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What are the three main symptoms of a seizure?
- Clonus
- Tonus
- Complete relaxation/paralysis
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What are the 7 types of generalized seizure?
C-A-T-S-M-A-T
- Clonic
- Absence
- Tonic
- Status epilepticus
- Myotonic
- Atonic
- Tonic-clonic
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Which seizure involves the whole brain and involves rapidly repeated flexor motions?
Clonic seizure
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What type of seizure involves the whole brain and causes sudden loss of muscle tone?
Atonic seizure
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What type of seizure involves the whole brain and causes muscle contraction/rigidity?
Tonic seizure
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What type of seizure involves the whole brain and lasts for many minutes or returns after a brief pause?
Status epilepticus
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What type of seizure involves the whole brain and causes initial muscle contraction followed by repeated flexor motions?
Tonic-clonic
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What type of seizure involves the whole brain and causes sudden muscle contraction that lasts for 1 second?
Myotonic seizure
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What type of seizure involves the whole brain and causes loss of consciousness for 10-30 seconds?
Absence seizure
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What is the MOA of antiepileptic drugs?
- Raise Na+ channel depolarization threshold
- Block Ca2+ channels
- Enhances GABA
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What are four AED classes?
- Hydantoin
- Benzodiazepines
- Barbituate
- Miscellaneou
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What is the MOA of hydantoinin the treatment of seizures?
Blocks Na+ channels
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What is the MOA of Benzodiazepinesin the treatment of seizures?
Increases GABA efficacy
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What is the MOA of barbituates in the treatment of seizures?
Increases GABA efficacy
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What four AEDs fall into the miscellaneous class?
- carbamazepine
- valproic acid
- gabapentin
- ethosuximide
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What is the MOA of carbamazipine in the treatment of seizures?
Blocks Na+ channels
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What is the MOA of Valproic Acid in the treatment of seizures?
Blocks, Na+ channels, Ca2+ channels and increases GABA efficacy
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What is the MOA of gabapentin in the treatment of seizures?
Increases GABA efficacy
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What is the MOA of ethosuximide in the treatment of seizures?
Blocks Ca2+ channels
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Which AED is good for all seizures except myoclonic?
Lamotrigine
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Which AED is good only for absence seizures?
Ethosuximide
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What three reasons make it necessary to monitor plasma levels when taking AEDs?
- Narrow therapeutic window
- Complex metabolism rates
- Interaction with other drugs that increase/decrease metabolism of AED
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What MOA does phenytoin have in the treatment of seizures?
blocks Na+ channels
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What types of seizures is phenytoin used for?
- Partial seizures
- Tonic-clonic seizures
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What three booby traps are associated with phenytoin?
- Highly protein bound
- Half-life is dose dependent
- Can be fatal if IV is administered to quickly
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What are the adverse effects of phenytoin?
- Mild sedation
- Stevens-Johnson Syndrome
- Gingival hypoplasia
- Hirsutism
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What can be used to more easily administer phenytoin by IV?
Fosphenytoin
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What kinds of seizures can carbamazepine be used to treat?
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What are the booby traps associated with carbamazepine?
- Can only be taken PO
- P450 inducer
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What are the adverse effects of Carbamazepine?
- SIADH (water overload)
- Can affect blood cells
- Aplastic anemia
- mild sedation
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Which two AEDs do not induce P450 enzymes?
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What are the major side effects of Valproate?
- Nausea/vomiting
- Weight gain
- Rare/severe hepatotoxicity
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What type of seizure is phenobarbitol used to treat?
- febrile seizure
- partial
- tonic-clonic
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What is the prodrug for phenobarbitol?
Primidone
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What is the major booby trap associated with phenobarb?
Major P450 inducer
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What are the adverse effects of phenobarbitol?
- Heavy sedation
- Folic Acid and Vit. K depletion
- Increases its own metabolism
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What are the major adverse effects associated with ethosuximide?
- Aplastic anemia
- Nausea/vomiting
- Mild neurological effects
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What is a precipitating factor for status epilepticus?
abrupt discontinuation of meds
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What is given to a person having a tonic-clonic status epilepticus seizure to prevent the seizure from returning?
