NUR 516 > siezures > Flashcards

siezures Flashcards

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1
Q

What are the inhibitory neurotransmittors?

A

dopamine, serotonin, and GABA

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2
Q

What are the excitatory neurotransmitters?

A

ACH (acetylcholine) and norepinephrine

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3
Q

Neurotransmitters: Acetylcholine - where is it found, what type of action?

A
  • found in the CNS, PNS, and ANS
  • can be either excitatory or inhibitory (depends on neurons secreting it)
    – PNS: excitatory at neuromuscular junctions
    – ANS: inhibitory and slows heart rate
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4
Q

Neurotransmitters: Serotonin (5-hydroxytrptamine) - where is it found, what type of action?

A
  • derived from tryptophan
  • found primarily in the GI tract, platelets, and brainstem
  • contributor to feeling of well being
  • inhibitory
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5
Q

Neurotransmitters: Dopamine - where is it found, what type of action?

A
  • located mainly in the substantia nigra of midbrain/basal ganglia region
  • numerous functions:
    – behavior and cognition
    – voluntary motor movement
    – motivation punishment and reward
    – attention
    – working memory
    – learning
  • involved in many neuropsychiatric and voluntary motor movement disorders:
    – social phobia, ADHD, drug and alcohol dependence
    – Parkinson’s disease
    – Tourette’s syndrome
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6
Q

Neurotransmitters: GABA (gamma amino butyric acid) - where is it found, what type of action?

A
  • chief inhibitory transmitter in the CNS
  • has a relaxing, antianxiety, and anticonvulsant effect on the brain
  • has inhibitory effect on muscles (decreases muscle spasms and improved tone)
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7
Q

Neurotransmitters: Norepinephrine

A

an excitatory neurotransmitter in the brain
stress hormone within the endocrine system

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8
Q

Neurotransmitters: Glutamate

A
  • major mediator of excitatory signal
  • involved in cognition, memory, and learning
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9
Q

How do neurons do conduction?

A

action potential (neuron conducts impulses)
- abrupt changes in the membrane potential permit nerve signals to be transmitted from the cell body down the axon
- stimulates sodium, potassium, and calcium ions to move across the axonal membrane

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10
Q

What are the three phases of an action potential?

A
  • depolarization of the neuron: positively charged ion
  • repolarization of neuron: return of neuron to a negative value
  • resting period
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11
Q

What leads to seizures, regarding the action potential?

A

impulses that do not maintain a systematic order (excitatory, inhibitory, and resting phase) become irregular and chaotic and can lead to seizures

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12
Q

What are seizures?

A

a single episode of abnormal electrical discharge from cortical neurons that results in an abrupt and temporary altered state

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13
Q

What is epilepsy

A

a group of syndromes characterized by unprovoked, recurrent seizures

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14
Q

What is status epilepticus?

A

continuous seizure activity for more than 5 minutes
- OR 2 or more sequential seizures that occur WITHOUT full recovery of consciousness between attacks
- is a neurological emergency
- requires immediate intervention

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15
Q

What are common causes of seizures?

A
  • trauma
  • ETOH withdrawal
  • illicit drug use
  • brain tumor
  • congenital malformations
  • stroke
  • metabolic disorders (uremia, electrolyte imbalance)
  • alzheimer’s disease
  • neurodegenerative disease
  • idiopathic
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16
Q

What are common causes of epilepsy?

A
  • genetic causes (mutated genes)
  • head trauma
  • medical disorders (dementia, meningitis, encephalitis)
  • prenatal injury
  • developmental disorders (autism, Down syndrome)
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17
Q

Pathophysiology of seizures

A
  • messages from the body are carried by the neurons of the brain through discharges of electrochemical energy; impulses occur in bursts
  • during periods of unwanted discharged, parts of body may act erratically
  • for an actual seizure to occur:
    – need excitable neurons
    – need increase in excitatory glutaminergic activity
    – need reduction in activity of normal inhibitory GABA projection
  • anyone can have a seizure
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18
Q

Examples of generalized seizures?

A
  • absence (petit mal)
  • tonic-clonic (grand mal)
  • atonic/akinetic (drop attacks)
  • status epilepticus
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19
Q

Pathophysiology of focal seizure

A
  • starts and remains in one hemisphere
  • high-frequency bursts of action potentials and hypersynchronization
  • may have motor, sensory, and autonomic symptoms and automatisms
    – autonomic: due to stimulation of ANS (pallor, sweating, pupillary dilation, epigastric sensation)
    – automatisms: often associated with temporal lobe seizures; patient is unaware
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20
Q

What are automatisms?

