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NE3 Epilepsy

Deleted user 14 questions Updated 11 Oct 2019

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Questions in this quiz (14)

  1. 1Epilepsy, the [blank_start]4th[blank_end] most common neurological disorder, is a brain disorder leading to recurring seizures.
    A seizure is a sudden abnormal and excessive [blank_start]firing[blank_end] of neurons. It affects 1-2% of the population. 1/3 of epilepsy is [blank_start]genetic[blank_end]. It can also be caused by: Brain injury, tumour, stroke, infections ([blank_start]meningitis, encephalitis[blank_end]), other brain disorders (Autism spectrum, dementia)
    Challenges: Depression, [blank_start]mood[blank_end] disorders, ADHD, sleep, falls, [blank_start]reproductive[blank_end] issues, osteoporosis, risk of death.
    Diagnosis involves [blank_start]EEG and MRI[blank_end].
    1. A4th
    2. Bfiring
    3. Cgenetic
    4. Dmeningitis, encephalitis
    5. Emood
    6. Freproductive
    7. GEEG and MRI
  2. 2Types of epilepsy:
    Note - Site of discharge and extent of spread affects symptoms.

    [blank_start]Simple[blank_end] (consciousness not affected) or [blank_start]Complex[blank_end] (consciousness affected)
    [blank_start]Focal[blank_end] (begins and remains local) or [blank_start]Generalised[blank_end] (whole brain inc. reticular system)
    Generalised can be classesd as: Absence, Myoclonic, Clonic, Tonic-clonic (very bad)
    1. ASimple
    2. BComplex
    3. CFocal
    4. DGeneralised
  3. 3Neural mechanisms are poorly understood.
    Epileptogenesis:
    • Facilitation of [blank_start]excitatory[blank_end] neurotransmission
    • Reduced [blank_start]inhibitory[blank_end] transmission
    • Abnormal [blank_start]electrical properties[blank_end] of cells
    Repeated epileptic [blank_start]discharge[blank_end] causes cell death ([blank_start]excitotoxicity[blank_end])... this is brain damage.
    1. Aexcitatory
    2. Binhibitory
    3. Celectrical properties
    4. Dexcitotoxicity
    5. Edischarge
  4. 4Which of these is NOT a drug that lowers seizure threshold?
    1. ATramadol
    2. BLithium
    3. CAntidepressants
    4. DAntipsychotics
    5. EMacrolides
  5. 5Antiepileptic drug action is effective in 70-80% of patients.
    Three main mechanisms:
    • Inhibition of [blank_start]Na+ channel[blank_end] function
    • Enhancement of [blank_start]GABA[blank_end] action
    • Inhibition of [blank_start]Ca2+[blank_end] channel function (T type)
    1. ANa+ channel
    2. BGABA
    3. CCa2+
  6. 6Moa: Inhibition of sodium channels.
    Affect membrane excitability. Inhibit high [blank_start]frequency[blank_end] neuronal firing through their action on Na+ channels.

    1. Phenytoin
    [blank_start]Tonic-clonic and focal[blank_end] seizures (not absence and myoclonic). [blank_start]Non-linear[blank_end] kinetics – acute toxicity. >[blank_start]90%[blank_end] bound to plasma proteins. Hepatic metabolism CYP1A2 and 3A4. Toxicity signs: [blank_start]Nystagmus[blank_end](uncontrolled eye movements), [blank_start]diplopia[blank_end](double vision), slurred [blank_start]speech[blank_end], ataxia, confusion, hyperglycaemia. Unwanted effects: GI, drowsiness, tremor, dizziness, headache, [blank_start]gingival hypertrophy, hirsuitism, acne.[blank_end]

    2. Carbamazepine
    Widely used: [blank_start]focal and generalised TC[blank_end], only. Substrate and autoinducer of CYP3A4. [blank_start]Variable[blank_end] half-life (3-5 wks, OK). Decreases [blank_start]warfarin[blank_end], increases [blank_start]erythromycin[blank_end]. Adverse effects are [blank_start]dose[blank_end] related and dose limiting: headache, N&V, ataxia, drowsiness, blurred vision, [blank_start]hyponatraemia.[blank_end]

    3. Sodium Valproate
    All forms of epilepsy. Chemically [blank_start]unrelated[blank_end] to other antiepileptics. Increases [blank_start]GABA[blank_end] content, weak [blank_start]Na[blank_end]+ block. Interactions: AEDs([blank_start]defibrillator[blank_end]), antidepressants, antimalarials, antipsychotics, carbapenems. Unwanted Effects: GI irritation, thrombocytopenia, transient [blank_start]hair loss[blank_end], liver toxicity and pancreatitis.

    4. Lamotrigine
    Focal seizures, generalised tonic-clonic, [blank_start]absence, Lennox-Gastaut syndrome[blank_end]. Valproate will [blank_start]increase[blank_end] its concentration. Carbamazepine and phenytoin will [blank_start]decrease[blank_end] its concentration. SEs: Nausea, dizziness, ataxia, (serious) skin reactions
    1. Afrequency
    2. BTonic-clonic and focal
    3. Cfocal and generalised TC
    4. Dabsence, Lennox-Gastaut syndrome
    5. ENon-linear
    6. F90%
    7. GNystagmus
    8. Hdiplopia
    9. Ispeech
    10. Jgingival hypertrophy, hirsuitism, acne.
    11. KVariable
    12. Lwarfarin
    13. Merythromycin
    14. Ndose
    15. Ohyponatraemia.
    16. Punrelated
    17. QGABA
    18. RNa
    19. Shair loss
    20. Tincrease
    21. Udecrease
    22. Vanti-epileptic drugs
  7. 7Which two sodium channel inhibitors can never be used in pregnancy?
    1. ACarbamazepine, Valproate
    2. BPhenytoin, Lamotrigine
    3. CCarbamazepine, Lamotrigine
    4. DPhenytoin, Valproate
  8. 8MoA: Enhancement of GABA.

