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207 Cards in this Set
- Front
- Back
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Simple Partial Seizure aka Focal Seizure
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episodes of motor activity in only one focal part of the body (rare) or, more frequently, motor activity that begins focally, then spreads throughout the limb, that side of the body, other limb and/or face
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Simple Partial Seizure aka Focal Seizure
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somatosensory episodes (paresthesias) in a focal area, i.e. numbness, tingling, pins and needles, burning or vibration.
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Simple Partial Seizure aka Focal Seizure
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special sensory episodes (hallucinations) i.e. flashing lights, kaleidoscope of colors, darkness moving across visual field, or buzzing, clicking or roaring sound... or visual perception that things are unusually large (macropsia) or small (micropsia).
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Simple Partial Seizure aka Focal Seizure
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may progress to generalized tonic-clonic seizure, i.e. secondary generalized seizure.
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Simple Partial Seizure aka Focal Seizure
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Tx is difficult but phenytoin or carbamazepine is initial choice
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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Usually preceded by an aura, such as:
-bitter taste in mouth -olfactory hallucinations of bad odor -nonspecific fear or anger -abdominal sensations |
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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during seizure of several minutes duration, pt is dazed, confused, agitated or acts weird. No change in body tone.
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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may also show automatism:
-picking at self or clothes -repetitive hand rubbing |
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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when addressed, can turn toward sound but only mumble incoherantly
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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can become agitated or aggressive if restrained
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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May progress to secondary generalized seizure
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Complex Partial Seizure aka temporal lobe or psychomotor seizure
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Carbamazepine= DOC
Phenytoin= second choice |
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Absence Seizure aka Petite Mal seizure
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occurs w/o preceding aura
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Absence Seizure aka Petite Mal seizure
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occur primarily in children and may remit during puberty
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Absence Seizure aka Petite Mal seizure
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sudden cessation of conscious activity without convulsive muscular activity. Child is out to lunch mentally and unresponsive.
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Absence Seizure aka Petite Mal seizure
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Calling or shaking the child does not interupt the OTLness
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Absence Seizure aka Petite Mal seizure
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Episodes are brief, 10-45 min, rarely longer
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Absence Seizure aka Petite Mal seizure
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Episodes may be so infrequent that they go unnoticed, or may occure hundreds of times per day
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Absence Seizure aka Petite Mal seizure
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EEG recorded during episode shows characteristic 3Hz spike and wave pattern
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Absence Seizure aka Petite Mal seizure
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About 50% of pts go on to develop generalized tonic-clonic seizures, usually during teen years
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Absence Seizure aka Petite Mal seizure
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Zarontin(ethosuximide)= DOC
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Absence Seizure aka Petite Mal seizure
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Second Choice Drugs
Depakote (divalproex sodium) Depakene (valproic acid) |
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Depakote (divalproex sodium)
Depakene (valproic acid) |
May cause hepatotoxicity
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Phenytoin and carbamazepine (Tegretol)
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Absence Seizure aka Petite Mal seizure may be exacerbated by
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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begin without a preceding aura
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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sudden loss of consciousness
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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pt falls tot he ground in rigid (tonic) posture, trunk and neck hyperextended
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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an epileptic cry may be emitted as air is tonically forced out
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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tonic contraction usually causes temporary respiratory arrest and temporary cyanosis. Urinary or fecal incontinance may occur. Tongue may be bitten and macerated
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Clonic phase begins within 30-60 seconds, symmetric and rhythmic whole body contractions which ends gradually, never abruptly
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Whole seizure lasts 2-5 minutes
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Postictally pt is confused and drowsy for minute to hours
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Most commonly used drug= Phenytoin (Dilantin)
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Valproic Acid, carbamezepine and phenobarbital are also used.
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Dilantin
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Nonsedative at therapeutic Doses
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Phenobarbital
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Sedative
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Status Epilepticus
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one ssizure leads to another
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Status Epilepticus
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any time one tonic-clonic seizure is witnessed the pt enters the immediate postictal phase and then, typically w/o fully regaining consciousness, begins tonic-clonic seizure number 2
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Status Epilepticus
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Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
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Status Epilepticus
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hyperthermia
rhabdomyolysis hypoglycemia lactic acidosis cardiac dysrhythmias |
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Status Epilepicus
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Abrupt cessation of anticonvulsant meds causes...