Loading dose of fosphenytoin or any long-acting anticonvulsant
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What is used to stop a status epilepticus seizure?
Lorazepam or Diazepam (benzodiazepine class AEDs)
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What kind of paralysis does damage to upper motor neurons cause?
spastic paralysis
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What kind of paralysis does lower motor neuron damage cause?
flaccid paralysis
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What is myopathy?
Disease that causes the muscle to be unable to respond to nerve impulse
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What is an example of a myopathy?
Muscular dystrophy
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What two treatments are used to treat myasthenia gravis?
- Immunosuppressants
- Acetylcholinesterase Inhibitors
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What are three Upper Motor neuron diseases?
- ALS
- Multiple sclerosis
- Parkinsons
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What disease has a relapsing-remitting condition that makes it difficult to conduct drug trials?
Multiple sclerosis
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What disease is characterized by a demyelination of the nerves in the CNS that is relapsing and remitting and may be autoimmune in nature?
MS
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What disease is characterized by progressive death of motor neurons in the CNS?
ALS
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What are three characteristics of disorders of the basal ganglia?
- Involuntary movement
- Alteration in muscle tone
- Disturbances in body posture
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What is tremor?
Rhythmic shaking or extremity or head.
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What is a tic?
Irregular coordinated movement: winking, grimacing, shrugging
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What is chorea?
Brief, rapid and coordinated graceful movements
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What is athetosis?
slow, continuous, wormlike movement
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What is ballismus?
Violent, sweeping movements
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What is dyskinesia?
rhythmic, repetitive bizarre movements in the face
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What kind of motor function disorder is Parkinsons?
Basal ganglia
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What are seven types of involuntary movement?
- Athetosis
- Bellasimus
- Chorea
- Dystonia
- Dyskenesia
- Tremors
- Tics
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What is bradykinesia?
Difficulty in starting and stopping movement.
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What disease is characterized by a reduction in the concentration of dopamine in the striatum?
Parkinsons
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What are the three main symptoms associated with Parkinsons?
- Resting tremor
- Rigidity
- Bradykinesia
-
What are three methods used to treat Parkinsons?
- Increase dopamine concentrations
- Decrease dopamine loss
- Decrease ACh concentration or activity
-
What are five antiparkinson drug treatments?
- Dopamine replacement
- COMT inhibitors
- MAO inhibitors
- Dopamine agonists
- Anticholinergics
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Two benefits of using carbidopa when treating Parkinsons with dopamine replacement
- Keeps levodopa from being converted to dopamine in the periphery
- Can give lower dose of levadopa
-
What can inhibit levadopa absorption?
-
What treatment can be used in combination with dopamine replacement?
Dopamine agonist
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What are the side effects of dopamine agonists?
- Nausea/vomiting
- Sleep Attacks
- Inc. risk of orthostatic hypotension, hallucination, dyskinesias
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Which PD treatment will cause liver failure if used in conjunction with dobutramine?
COMT inhibitors
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What is the MOA of Amantidine in the treatment of PD?
Increases release of dopamine and blocks muscarinic receptors (anticholinergic)
-
Is Amantadine a 1st line or 2nd line drug for PD?
2nd line
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In what kinds of patients should anticholinergic drugs not be used when treating PD?
- Patients with:
- Memory Loss
- Dementia
- Glaucoma
-
What three conditions does balanced general anesthesia result in:
- Loss of consciousness
- Analgesia
- Muscle relaxation
-
Why do people get IV fluids during surgery?
To counteract the decrease in blood pressure caused by inhalation anesthetics.
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What must occur during the reversal phase of general anesthesia?
The neuromuscular blocker must be reversed as soon as inhalation anesthetics are removed.
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What type of drugs are local anesthetics?
Sodium channel blockers.
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Which class of local anesthetics is more likely to induce an allergic reaction?
Ester class like Novacaine
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What is an example of using a local anesthetic to produce regional anesthesia?
Epidural
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What is a common local anesthetic?
Lidocaine
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