    1. Clobazam, clonazepam - Enhances [blank_start]activation of GABA(A) R[blank_end], facilitates Cl- channel [blank_start]opening[blank_end] ([blank_start]lower[blank_end] threshold for AP)

    2. Tiagabin - [blank_start]inhibits GABA uptake[blank_end].
    • Confusion, difficulty [blank_start]speaking[blank_end], mild [blank_start]sedation[blank_end], paraesthesia
    Overdose: lethargy, [blank_start]respiratory depression, tachycardia[blank_end]

    3. Vigabatrin - [blank_start]prevents GABA breakdown[blank_end]. (GABA transaminase inhibitor.)
    • 1/3 experience [blank_start]visual[blank_end] field disturbances
    • [blank_start]behavioural[blank_end] adverse effects
    1. Aactivation of GABA(A) R
    2. Bopening
    3. Cinhibits GABA uptake
    4. Dprevents GABA breakdown
    5. Espeaking
    6. Fsedation
    7. Grespiratory depression, tachycardia
    8. Hvisual
    9. Ibehavioural
    10. Jraise
  9. 9MoA: Inhibition of calcium channels.

    1. Ethosuximide
    • Specific block of T type Calcium channels (thalamic relay)
    • [blank_start]Absence[blank_end] seizures
    • Side Effects: [blank_start]Nausea, anorexia, lethargy,[blank_end] dizziness, hypersensitivity (rarely)

    2. Gabapentin (Pregabalin)
    • T type calcium channels ([blank_start]Low[blank_end] voltage activated)
    • [blank_start]Adjunct[blank_end]
    Relatively SE free: [blank_start]sedation, ataxia[blank_end]. Abuse/addiction/safety risks.

    3. Levetiracetam
    [blank_start]Focal[blank_end] w/wo generalisation; prophylaxis post [blank_start]neurosurgery[blank_end]
    • Binds to a [blank_start]synaptic vesicle glycoprotein[blank_end], SV2A
    • Inhibits [blank_start]presynaptic[blank_end] calcium channels ([blank_start]N[blank_end] type)
    • No CYP450 interactions
    • 100% oral bioavailability
    Side Effects: ataxia, dizziness, headache, tremor, behavioural disturbances, GI, [blank_start]suicidal ideation[blank_end]
    1. AAbsence
    2. BNausea, anorexia, lethargy,
    3. CLow
    4. DAdjunct
    5. Esedation, ataxia
    6. FFocal
    7. Gneurosurgery
    8. Hsynaptic vesicle glycoprotein
    9. Ipresynaptic
    10. JN
    11. Ksuicidal ideation
  10. 10Drag the drug to match the interactions and unwanted side effects. (Assessable Task...)

    1. [blank_start]Phenytoin[blank_end]
    UE: GI, drowsiness, tremor, dizziness, headache, gingival hypertrophy, hirsuitism, acne
    Interactions: MANY including amiodarone, trimethoprim, SSRIs, TCAs, MAOIs, warfarin

    2. [blank_start]Carbamazepine[blank_end]
    UE: • headache, N&V, ataxia, drowsiness, blurred vision, hyponatraemia. blood, hepatic and skin disorders.
    Interactions: warfarin, clopidogrel, simvastatin, oestrogens/progesterone, erythromycin

    3. [blank_start]Sodium Valproate[blank_end]
    UE: GI irritation, thrombocytopenia, transient hair loss, liver toxicity and pancreatitis
    Interactions: [blank_start]Defibrillator[blank_end]/AEDs, antidepressants, antimalarials, antipsychotics, carbapenems

    4. [blank_start]Lamotrigine[blank_end]
    UE: Nausea, dizziness, ataxia, (serious) skin reactions (SJS and TEN). hypersensitivity syndrome)
    Interactions: valproate, carbamazepine, phenytoin

    5. [blank_start]Tiagabine[blank_end]
    UE: Confusion, difficulty speaking, mild sedation, paraesthesia

    6. [blank_start]Ethosuximide[blank_end]
    UE: Nausea, anorexia, lethargy, dizziness, hypersensitivity (rarely)

    7. [blank_start]Gabapentin (Pregabalin)[blank_end]
    UE: Sedation, ataxia

    8. [blank_start]Levetiracetam[blank_end]
    UE: ataxia, dizziness, headache, tremor, behavioural disturbances, GI, suicidal ideation
    1. APhenytoin
    2. BLevetiracetam
    3. CGabapentin (Pregabalin)
    4. DEthosuximide
    5. ETiagabine
    6. FLamotrigine
    7. GSodium Valproate
    8. HCarbamazepine
    9. IAnti-epileptics

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User has deleted their subject information Quiz on NE3 Epilepsy, created by Deleted user on 11/10/2019.
Author
Deleted user
Language
English
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145
History
Created on 11 Oct 2019 · updated on 11 Oct 2019
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