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Status Epilepticus
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ICH, brain neoplasm and brain trauma all cause
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Status Epilepticus
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Intubate, Turn on Side, blood sample for lytes, glu and Ca
50g glu IV Valium (diazepam)- stops seizure w/i minutes- short acting Ativan (lorazepam)- longer acting 4-24hrs |
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Whole seizure lasts 2-5 minutes
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Postictally pt is confused and drowsy for minute to hours
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Most commonly used drug= Phenytoin (Dilantin)
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Valproic Acid, carbamezepine and phenobarbital are also used.
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Dilantin
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Nonsedative at therapeutic Doses
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Phenobarbital
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Sedative
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Status Epilepticus
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one ssizure leads to another
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Status Epilepticus
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any time one tonic-clonic seizure is witnessed the pt enters the immediate postictal phase and then, typically w/o fully regaining consciousness, begins tonic-clonic seizure number 2
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Status Epilepticus
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Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
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Status Epilepticus
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hyperthermia
rhabdomyolysis hypoglycemia lactic acidosis cardiac dysrhythmias |
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Status Epilepicus
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Abrupt cessation of anticonvulsant meds causes...
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Status Epilepticus
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ICH, brain neoplasm and brain trauma all cause
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Status Epilepticus
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Intubate, Turn on Side, blood sample for lytes, glu and Ca
50g glu IV Valium (diazepam)- stops seizure w/i minutes- short acting Ativan (lorazepam)- longer acting 4-24hrs |
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Whole seizure lasts 2-5 minutes
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Postictally pt is confused and drowsy for minute to hours
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Most commonly used drug= Phenytoin (Dilantin)
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Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
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Valproic Acid, carbamezepine and phenobarbital are also used.
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Dilantin
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Nonsedative at therapeutic Doses
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Phenobarbital
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Sedative
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Status Epilepticus
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one ssizure leads to another
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Status Epilepticus
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any time one tonic-clonic seizure is witnessed the pt enters the immediate postictal phase and then, typically w/o fully regaining consciousness, begins tonic-clonic seizure number 2
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Status Epilepticus
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Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
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Status Epilepticus
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hyperthermia
rhabdomyolysis hypoglycemia lactic acidosis cardiac dysrhythmias |
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Status Epilepicus
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Abrupt cessation of anticonvulsant meds causes...
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Status Epilepticus
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ICH, brain neoplasm and brain trauma all cause
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Status Epilepticus
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Intubate, Turn on Side, blood sample for lytes, glu and Ca
50g glu IV Valium (diazepam)- stops seizure w/i minutes- short acting Ativan (lorazepam)- longer acting 4-24hrs |
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hydroxychloroquine (plaquenil) and Sulfasalazine (azulfidine)
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milder disease of RA b.c of safety and convenience of drugs
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hydroxychloroquine (plaquenil)
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renal toxicity and diarrhea
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Sulfasalazine (azulfidine)
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bone marrow suppression and GI intolerance
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methotrexate (rheumatrex)
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severe diease of RA b/c has the most rapid onset and sustained benefit; has to be monitored closely
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methotrexate (rheumatrex)
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bone marrow suppression, liver and pulmonary toxicity, GI intolerance, stomatitis, rash
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leflunomide (arava)
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Used for RA, inhibits pyrimidine synthesis. Immunomodulary and antiproliferative effects
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leflunomide (arava)
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CI- hepatitis B and C, intercurrent liver, gall bladder and renal disease; pregnancy or delayed menses
TERATOGEN |
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leflunomide (arava)
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must monitor CBC, creatine, LFT, elevations in AST or ALT
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leflunomide (arava)
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diarrhea, alopecia, rash, h/a, immunosuppression (theory), infection
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etanercept (enbrel)
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RA, binds and inhibits tumor necrosis factor
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etanercept (enbrel)
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assess for infections or risk factors for infection
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infliximab (remicade)
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RA binds and inhibits TNF alpha
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infliximab (remicade)
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use in combo with oral or SC MTX
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azathioprine (imuran)
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RA, inhibits T-lymphs
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azathioprine (imuran)
