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207 Cards in this Set

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Simple Partial Seizure aka Focal Seizure
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
Simple Partial Seizure aka Focal Seizure
somatosensory episodes (paresthesias) in a focal area, i.e. numbness, tingling, pins and needles, burning or vibration.
Simple Partial Seizure aka Focal Seizure
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).
Simple Partial Seizure aka Focal Seizure
may progress to generalized tonic-clonic seizure, i.e. secondary generalized seizure.
Simple Partial Seizure aka Focal Seizure
Tx is difficult but phenytoin or carbamazepine is initial choice
Complex Partial Seizure aka temporal lobe or psychomotor seizure
Usually preceded by an aura, such as:
-bitter taste in mouth
-olfactory hallucinations of bad odor
-nonspecific fear or anger
-abdominal sensations
Complex Partial Seizure aka temporal lobe or psychomotor seizure
during seizure of several minutes duration, pt is dazed, confused, agitated or acts weird. No change in body tone.
Complex Partial Seizure aka temporal lobe or psychomotor seizure
may also show automatism:
-picking at self or clothes
-repetitive hand rubbing
Complex Partial Seizure aka temporal lobe or psychomotor seizure
when addressed, can turn toward sound but only mumble incoherantly
Complex Partial Seizure aka temporal lobe or psychomotor seizure
can become agitated or aggressive if restrained
Complex Partial Seizure aka temporal lobe or psychomotor seizure
May progress to secondary generalized seizure
Complex Partial Seizure aka temporal lobe or psychomotor seizure
Carbamazepine= DOC
Phenytoin= second choice
Absence Seizure aka Petite Mal seizure
occurs w/o preceding aura
Absence Seizure aka Petite Mal seizure
occur primarily in children and may remit during puberty
Absence Seizure aka Petite Mal seizure
sudden cessation of conscious activity without convulsive muscular activity. Child is out to lunch mentally and unresponsive.
Absence Seizure aka Petite Mal seizure
Calling or shaking the child does not interupt the OTLness
Absence Seizure aka Petite Mal seizure
Episodes are brief, 10-45 min, rarely longer
Absence Seizure aka Petite Mal seizure
Episodes may be so infrequent that they go unnoticed, or may occure hundreds of times per day
Absence Seizure aka Petite Mal seizure
EEG recorded during episode shows characteristic 3Hz spike and wave pattern
Absence Seizure aka Petite Mal seizure
About 50% of pts go on to develop generalized tonic-clonic seizures, usually during teen years
Absence Seizure aka Petite Mal seizure
Zarontin(ethosuximide)= DOC
Absence Seizure aka Petite Mal seizure
Second Choice Drugs
Depakote (divalproex sodium)
Depakene (valproic acid)
Depakote (divalproex sodium)
Depakene (valproic acid)
May cause hepatotoxicity
Phenytoin and carbamazepine (Tegretol)
Absence Seizure aka Petite Mal seizure may be exacerbated by
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
begin without a preceding aura
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
sudden loss of consciousness
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
pt falls tot he ground in rigid (tonic) posture, trunk and neck hyperextended
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
an epileptic cry may be emitted as air is tonically forced out
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
tonic contraction usually causes temporary respiratory arrest and temporary cyanosis. Urinary or fecal incontinance may occur. Tongue may be bitten and macerated
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Clonic phase begins within 30-60 seconds, symmetric and rhythmic whole body contractions which ends gradually, never abruptly
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Whole seizure lasts 2-5 minutes
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Postictally pt is confused and drowsy for minute to hours
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Most commonly used drug= Phenytoin (Dilantin)
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Valproic Acid, carbamezepine and phenobarbital are also used.
Dilantin
Nonsedative at therapeutic Doses
Phenobarbital
Sedative
Status Epilepticus
one ssizure leads to another
Status Epilepticus
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
Status Epilepticus
Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
Status Epilepticus
hyperthermia
rhabdomyolysis
hypoglycemia
lactic acidosis
cardiac dysrhythmias
Status Epilepicus
Abrupt cessation of anticonvulsant meds causes...
Status Epilepticus
ICH, brain neoplasm and brain trauma all cause
Status Epilepticus
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
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Whole seizure lasts 2-5 minutes
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Postictally pt is confused and drowsy for minute to hours
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Most commonly used drug= Phenytoin (Dilantin)
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Valproic Acid, carbamezepine and phenobarbital are also used.
Dilantin
Nonsedative at therapeutic Doses
Phenobarbital
Sedative
Status Epilepticus
one ssizure leads to another
Status Epilepticus
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
Status Epilepticus
Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
Status Epilepticus
hyperthermia
rhabdomyolysis
hypoglycemia
lactic acidosis
cardiac dysrhythmias
Status Epilepicus
Abrupt cessation of anticonvulsant meds causes...
