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84 Cards in this Set

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what is status epilepticus
a single seizure for longer than 30 minutes OR frequent seizures without recovery of awareness in between
what is the definition of focal/partial seizures and what are the 2 subcategories?
focal/partial seizures arise in one area of the brain

there are simple partial seizures, and complex partial seizures

what is the difference between simple partial seizures and complex partial seizures?
simple partial seizures involve no loss of consciousness, while complex partial seizures do
what is a generalized seizure?
these seizures have a bilateral diffuse onset, and come from all areas of the brain at once
what are the 5 types of generalized seizure? (atm ta)
absence seizure

tonic/clonic seizure

myoclonic seizure

tonic seizure

atonic seizure

name 3 symptoms of absence seizures
1. loss of consciousness

2. behavioral arrest

3. staring


a) absence seizures occur most in adulthood

b) absence seziures are rarely associated with automatisms

a) false. absence seizures occur most in childhood

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

what are three events that occur during tonic clonic seizures
1. loss of consciousness

2. a tonic period of muscle rigidity

3. a clonic period of involuntary muscle movement

t/f patients may become incontinent and have tongue biting in absence seizures
false. patients may become incontinent and have tongue biting in tonic/clonic seizures
a patient who just had a seizure is drowsy, confused, and is having a lot of headaches. what seizure was it?

what seizure is petit mal?

what seizure is grand mal?

petit mal is absence

grand mal is tonic/clonic

name 2 hallmarks of myoclonic seizures
1. brief, sudden muscle contractions that involve any muscle group

2. no loss of consciousness

t/f only the 'mal' seizures have no loss of consciousness
false. only the petit and grand mal seizures DO have a loss of consciousness
name 2 hallmarks of tonic seizures
1. muscle rigitidy

2. impaired, but not lost, consciousness

describe atonic seizures
1. aka 'drop' seizures, these result from a loss of muscle tone. there is a risk of falling injury.
what is a secondary generalized seizure?
a seizure that begins at one area of the brain (like a focal seizure) then spreads throughout the brain
what is the preliminary focal phase of a secondary generalized seizure referred to?
an aura
what are the three regions of the frontal lobe that are affected by focal seizures?
1. primary motor cortex

2. supplemental motor area (SMA)

3. higher areas of the frontal cortex

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

name some movements that may arise from focal seizure in the supplemental motor area of the frontal lobe
tonic posturing (rigidity) affecting the entire side of the body
name some movements that may arise from focal seizure in the higher areas of the frontal cortex of the frontal lobe
very complex behavioral automatisms such asriding a bikeswimminglaughingcrying
temporal lobe seizures show a number of effects.

name 4

1. emotions

2. psychic symptoms (deja vu)

3. sensory hallucinations (auditory, olfactory, gustatory)

4. visual distortions

what are the three regions of the parietal lobe that are affected by focal seizures?
1. somatosensory cortex

2. somatosensory association cortex

3. higher order sensory association areas

name some effects that may arise from focal seizure in the somatosensory cortex of the parietal lobe
paresthesias (numbness) and 'pins and needles'
name some effects that may arise from focal seizure in the somatosensory association cortex of the parietal lobe
more widespread paresthesias than in the somatosensory cortex
name some effects that may arise from focal seizure in the higher sensory association areas of the parietal lobe
hallucinations and illusions. very similar to temporal lobe focal seizures
what two focal seizures are the most similar?
temporal lobe and parietal lobe
occipital lobe focal seizures are associated with visual hallucinations. are these more or less likely to be of discrete object
less likely
what focal seizure can cause temporary blindness and reflex nastygmus?
occibital lobe focal seizure
what are the three classifications of epilepsy etiology? describe them
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

what is the seizure threshold?
the balance between exitable and inhibitory forces in the brain
name 3 factors that can affect the seizure threshold
1. stroke2. head injury3. visual stimuli (flashing lights)
what are the 4 mechanisms of action of antiepileptic drugs?
1. blocking sodium channels

2. blocking voltage dependent calcium channels

3. glutamate antagonists

4. potentiating actions of GABA

how does AED blocking sodium channels decrease seizures?
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
what is the most widely used aed? which one of the 4 aeds is it?
phenytoin. it is a sodium channel blocker
_______ (sodium channel blocker) is useful for all types of seizures except _____ seizures
phenytoin is useful for all types of seizures except absence seizures
a _____ increase in phenytoin dose produces a _____ increase in plasma concentration. why?
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
t/f phenytoin is teratogenic
how do blocking voltage dependent calcium channels work as an AED?
calcium is necessary to push neurotransmitters out into the synapse. blocking calcium influx stops this
glutamate antagonists block what two receptors to treat epilepsy?
why does potentiating GABA prevent seizures?
GABA binding to its receptor causes an influx of Cl-, which makes it harder for the cell to depolarize.
what are the 4 ways drugs can potentiate gaba? (pretty basic)
1. enhance GABA binding to receptor