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used when disease activity persists on other DMARDS
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azathioprine (imuran)
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safer than MTX for pts >65
SE- renal insufficiency |
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Gold Salts
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auranofin (ridaura)
minocycline (minocin) D-penicillamine (cuprimine) cyclophosphamide (cytoxan) anakinra (kineret) adalimumab (humira) |
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auranofin (ridaura)
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RA, used IM
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auranofin (ridaura)
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bone marrow suppression, rash, stomatitis, proteinuria
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minocycline (minocin)
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RA, renal toxicity
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D-penicillamine (cuprimine)
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RA, used when disease activity persists on other DMARDS
Associated with high incidence of Lupus and MG |
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D-penicillamine (cuprimine)
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bone marrow suppression, rash, stomatitis, dysguesia, proteinuria, autoimmune disease
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cyclophosphamide (cytoxan)
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severe vasculitis and other extraarticular involvement
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cyclophosphamide (cytoxan)
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bone marrow suppression, hemorrhagic cystitis, malignancy, infertility
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anakinra (kineret)
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RA, should not be used with active infections or with live vaccines
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anakinra (kineret)
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IL-1 antagonist
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anakinra (kineret)
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bone marrow suppression and infection
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adalimumab (humira)
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RA, used in combo with MTX
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adalimumab (humira)
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binds TNF alpha
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adalimumab (humira)
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bone marrow suppresison, CHF exacerbations, reactivation of TB, adn risk of malignancy
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Tobramycin
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P.aeruginosa
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Rifampin
Casopofungin (antifungal) |
CI in hepatic disease
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Concentration dependant drugs
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Metronidazole
Aminoglycosides Fluroquinolones Daptomycin Ketolides |
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Bacteriostatic
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Macrolides
Tetracyclines Clindamycin Sulfonamides Chloramphenicol |
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Bacteriocidal
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B-lactams
aminoglycosides Fluroquinolones Metronidazole Vancomycin Daptomycin |
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TMX/SMX
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Bloking sequential metabolic Steps
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Ampicillin + sulbactam
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inhibiting enzymatic inactivation
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ampicillin + gentamicin
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enhancement of antibiotic uptake
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tetracyline + amoxicillin
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inhibiting cidal activity of cell wall uptake agents
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ceftazidime + piperacillin
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induction of enzymatic inactivation
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PCN
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S. pneumo
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Clavulanate
Ammoxicillin |
For enzyme inhibition to overcome Ab resistance
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B lactams
glycopeptides bacitracin fosfomycin fosmidomycin |
cell wall synthesis inhibitors
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Aminoglycosides
Lincosamides Macrolides Ketolides Tetracyclines Glycylclines chloramphenicol streptogramins oxazolidinones nitroimidazoles fluroquinolones TMX/SMX |
Inhibitors of Bacterial Protein Synthesis
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Quinolones
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inhibit DNA replication
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Nitroimidazoles (metronidazole)
nitrofurans (mitrofurantoin) |
inhibit DNA
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rifampin
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inhibit RNA Polymerase
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Trimethoprim
Sulphonamides |
Inhibit Folate Metabolism
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tet + sulbactam
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inhibiting enzymatic inactivation
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ampicillin + gentamycin
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enhancement of Abx uptake
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tet + amoxicillin
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static agents inhibiting cidal activity of cell wall active agents
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ceftazidime + piperacillin
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induction of enzymatic inactivation
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Mechanism of acquired resistance
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decreased cellular mb penetration
active efflux enzymatic inactivation loss or modification of target site |
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increased doses
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low or intermediate level resistance can be overcome by...
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increase toxicity
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increased dose may...
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reduce resistance
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combination therapy may...
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Non-acetylated salicylates
IBU Nabumatone |
If you have a bleeding problem you should try....
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Salsalate
Sulindac |
If you have renal issues you should try...
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Nonacetylated salicylates
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If you have hematologic, bleeding or ulcer problems you should try...
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Diclofenac
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If you have hepatoxicity you should try...
