The Diagnosis and Treatment of Epilepsy and AEP Drugs
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44 terms
Terms | Definitions |
|---|---|
 Differential Diagnosis of Seizures | Syncope Cardiac Arrhythmia Panic Attack Transient Ischemic Attack Narcolepsy with Cataplexy Psychogenic Breath Holding Spells in Children |
| First Seizure Patients | Should be screened for symptoms and signs of an acute medical/neurological illness |
| Common Causes of First Seizures | Illicit Drugs Electrolyte Imbalance Meningitis/Encephalitis Cardiorespiratory Dysfunction Liver/Kidney Function |
| Evaluation of First Seizure | History/Physical Blood Test - CBC, Electrolytes, Ca, Mg Hepatic/Renal Function Lumbar Puncture for Infection Blood/Urine Screen for Drugs EEG MR of Brain |
| Most useful tool for classifying Seizure | EEG |
| Generalized Seizure in EEG | Generalized spike/Wave pattern in all lines |
| Partial Onset Seizures in EEG | Spike/Wave pattern in only one line |
| Imaging choice for Seizure Pts | MRI |
| Absence Seizures | No Aura/Warning Motionless with Blank Stare Eyelid Fluttering or Other Automatisms Short Duration Little Postictal Confusion Hyperventilation Precipitates Photosensitivity 3 Hz spike wave |
| Temporal Lobe Complex Partial Seizure | Aura of Autonomic, Psychic, Epigastric, Olfactory Arrest of Movement Oroalimentary Automatisms 60 - 90 Seconds Postictal language disturbance when in dominant hemisphere Confused with gradual recovery Amnesia for event |
| Partial Onset Seizure | Another name for Temporal Lobe Complex Partial Seizure |
| Myoclonic Seizure | Myoclonus Focal, Regional, or Generalized Single or Repetitive Various Amplitudes Hallmark of Juvenile Myoclonic Epilepsy |
| Generalized Tonic Clonic Seizure | Generalized or Partial in Origin Initial extension of extremities (Tonic) Muscle Jerks (Clonic) Unresponsive 15 - 20 min after Tongue Biting and Urinary Incontinence |
| Common Features of Seizures | Tonic/Clonic Movements 1-2 Min Postictal Confusion |
| Hallmarks of Seizures | Tongue Biting Postictal Focal Signs |
| Syncope Common Features | Sweating and Pallor Brief 5 - 15 sec Stiffening/Brief Clonic Little confusion after |
| Hallmarks of Syncope | Precipitated by Pain Attacks when sitting/standing |
| Differences in Antiepileptic Drugs | No differences in Efficacy Adverse Effects, Pharmacokinetic, Expense differ Should prescribed based on differences |
| Monotherapy vs Multi therapy | Start with Mono Mono has less SE |
| Goal of Therapy | No seizures No Side effects Often therapeutic range will not be same for all pts |
| Partial Seizure Drug of Choice | Carbamazepine Phenytoin |
| Generalized Onset Drug of Choice | Valproate |
| Least Drug Interaction / Protein Binding Drug | Levetiracetam |
| Least Sedating Drug | Lamotrigine |
| Least Tolerated Drug | Phenobarbital Primidone |
| Serum Levels of AEP Drugs | Should be used as a guideline Should be measured Should be determined based on pt reaction |
| Phenytoin Increases in Dose | < 7 mg/mL - Increase by 100 mg 7 - 11 mg/mL - Increase by 50 mg > 11 mg/mL - Increase by 30 mg |
| Removing Multiple Drug Therapy | Remove the sedatives first Withdraw over the course of months |
| Protein bound drugs | Can displace other protein bound drugs Measure free drug and bound drug |
| Drugs that induce Metabolism of Other Drugs | Carbamazepine Phenytoin |
| Drugs that inhibit Metabolism of Other Drugs | Valproate |
| Drugs that are Highly Protein Bound | Valproate Phenytoin |
| When to stop Therapy | If seizure free for 2 - 4 yrs The longer seizure free, the better the outcome |
| Drug Withdraw | Should be done over a period of 2 - 6 months |
| Child Therapy | Pharmacokinetics can vary from adults Can also vary based on age of child |
| AEP Drugs and Pregnancy | Should receive High dose Folic acid if on drugs Use lowest possible dose Monotherapy Valproate and Phenobarbital is the worst |
| Two most common seizures in adults | Generalized Tonic Clonic Complex Partial Seizure |
| Generalized Tonic-Clonic Seizure Symptoms | Sudden Cry/Fall Rigidity then Muscle Jerks Shallow Breathing/Apnea Urinary Incontinence 1 - 2 Min in duration Postictal confusion |
| Generalized Tonic-Clonic Seizure What to do | Turn on side Keep airway clear Protect from environment If first seizure go to hospital If longer than 5 min or multiple seizures should administer tx for status epilepticus |
| Generalized Tonic-Clonic Seizure What not to do | Nothing in mouth Don't hold Tongue No artificial respirator until after jerks |
| Complex Partial Seizure Symptoms | Blank Stare, chewing, random activity Unaware of surroundings Unresponsive to commands 1 - 2 minutes Postictal confusion Memory Loss |
| Complex Partial Seizure What to do | Speak Calmly Protect from Environment If First time take to hospital Babysit postictal |
| Complex Partial Seizure What not to do | No grabbing No Restraining No shouting |
| When to take someone with Seizure to hospital | First Time Pregnant Diabetic |
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