Status Epilepticus
ICH, brain neoplasm and brain trauma all cause
Status Epilepticus
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
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Whole seizure lasts 2-5 minutes
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Postictally pt is confused and drowsy for minute to hours
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Most commonly used drug= Phenytoin (Dilantin)
Generalized Tonic-Clonic Seizures aka Primary Generalized, Major Motor or Grand Mal Seizures
Valproic Acid, carbamezepine and phenobarbital are also used.
Dilantin
Nonsedative at therapeutic Doses
Phenobarbital
Sedative
Status Epilepticus
one ssizure leads to another
Status Epilepticus
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
Status Epilepticus
Process can go on for hours witht he end result being severe brain damage or death due to neuronal hypoxia and/or excitotoxicity.
Status Epilepticus
hyperthermia
rhabdomyolysis
hypoglycemia
lactic acidosis
cardiac dysrhythmias
Status Epilepicus
Abrupt cessation of anticonvulsant meds causes...
Status Epilepticus
ICH, brain neoplasm and brain trauma all cause
Status Epilepticus
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
hydroxychloroquine (plaquenil) and Sulfasalazine (azulfidine)
milder disease of RA b.c of safety and convenience of drugs
hydroxychloroquine (plaquenil)
renal toxicity and diarrhea
Sulfasalazine (azulfidine)
bone marrow suppression and GI intolerance
methotrexate (rheumatrex)
severe diease of RA b/c has the most rapid onset and sustained benefit; has to be monitored closely
methotrexate (rheumatrex)
bone marrow suppression, liver and pulmonary toxicity, GI intolerance, stomatitis, rash
leflunomide (arava)
Used for RA, inhibits pyrimidine synthesis. Immunomodulary and antiproliferative effects
leflunomide (arava)
CI- hepatitis B and C, intercurrent liver, gall bladder and renal disease; pregnancy or delayed menses
TERATOGEN
leflunomide (arava)
must monitor CBC, creatine, LFT, elevations in AST or ALT
leflunomide (arava)
diarrhea, alopecia, rash, h/a, immunosuppression (theory), infection
etanercept (enbrel)
RA, binds and inhibits tumor necrosis factor
etanercept (enbrel)
assess for infections or risk factors for infection
infliximab (remicade)
RA binds and inhibits TNF alpha
infliximab (remicade)
use in combo with oral or SC MTX
azathioprine (imuran)
RA, inhibits T-lymphs
azathioprine (imuran)
used when disease activity persists on other DMARDS
azathioprine (imuran)
safer than MTX for pts >65
SE- renal insufficiency
Gold Salts
auranofin (ridaura)
minocycline (minocin)
D-penicillamine (cuprimine)
cyclophosphamide (cytoxan)
anakinra (kineret)
adalimumab (humira)
auranofin (ridaura)
RA, used IM
auranofin (ridaura)
bone marrow suppression, rash, stomatitis, proteinuria
minocycline (minocin)
RA, renal toxicity
D-penicillamine (cuprimine)
RA, used when disease activity persists on other DMARDS
Associated with high incidence of Lupus and MG
D-penicillamine (cuprimine)
bone marrow suppression, rash, stomatitis, dysguesia, proteinuria, autoimmune disease
cyclophosphamide (cytoxan)
severe vasculitis and other extraarticular involvement
cyclophosphamide (cytoxan)
bone marrow suppression, hemorrhagic cystitis, malignancy, infertility
anakinra (kineret)
RA, should not be used with active infections or with live vaccines
anakinra (kineret)
IL-1 antagonist
anakinra (kineret)
bone marrow suppression and infection
adalimumab (humira)
RA, used in combo with MTX
adalimumab (humira)
binds TNF alpha
adalimumab (humira)
bone marrow suppresison, CHF exacerbations, reactivation of TB, adn risk of malignancy
Tobramycin
P.aeruginosa
Rifampin
Casopofungin (antifungal)
CI in hepatic disease
Concentration dependant drugs
Metronidazole
Aminoglycosides
Fluroquinolones
Daptomycin
Ketolides
Bacteriostatic
Macrolides
Tetracyclines
Clindamycin
Sulfonamides
Chloramphenicol
Bacteriocidal
B-lactams
aminoglycosides
Fluroquinolones
Metronidazole
Vancomycin
Daptomycin
TMX/SMX
Bloking sequential metabolic Steps
Ampicillin + sulbactam
inhibiting enzymatic inactivation
ampicillin + gentamicin
enhancement of antibiotic uptake
tetracyline + amoxicillin
inhibiting cidal activity of cell wall uptake agents
ceftazidime + piperacillin
induction of enzymatic inactivation
PCN
S. pneumo
Clavulanate
Ammoxicillin
For enzyme inhibition to overcome Ab resistance
B lactams
glycopeptides
bacitracin
fosfomycin
fosmidomycin
cell wall synthesis inhibitors
Aminoglycosides
Lincosamides
Macrolides
Ketolides
Tetracyclines
Glycylclines
chloramphenicol
streptogramins
oxazolidinones
nitroimidazoles
fluroquinolones
TMX/SMX
Inhibitors of Bacterial Protein Synthesis
Quinolones
inhibit DNA replication
Nitroimidazoles (metronidazole)

nitrofurans (mitrofurantoin)
inhibit DNA
rifampin
inhibit RNA Polymerase
Trimethoprim
Sulphonamides
Inhibit Folate Metabolism
tet + sulbactam
inhibiting enzymatic inactivation
ampicillin + gentamycin
enhancement of Abx uptake
tet + amoxicillin
static agents inhibiting cidal activity of cell wall active agents
ceftazidime + piperacillin
induction of enzymatic inactivation
Mechanism of acquired resistance
decreased cellular mb penetration
active efflux
enzymatic inactivation
loss or modification of target site
increased doses
low or intermediate level resistance can be overcome by...
