

Back 78

panic disorder

Front 79

what are the three classes of drugs used to treat anxiety?

Back 79

benzos (BDZ)

buspirone

antidepressants

Front 80

what is the first line therapy for anxiety?

Back 80

benzos!

Front 81

how do benzos work to treat anxiety?

Back 81

they bind to a DIFFERENT SITE on the GABA receptor than GABA, and potentiate GABAs activity by enhancing its binding to the receptor. this allows more cl- into the cell, making it more negative, depressing the cns and making it harder to generate action potentials (seizures)

Front 82

what 2 anxiety disorders are benzos used to treat?

Back 82

generas anxiety disorder and social anxiety disorder

Front 83

t/f buspirone and benzos are cns depressants

Back 83

false. buspirone is NOT a cns depressant, but benzos are

Front 84

what is buspirone used to treat?

Back 84

general anxiety disorder