Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
what are the types of seizures
|
partial simple
partial complex absence myoclonic tonic-clonic tonic or clonic atonic |
|
what is main difference between simple and complex
|
loss of consciencness
|
|
which partial seizure has loss of consciecness
|
complex
|
|
most common seizure in adults
|
partial secondary generalized
|
|
the most common aura is what
|
indescribable
|
|
when is the onset of absence seizures
|
between 4-12
|
|
what are the characteristics of absence seizures
|
brief loss of consciencness
no memory of episode mulitple daily |
|
how can absence seizures be induced
|
via hyperventalation
|
|
how do you treat absence seizures
|
valproic acid
|
|
what are the characteristics of myoclonic seizures
|
brief suden shocklike muscle contraction
polyspike pattern on EEG |
|
what might patients do who are experiencing myoclonic seizures
|
drop objects
spill food be propelled out of chairs or beds |
|
onset of atonic seizures
|
2-5
|
|
characteristics of atonic seizures
|
in developmentally disabled
legs lose tone patients fall to ground brief up to one minute |
|
what are the firing modes of thalamic neurons
|
oscillatory and tonic
|
|
oscillatory firing depends on what structure
|
nucleus reticularis thalami
|
|
what type of neurons are those in the NRT
|
gabaergic neurons
|
|
what effect does increased GABA have on NRT neurons
|
inhibits NRT neurons reducing duration of spike-wave discharges
|
|
what is the other important mechanism in some types of epilepsy
|
glutamate mediated excitation of thalamocortical and corticothalamic pathways
|
|
indications for pheytoin and fospheytoin
|
simple/complex partial
generalized tonic/clonic |
|
pheytoin and fospheytoin do not work for what
|
myoclonic, atonic or absence
|
|
MOA for phenytoin and fosphenytoin
|
sodium channel antagonist
|
|
brand names for carbamazepine
|
tegretol and carbatrol
|
|
what are indication for carbamazepine
|
simple/complex partial
generalized tonic-clonic |
|
MOA of carbamazepine
|
sodium channel antagonist
|
|
what has longer half life phenytoin or carbamazepine
|
phenytoin
|
|
what are indications for valproic acid
|
myoclonic
absence simple/complex partial generalized |
|
valproic acid is treatment of choice in what cases
|
idiopathic epilepsies
|
|
MOA of valproic acid
|
enhances GABA mediated inhibitory activity
sodium channel antagonist |
|
preferred treatment for generalized
|
valproic acid
|
|
dosing for valproic acid
|
BID-TID
|
|
indications for phenobarbital/primidone
|
partial and generalized seizures
|
|
MOA of phenobarbital/primidone
|
increases open state in GABA mediated chloride channels
reduces effect of glutamate reduces presynaptic Ca channel effect blocking neurotransmission |
|
primidone is metabolized to what
|
phenobarbital/phenylethylmalonamide
|
|
what is half life of pheonbarbital
|
1-5 days
|
|
side effect of phenobarbital
|
significant sedation
|
|
New drugs
|
gabapentin
lamotrigine tiagabine topiramate oxcarbazepine levetriacetam |
|
indication for gabapentin
|
complex partial seizures
|
|
what is dosing with gabapentin
|
TID
|
|
what is needed maintenance dose in gabapentin
|
300mg
|
|
what is real world max dose of gabapentin
|
4800mg daily
|
|
what is indication for lamotrigine
|
adjunct for complex partial seizures
|
|
MOA of lamotrigine
|
sodium channel antagonist
inhibits glutamate release |
|
what happens to half life when used with valproic acid
|
it is increased
|
|
where is lamotrigine metabolized
|
in the liver
|
|
indications for tigabine
|
complex partial
|
|
tigabine may exacerbate what type of seizures
|
generalized seizures
|
|
MOA of tigabine
|
inhibits GABA uptake at axonal terminal increasing levels of GABA at synapse
|
|
where is tigabine metabolized
|
in the liver
|
|
indications for topiramate
|
partial and generalized seizures
lennox-gastaut |
|
MOA for topiramate
|
sodium and calcium channel antagonist
increases GABA mediated antagonism weak carbonic anhydrase inhibitor |
|
indications for oxcarbazepine
|
complex partial seizures
|
|
MOA for oxcarbazepine
|
sodium channel antagonist
|
|
what is advantage of oxcarbazepine over carbamazepine
|
not autoinducing
|
|
oxcarbazepine is a what
|
prodrug
|
|
what is the metabolite of oxcarbazepine
|
monhydroxycarbamazepine
|
|
what is indication for levetiracetam
|
partial and generalized seizures
|
|
what is 1st choice drug in hepatic failure
|
levetiracetam
|
|
what should be included in work up for seizures
|
MRI brain with/without contrast
if negative sleep deprived EEG fasting glucose, routine labs |
|
what is risk of 2nd seizure with normal EEG
|
24% in two years
|
|
what is risk of 2nd seizure with abnormal EEG
|
50% in two years
|
|
what is risk of 2nd seizure with symptomatic seizure and abnormal EEG
|
65%
|
|
what is risk of seizure after second seizure
|
80%
|
|
status epilepticus
|
more than one seizure with no cognitive revovery between seizures or continous seizure of more than 10 min
|
|
what is treatment of status epilepticus if seizing
|
load with benzodiazepines
|
|
what is the preferred benzo
|
lorazepam
|
|
what is the next step in status epilepticus treatment after benzos
|
phenytoin 20mg/kg
|
|
what is infusion rate for phenytoin with status epilepticus
|
no faster than 50mg/min
|
|
what is the infusion rate for fosphenytoin in status epilepticus
|
150mg/min
|
|
if seizure recur what is done
|
give another 10mg/kg load
|
|
if seizure recur after this what is done
|
phenobarbital 20mg/kg
|
|
if seizure recurs after this what is done
|
pentobarbital coma or midazolam drip with intubation
|