increase toxicity
increased dose may...
reduce resistance
combination therapy may...
Non-acetylated salicylates
IBU
Nabumatone
If you have a bleeding problem you should try....
Salsalate
Sulindac
If you have renal issues you should try...
Nonacetylated salicylates
If you have hematologic, bleeding or ulcer problems you should try...
Diclofenac
If you have hepatoxicity you should try...
Beta Lactams
PCN, cephalosporins, carbapenems, monobactams
Beta Lactams
good tissue penetration, bacteriocidal
Natural PCN
PCN G and V
PCN G and V
streptococci, enterococci, T. pallidum
ANtistaphylococcal PCN
methcillin, nafcillin, oxacillin, dicloxacillin, cloxacillin
methcillin, nafcillin, oxacillin, dicloxacillin, cloxacillin
MSSA, +/- streptococci, cellulitis, staphylococci, endocarditis
Antipseudomonal PCN
Ureidopenicillin, piperacillin, mezlocillin, azlocillin, carboxypenicillins, carbenicillin, ticarcillin
Ureidopenicillin, piperacillin, mezlocillin, azlocillin, carboxypenicillins, carbenicillin, ticarcillin
Pseudomonas, suseptible to beta lactams, HAP, nosocomial infx
Antipseudomonal PCN
can cause thrombocytopenia
beta lactam/beta lactamase inhibitor combos
piperacillin/taxobactam (zosyn)
ticarcillin/clavulanate (timentin)
ampicillin/sulbactam (unasyn)
amoxicillin/clavulanate (augmentin)
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
1st generation cephalosporins
cefazolin (ancef), cephalexin (keflex), cefadroxil (duricef)
cefazolin (ancef), cephalexin (keflex), cefadroxil (duricef)
MSSA, strep, some GNR, surgical prophylaxis, cellulitis, UTIs
2nd generation cephalosporins
cefuroxime (ceftin), cefaclor (ceclor), cefoxitin (mefoxin), cefprozil (cefzil), cefotetam (cefotan)
cefuroxime (ceftin), cefaclor (ceclor), cefoxitin (mefoxin), cefprozil (cefzil), cefotetam (cefotan)
worse gram positive coverage compared to 1st generation, better gram negative (neisseria)
URIs, surgical prophylaxis, gonorrhea
3rd generation cephalosporins
ceftriaxone (rocephin), cefotaxime (claforan), ceftazidime (fortaz), cefixime (suprax), cefpodoxime (vantin)
cefotaxime (claforan), ceftazidime (fortaz), cefixime (suprax), cefpodoxime (vantin)
decreased antistaphylococcal activity
better antistreptococcal activity
better gram negative coverage
meningitis, CAP/HAP, lyme disease, SSTIs, UTIs, febrile, neutropenia
4th generation cephalosporins
cefepime (maxipime)
cefepime (maxipime)
MSSA, strep, GNR, HAP, nosocomial infections, febrile neutrophenia
Monobactam
aztreonam (azactram)
aztreonam (azactram)
only active vs GNR, including pseudomonas, gram neg infections in pts with allergies to other beta lactams
Glycopeptides
vancomycin, teicoplanin
vancomycin, teicoplanin
bind to peptidoglycan, halting cell wall synthesis
vancomycin, teicoplanin
gram + anaerobes and aerobes, including MRSA
vancomycin, teicoplanin
DOC for MRSA
vancomycin, teicoplanin
causes Red-man Syndrom
Possible nephrotoxicity, ototoxicity
Inhibitors of Bacterial Protein Synthesis
Aminoglycosides, Lincosamides, Macrolides, Ketolides, Tetracylcines, Glycylcyclines, Chloramphenicol, Streptogramins, Oxazolidinones, Nitroimidazoles, Fluroquinolones, TMX/SMX
Aminoglycosides
gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
inhibit translation by binding to rRNA ribosomal unit
gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
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
gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
resistance due to: enzymatic activity inactivation, altered mb permeability, target site mutation
lincosamides
clindamycin (cleocin)
lincomycin (linocin)
clindamycin (cleocin)
lincomycin (linocin)
