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49 Cards in this Set
- Front
- Back
ASD/AED
goals |
depress synaptic transmission and dec. nerve conduction
limit propagation elevate threshold of stimuli |
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Classification of Epilepsies
Partial seizures |
discrete focus
one hemisphere can generalize |
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Classification of Epilepsies
Partial seizures simple partial |
Jacksonian
does not spread no alteration of consciencousness 20-60 sec m. contractions and hall |
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Classification of Epilepsies
Partial seizures complex partial |
local discharge which becomes more widespread with alteration of consciousness
most common automatism/hall |
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Classification of Epilepsies
Generalized seizures |
both hemispheres with rapid spread
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Classification of Epilepsies
Generalized seizures tonic-clonic (grand mal) |
most common generalized
bilat movement that begin suddenly abrupt loss of consciousness tonic contractions for 10-20 sec; followed by relaxation amnesea |
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Classification of Epilepsies
Generalized seizures absence petit mal |
sudden onset and offset
non-convulsive 10 sec alteration of consciousness and cessation of ongoing activity childhood - ADHD diag. up too 100/day |
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Classification of Epilepsies
Generalized seizures Myoclonic |
rare
non-convulsive, sudeen lightening like jerks no alteration of consciousness can become tonic clonic |
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Classification of Epilepsies
Generalized seizures Atonic |
children
sudden loss of m. tone head drops; wear helmets b.c of frequent falls |
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Classification of Epilepsies
Generalized seizures tonic clonic treatment |
Carbamazepine
Phenytoin |
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Classification of Epilepsies
Generalized seizures absence treatment |
Ethosuximide
Valproic acid |
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Classification of Epilepsies
Generalized seizures atonic treatment |
valproic acid
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Classification of Epilepsies
partial seizures Complex partial treatment |
Carbamazepine
Phenytoin |
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Classification of Epilepsies
Febrile seizures treatment |
typically do not require medication
Phenobarbitol |
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Classification of Epilepsies
Status Epilepticus treatment |
IV Diazepam or lorazepam
IV fosphenytoin or phenobarbital |
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Classification of Epilepsies
Febrile seizures |
kids up to 5 yrs
2-4% of kids generalized tonic clonic of short duration |
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Classification of Epilepsies
Status Epilepticus |
prolonged >20 min of any type
tonic clonic is life threatening |
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AED General Side E
Females |
decrease oral contraceptive
adverse fetal abnormalities folic acid supp. helps Vit K def. in newborns |
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Drugs
Phenytoin Fosphenytoin Indications |
status epileticus
partial seizures tonic clonic |
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Drugs
Phenytoin Fosphenytoin Mech |
block Na channels in inactive state; prolong refractory period
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Drugs
Phenytoin Fosphenytoin Pharmaco |
slowly absorbed; slow on and long duration
maintence therapy rate of ab very different for diff patients (35-95%); don't change brands |
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Drugs
Phenytoin Metab |
liver enz. saturates at high doses so zero order kinetics
half life 7-42 hrs low TI, monitor plasma level |
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Drugs
Phenytoin Fosphenytoin Adverse Effects (Impt.) common |
N&V; visual (early)
ataxia confusion gingival hyperplasia - benign hirsutism - facial hair |
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Drugs
Phenytoin Fosphenytoin Adverse Effects (Impt.) Rare |
megoblastic anemia
coarsening of facial features - kids (bone and collagen growth) rashes and blood dyscrasias fetal malformation - fetal-hydantoin syndrome Osteomalacia |
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Drugs
Phenytoin Interactions |
inc. metab of oral contraceptives and coagulants;
inc metab of cabam and VA Carbamazepine and phenobarbital inc metab of phenytoin VA and Cimetidine dec metab of phenytoin |
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Drugs
Carbamazepine Oxcarbazepine Indications |
partial and tonic-clonic
also trigeminal neuralgia also biploar disease |
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Drugs
Carbamazepine Oxcarbazepine Mech |
block Na channels in inactive state
prolong cell refract |
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Drugs
Carbamazepine Oxcarbazepine Adverse Common |
N&V
visual Ataxia Sedation at high doses |
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Drugs
Carbamazepine Oxcarbazepine Adverse Rare |
hyponatremia with water retention
idiosyncratic rxn: rashes and blood dyscrasis |
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Drugs
Carbamazepine Oxcarbazepine Interactions |
autometabolism
Inc metab of other anticonvulsants and oral contraceptives Cimetidine dec metab |
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Drugs
Valproic Acid Indications |
absence
myoclonic atonic |
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Drugs
Valproic Acid Adverse Common |
N&V
heart burn wt gain hair loss - temporary ataxia tremor!! |
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Drugs
Valproic Acid Adverse Rare |
fetal malformations - spina bifida
idiosyncratic hepatoxicity polycystic ovarian syndrome |
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Drugs
Valproic Acid Interactions |
inhib metab of carbamazeoine and phenytoin
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Drugs
Ethosuximide Indications |
Absence
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Drugs
Ethosuximide Mech |
reduces low threshold T-type Ca current that provides pacemaker activity in thalamus
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Drugs
Ethosuximide Adverse effects |
N&V and fatigue
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Drugs
Ethosuximide Adverse Rare |
rashes and blood dyscrasias
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Drugs
Phenobarbital Indications |
febrile seizures in infants
status epilepticus |
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Drugs
Phenobarbital Mech |
GABA mediated inhibition of neuronal activity
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Drugs
Phenobarbital Adverse Effects |
paradoxical hyperactivity and shrotened attention span
sedation and nystagmus with chronic use seizure if abruptly discontinued |
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Drugs
Phenobarbital Chronic use |
induction of metab of other microenzymes
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Drugs
Diazepam Lorazepam INdications |
status epilepticus
it's a benzo! |
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Drugs
Diazepam Lorazepam Mech |
GABA mediated inhibitions of neuronal
rapid onset/ short acting (30-45min) rapid tolerance |
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Drugs
Diazepam Lorazepam Adverse Effects |
rapid development of tolerance limits chronic use
sedation and paradoxical hyperactivity |
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Drugs
Diazepam Lorazepam Adverse Effects |
rapid development of tolerance
sedation and paradoxical hyperactivyt limit use |
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Newer AEDs
Lamotrigene Mech |
voltage and use dependent Na channel blockade
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Newer AEDs
Lamotrigene Adverse Effects |
dizziness
headache diplopia nausea S-J syndrome and toxic epidermal necoriss in kids |
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Newer AEDs
Lamotrigene Pharmaco/Interactions |
half life reduced by 50% by inducing agents phenytoin an dcarbamazepine.
valproic acid inhibits clearance |