2. stimulating GABA release

3. inhibiting GABA breakdown

4. inhibiting GABA reuptake

diagnosis of depression requires ___ symptoms over __ weeks
diagnosis of depression requires 5 symptoms over 2 weeks
What are the two major types of depression?
exogenous and endogenous
What are two signs of exogenous depression? Name 2 symptoms for each
1. Pathological grief - symptoms are prolonged grieving with excess guilt

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

exogenous depression is best treated by ____
name 3 symptoms of major depression
1. lack of response to positive stimuli

2. weight loss

3. insomnia

what is the difference between major depression and severe depression?
severe depression has suicidal tendencies and psychoses as added symptoms
what is the difference between atypical depression and major depression?
similar symptoms except atypical depression has the atypical symptoms of hypersomnia and hyperphagia
those with atypical depression are usually ______
those with atypical depression are usually obese
what is the difference between dysythmia and major depression?
dysythmia symptoms are not as severe, also symptoms are more noticable to family and friends than they are to the patient
which of the endogenous depressive disorders would you treat with psychotherapy?
what are the last 3 endogenous depressive disorders?
SADpostpartum depressionbipolar disorder
what is the monoamine hypothesis for depression?
depression results from an altering of

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

what are the two ways antidepressant drugs mediate their effect?
inhibitng monoamine reuptake

inhibiting monoamine metabolism

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


SNRIs (selective norepinephrine/serotonin reuptake inhibitors)

MAO Is (monoamine oxidase inhibitors)

what is the tricyclic antidepressant mechanism of action?

what type of endogenous depression do they help treat?

inhibit the reuptake of both serotonin and norepinephrine

they help treat major depression

name 3 adverse FX of tricyclic antidepressants
1. weight gain

2. sedation

3. decreased seizure threshold

what are the most commonly used antidepressant and what type of depression are they most commonly used for?
SSRIs they have the same mech of action as tricyclic antidepressants except they only inhibit serotonin reuptake. they are mostly used for major depression
what is the main adverse effect of SSRI use and what is it?
serotonin syndrome. excess serotonin transmission can cause agitation, confusion, anxiety
what is the main advantage to SNRIs?

How are they different from TCA?

a) they have a rapid onset of action

b) they dont have a 3 ring structure

what is the mechanism of action of MAO I
MAO is an enzyme that inactivates monoamine neurotransmitters. MAO I stops that from happening
what does MAO A do?

What does MAO B do?

MAO a metabolizes serotonin and norepinephrine

MAO B metabolizes dopamine

t/f MAO inhibitors used to treat depression are selective
false. they are non selective, so they can also help with parkinsons treatments as well
MAO inhibitors are useful in the treatment of what forms of depression?
atypical and dysythmia
how do mao inhibitors mediate their effects?
by inhibiting metabolism of serotonin and norepinephrine in the synapse
name 2 adverse effects of MAO inhibitors
1. CNS excitation

2. hypertensive crisis if taken with tyramine containing foods

what is biploar disorder characterized by?
recurrent fluctuations between episodes of mania and depression
what three major groups of drugs are used to treat bipolar disorder?
1. mood stabilizers

2. antipsychotics

3. antidepressants

what are the three effects of mood stabilizers (bipolar)
1. relieve symptoms during manic or depressive episodes

2. prevent reocurrence of episodes

3. do not worsen symptoms or change rate of cycling

what are the two drugs used as mood stabilizers?
lithium and valproic acid
why is giving lithium and a diuretic bad?
it actuallly increases lithium concentrations. diuretic could increase GI upset and tremors
what are antipsychotics used for specifically for bipolar disorder?
to help stabilize mood during manic episodes
t/f antipsychotic drugs benefit bipolar patients even when they dont have psychotic symptoms
what are used to treat bipolar patients, conventional or atypical antipsychotics?
atypical. this is because they wont cause extrapyrimidal symptoms
when treating bipolar episodes, antidepressants are usually combined with a _____. why?
antidepressants are usually combined with a mood stabilizer because it is thought that antidepressants on their own can cause mania
t/f those with depression usually have bipolar
false. those with depression probably have anxiety
which anxiety disorder is often confused for heart attack?
panic disorder
what are the three classes of drugs used to treat anxiety?
benzos (BDZ)



what is the first line therapy for anxiety?
how do benzos work to treat anxiety?
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)
what 2 anxiety disorders are benzos used to treat?
generas anxiety disorder and social anxiety disorder
t/f buspirone and benzos are cns depressants
false. buspirone is NOT a cns depressant, but benzos are
what is buspirone used to treat?
general anxiety disorder