inhibits translation by binding to bacterial ribosomes
clindamycin (cleocin)
lincomycin (linocin)
BACTERIOSTATIC
not active against C.diff
active against staphy, strep, anaerobes
aspiration pneumonia, SSTIs, anaerobic infx, acne
gentamycin, tobramycin, amikacin, neomycin, streptomycin, paromycin, netilmicin
adverse Effects= nephrotoxicity, ototoxicity, neuromuscular blockade
clindamycin (cleocin)
lincomycin (linocin)
Adverse effects= psuedomembranous colitis, diarrhea, abd pain, nausea, rash
Macrolides
erythromycin
clarithromycin (biaxin)
azithromycin (zithromax)
dirithromycin (dynabac)
erythromycin
clarithromycin (biaxin)
azithromycin (zithromax)
dirithromycin (dynabac)
inhibits translation by binding ribosome
bacteriostatic
excellent lung penetration, poor CNS penetration
erythromycin
clarithromycin (biaxin)
azithromycin (zithromax)
dirithromycin (dynabac)
strep, atypical pathogens, some GNR, H. flu, M. cat
clarithromycin
H. pylori
CAP
URIs
MAC
MAI infx
PUD
erythromycin
promotility
macrolides
AE= GI disturbances
ketolides
telithromycin (ketek)
telithromycin (ketek)
similar to macrolides
CAP (outpt)
telithromycin (ketek)
AE= Gi disturbances
tetracylines
minoclycline (minocin)
tetracyline (sumycin)
doxycycline (doryx)
minoclycline (minocin)
tetracyline (sumycin)
doxycycline (doryx)
inhibit translation
bacteriostatic
poor CNS penetration
minoclycline (minocin)
tetracyline (sumycin)
doxycycline (doryx)
atypical pneumonia (chlamydia and mycoplasma)
minoclycline (minocin)
tetracyline (sumycin)
doxycycline (doryx)
b. anthracis, borrelia, burgdorferi, y.pestis, t.pallidum, h.pylori, acne
doxycycline (doryx)
CAP, tick borne illness, PUD, STDs
minoclycline (minocin)
tetracyline (sumycin)
doxycycline (doryx)
AE= tooth discoloration, GI upset (N/V), photosensitivity
CI= preggers
glycylcylines
tigecyclines (tygacil)
tigecyclines (tygacil)
modified tetracycline that has an expanded spectrum, GNR and GPC, VRE, MRSA, SSTIs, intrabdominal infx
tigecyclines (tygacil)
AE= significant N/V
Chloramphenicol
binds to rRNA, inhibiting protein synthesis
bacteriostatic
good CNS penetration
Chloramphenicol
strep, staphylo, meth-sens only, enterococci including VRE, anaerobes, some GNR
Chloramphenicol
AE= gray baby syndrome- vomitting, flaccidity, gray color, respiratory distress, metabolic acidosis, bone marrow suppression
Streptogramins
Quinupristin/dalfopristin (synercid)
Quinupristin/dalfopristin (synercid)
bind to rRNA
halting protein synthesis
some CNS penetration
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
Quinupristin/dalfopristin (synercid)
AE= phlebitis, myalgias/arthralgias
Oxazolidinones
Linezolid (zyvox)
Linezolid (zyvox)
binds to rRNA, preventing protein synthesis (binding site is distinct from other protein synthesis inhibitors)
Linezolid (zyvox)
gram + anaerobes- staphyl (MRSA)
strept (including PCN resistant strains)
Enterococci (inc. VREF)
diabetic foot infections
Linezolid (zyvox)
AE= potential for increased BR with tyramine-containing foods, sympathomimetics, myelosuppression, particularly thrombocytopenia
Nitroimidazoles
Metronidazole (flagyl)
Metronidazole (flagyl)
causes DNA breakage
bacteriocidal
anaerobic infections Pseudomembranous colitis
Metronidazole (flagyl)
AE= GI N/V
Fluroquinolones
Ofloxacin (oflox), ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), gatifloxacin (tequin), gemifloxacin (factive)
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
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
TMP/SMX
AE= hyperkalemia, bone marrow suppression
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
TMP/SMX
AE= hyperkalemia, bone marrow suppression