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Beta Lactams
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PCN, cephalosporins, carbapenems, monobactams
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Beta Lactams
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good tissue penetration, bacteriocidal
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Natural PCN
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PCN G and V
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PCN G and V
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streptococci, enterococci, T. pallidum
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ANtistaphylococcal PCN
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methcillin, nafcillin, oxacillin, dicloxacillin, cloxacillin
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methcillin, nafcillin, oxacillin, dicloxacillin, cloxacillin
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MSSA, +/- streptococci, cellulitis, staphylococci, endocarditis
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Antipseudomonal PCN
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Ureidopenicillin, piperacillin, mezlocillin, azlocillin, carboxypenicillins, carbenicillin, ticarcillin
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Ureidopenicillin, piperacillin, mezlocillin, azlocillin, carboxypenicillins, carbenicillin, ticarcillin
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Pseudomonas, suseptible to beta lactams, HAP, nosocomial infx
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Antipseudomonal PCN
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can cause thrombocytopenia
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beta lactam/beta lactamase inhibitor combos
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piperacillin/taxobactam (zosyn)
ticarcillin/clavulanate (timentin) ampicillin/sulbactam (unasyn) amoxicillin/clavulanate (augmentin) |
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piperacillin/taxobactam (zosyn)
ticarcillin/clavulanate (timentin) ampicillin/sulbactam (unasyn) amoxicillin/clavulanate (augmentin) |
streptococci, MSSA, enterococci, anaerobes, GI infections, abscesses, serious nosocomial infx, diabetic wound infx
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1st generation cephalosporins
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cefazolin (ancef), cephalexin (keflex), cefadroxil (duricef)
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cefazolin (ancef), cephalexin (keflex), cefadroxil (duricef)
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MSSA, strep, some GNR, surgical prophylaxis, cellulitis, UTIs
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2nd generation cephalosporins
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cefuroxime (ceftin), cefaclor (ceclor), cefoxitin (mefoxin), cefprozil (cefzil), cefotetam (cefotan)
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cefuroxime (ceftin), cefaclor (ceclor), cefoxitin (mefoxin), cefprozil (cefzil), cefotetam (cefotan)
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worse gram positive coverage compared to 1st generation, better gram negative (neisseria)
URIs, surgical prophylaxis, gonorrhea |
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3rd generation cephalosporins
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ceftriaxone (rocephin), cefotaxime (claforan), ceftazidime (fortaz), cefixime (suprax), cefpodoxime (vantin)
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cefotaxime (claforan), ceftazidime (fortaz), cefixime (suprax), cefpodoxime (vantin)
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decreased antistaphylococcal activity
better antistreptococcal activity better gram negative coverage meningitis, CAP/HAP, lyme disease, SSTIs, UTIs, febrile, neutropenia |
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4th generation cephalosporins
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cefepime (maxipime)
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cefepime (maxipime)
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MSSA, strep, GNR, HAP, nosocomial infections, febrile neutrophenia
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Monobactam
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aztreonam (azactram)
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aztreonam (azactram)
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only active vs GNR, including pseudomonas, gram neg infections in pts with allergies to other beta lactams
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Glycopeptides
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vancomycin, teicoplanin
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vancomycin, teicoplanin
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bind to peptidoglycan, halting cell wall synthesis
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vancomycin, teicoplanin
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gram + anaerobes and aerobes, including MRSA
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vancomycin, teicoplanin
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DOC for MRSA
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vancomycin, teicoplanin
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causes Red-man Syndrom
Possible nephrotoxicity, ototoxicity |
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Inhibitors of Bacterial Protein Synthesis
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Aminoglycosides, Lincosamides, Macrolides, Ketolides, Tetracylcines, Glycylcyclines, Chloramphenicol, Streptogramins, Oxazolidinones, Nitroimidazoles, Fluroquinolones, TMX/SMX
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Aminoglycosides
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gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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inhibit translation by binding to rRNA ribosomal unit
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gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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bacteriocidal, excellent activity vs enterobacterieae, acinetobacter pseudomonas, other GNR
resistance in P.aeruginosa gram neg nosocomial infections, mycobacterial infections, pseudomonal infections, gram + synergy in endocarditis |
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gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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resistance due to: enzymatic activity inactivation, altered mb permeability, target site mutation
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lincosamides
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clindamycin (cleocin)
lincomycin (linocin) |
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clindamycin (cleocin)
lincomycin (linocin) |
inhibits translation by binding to bacterial ribosomes
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clindamycin (cleocin)
lincomycin (linocin) |
BACTERIOSTATIC
not active against C.diff active against staphy, strep, anaerobes aspiration pneumonia, SSTIs, anaerobic infx, acne |
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gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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adverse Effects= nephrotoxicity, ototoxicity, neuromuscular blockade
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clindamycin (cleocin)
lincomycin (linocin) |
Adverse effects= psuedomembranous colitis, diarrhea, abd pain, nausea, rash
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Macrolides
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erythromycin
clarithromycin (biaxin) azithromycin (zithromax) dirithromycin (dynabac) |
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erythromycin
clarithromycin (biaxin) azithromycin (zithromax) dirithromycin (dynabac) |
inhibits translation by binding ribosome
bacteriostatic excellent lung penetration, poor CNS penetration |
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erythromycin
clarithromycin (biaxin) azithromycin (zithromax) dirithromycin (dynabac) |
strep, atypical pathogens, some GNR, H. flu, M. cat
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clarithromycin
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H. pylori
CAP URIs MAC MAI infx PUD |
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erythromycin
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promotility
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macrolides
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AE= GI disturbances
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ketolides
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telithromycin (ketek)
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telithromycin (ketek)
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similar to macrolides
CAP (outpt) |
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telithromycin (ketek)
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AE= Gi disturbances
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tetracylines
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minoclycline (minocin)
tetracyline (sumycin) doxycycline (doryx) |
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minoclycline (minocin)
tetracyline (sumycin) doxycycline (doryx) |
inhibit translation
bacteriostatic poor CNS penetration |
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minoclycline (minocin)
tetracyline (sumycin) doxycycline (doryx) |
atypical pneumonia (chlamydia and mycoplasma)
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minoclycline (minocin)
tetracyline (sumycin) doxycycline (doryx) |
b. anthracis, borrelia, burgdorferi, y.pestis, t.pallidum, h.pylori, acne
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doxycycline (doryx)
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CAP, tick borne illness, PUD, STDs
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minoclycline (minocin)
tetracyline (sumycin) doxycycline (doryx) |
AE= tooth discoloration, GI upset (N/V), photosensitivity
CI= preggers |
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glycylcylines
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tigecyclines (tygacil)
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tigecyclines (tygacil)
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modified tetracycline that has an expanded spectrum, GNR and GPC, VRE, MRSA, SSTIs, intrabdominal infx
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tigecyclines (tygacil)
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AE= significant N/V
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Chloramphenicol
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binds to rRNA, inhibiting protein synthesis
bacteriostatic good CNS penetration |
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Chloramphenicol
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strep, staphylo, meth-sens only, enterococci including VRE, anaerobes, some GNR
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Chloramphenicol
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AE= gray baby syndrome- vomitting, flaccidity, gray color, respiratory distress, metabolic acidosis, bone marrow suppression
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Streptogramins
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Quinupristin/dalfopristin (synercid)
|
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Quinupristin/dalfopristin (synercid)
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bind to rRNA
halting protein synthesis some CNS penetration |
|
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Quinupristin/dalfopristin (synercid)
|
staphylo (including MRSA), strep including PCN resistant strains, enterococcus fascium including vanc resistant strains. Serious life threatening infections with VREF
MRSA infection in pts who cannot take other agents |
|
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Quinupristin/dalfopristin (synercid)
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AE= phlebitis, myalgias/arthralgias
|
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Oxazolidinones
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Linezolid (zyvox)
|
|
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Linezolid (zyvox)
|
binds to rRNA, preventing protein synthesis (binding site is distinct from other protein synthesis inhibitors)
|
|
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Linezolid (zyvox)
|
gram + anaerobes- staphyl (MRSA)
strept (including PCN resistant strains) Enterococci (inc. VREF) diabetic foot infections |
|
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Linezolid (zyvox)
|
AE= potential for increased BR with tyramine-containing foods, sympathomimetics, myelosuppression, particularly thrombocytopenia
|
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Nitroimidazoles
|
Metronidazole (flagyl)
|
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Metronidazole (flagyl)
|
causes DNA breakage
bacteriocidal anaerobic infections Pseudomembranous colitis |
|
|
Metronidazole (flagyl)
|
AE= GI N/V
|
|
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Fluroquinolones
|
Ofloxacin (oflox), ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), gatifloxacin (tequin), gemifloxacin (factive)
|
|
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Ofloxacin (oflox), ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), gatifloxacin (tequin), gemifloxacin (factive)
|
DNA breaks
bacteriocidal have good activity vs S. pneumonia |
|
|
cipro and levofloxacin
|
P. aeruginosa
|
|
|
cipro
|
poor gram + activity
|
|
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Ofloxacin (oflox), ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), gatifloxacin (tequin), gemifloxacin (factive)
|
AE= lower seizure threshold, N/V/d, photosensitivity
|
|
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TMP/SMX
|
staphy, strep, PCP, toxo gondi, UTI, SSTI, URI, opp infx
|
|
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TMP/SMX
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AE= hyperkalemia, bone marrow suppression
|
|
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Ofloxacin (oflox), ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), gatifloxacin (tequin), gemifloxacin (factive)
|
AE= lower seizure threshold, N/V/d, photosensitivity
|
|
|
TMP/SMX
|
staphy, strep, PCP, toxo gondi, UTI, SSTI, URI, opp infx
|
|
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TMP/SMX
|
AE= hyperkalemia, bone marrow suppression
|