A
  • may happen with focal seizures
  • coordinated involuntary movements happening during state of impaired consciousness either during or after seizure
  • patient is unaware
  • often associated with temporal lobe seizures
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21
Q

Types of focal or partial seizure

A
  • focal - retains awareness
  • focal - altered awareness
  • partial seizure
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22
Q

Focal seizure - retaining awareness

A
  • no impairment of consciousness
  • similar to partial seizures
  • may have movement of body parts
  • may experience an aura
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23
Q

Focal seizure - altered awareness

A
  • impairment of consciousness
  • spreads to both hemispheres (this confuses me though because i thought it should start and remain in one hemisphere)
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24
Q

Partial seizure

A
  • begins in one part of hemisphere (typically in the temporal or frontal lobe)
  • may be simple or complex
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25
Pathophysiology of generalized seizures
- **start in one hemisphere and spreads with involvement of both hemispheres** - may have motor and/or nonmotor symptoms - affects both hemispheres of the brain - impairment of consciousness
26
Tonic-clonic seizure
- begin with rigid violent contractions (tonic) - followed by repetitive clonic activity of all extremities - body stiffens and relaxes generalized
27
Tonic seizure
generalized - muscle stiffness, dilation of pupils, altered respirations - usually lasts less than a minute
28
Absence seizures
generalized - short episodes of staring and loss of consciousness for about 10 seconds
29
Myoclonic seizures
generalized - bilateral jerking of muscles - no loss of consciousness
30
Atonic seizure
generalized - sudden loss of muscle - "drop to the ground"
31
What is needed for a diagnosis of seizure and/or epilepsy
- H&P - neurological exam - diagnostic procedures (chemistries, tox screen, CT, MRI, EEG)
32
What are the phases of seizures?
Pre-ictal, ictal, and post-ictal
33
What is the pre-ictal phase of a seizure?
may be started by a trigger and/or preceded by an aura
34
What is the ictal phase of a seizure?
- actual seizure - increases in metabolic demand (uses a lot of energy)
35
What is the post-ictal phase of a seizure?
- has decreased responsiveness - feels fatigue
36
What are anticonvulsants used for
AKA antiepileptic drugs (AED) - used for long-term management of chronic epilepsy - management of seizures not caused by epilepsy - off label use: anxiety, bipolar disorder, chronic pain, migraines
37
What are broad-spectrum anticonvulsants used for
effective for treatment of focal and generalized seizures
38
What are narrow-spectrum anticonvulsants used for
used primarily for focal-onset seizures (including focal which evolve to be convulsive seizures)
39
Mechanism of actions by group - fit anticonvulsants (just an image in ppt that may be helpful)
40
Sodium channel blockers: what do they do with seizures
- prevent return of the channel to active state, stabilizes them to inactive state - prevents repetitive firing
41
Calcium channel blockers: what do they do with seizures
- calcium going in during cells' resting state facilitates development of an action potential - CCBs slow depolarization which is needed for spike-wave bursts - CCBs help to "lock the channel"
42
What do GABA enhancers do with seizures
- may enhance Cl- influx which makes cells more negative and harder for the cell to generate an action potential - some decrease metabolism of GABA so that more GABA is available (GABA is inhibitory)
43
What do glutamate blockers do with seizures?
- bind to glutamate, which is an excitatory neurotransmitter, therefore blocking it from binding and creating excitation - glutamate receptor has 5 potential binding sites
44
What does "pharmacologic management” mean regarding seizures
- medications are to control seizures NOT cure - medication prescribed based on the type of seizure - many drugs require blood monitoring - patient education (take as prescribed, never stop taking on own, side effect management)
45
Phenytoin (Dilantin): what type of med? How does it work? Indications?
Sodium channel blocker - works to stabilize the neurons from becoming too excited - stops the spread of seizure activity in the motor cortex - **highly (90%) protein-bound drug: increased risk of drug interactions** Indications: - tonic-clonic seizures - status epilepticus - prophylaxis for surgery
46
Phenytoin (Dilantin): Therapeutic range and administration?
Therapeutic range: 10-20mcg/mL - very narrow therapeutic window - need to monitor levels Given PO, IM, or IV - if administered IV, w/ NSS - infuse over 30-60 minutes - can be very irritating to veins Tube feeds: need to stop feed for 2 hours before AND after
47
Phenytoin (Dilantin): side effects? *”pheny” = funny smile *
- **gingival hyperplasia** - neurologic: -- drowsiness -- ataxia -- irritability -- visual problems -- peripheral neuropathy -- headache - N/V - Cardiovascular: hypotension, arrhythmias - can cause suicidal thoughts - skin rash including SJS can occur
48
Phenobarbital (Solfoton, Luminal): what does it do? what class? administration considerations?
Classified as a barbiturate - inactivates fast sodium channels leading to enhanced GABA effects and decreased glutamate release Administration consideration: very long half-life - habit forming and dependence
49
Phenobarbital (Solfoton, Luminal): side effects
- sedation - diplopia - cognitive skill impairment - respiratory depression - hypotension - hyperactivity and inattention in children
50
Carbamazepine (Tegretol): What class? What does it do? When is it used? Storage?
Sodium channel blocker - similar to Phenytoin (also an SCB) in mechanism of action - inhibits spread of seizure activity Used for several different types of seizures: - drug of choice for partial and generalized tonic-clonic seizures - also used for trigeminal neuralgia and bipolar disorder - WILL MAKE ABSENCE AND MYOCLONIC SEIZURES WORSE Needs to be in dry location
51
What type of seizures is carbamazepine (tegretol) the drug of choice for?
partial and generalized tonic-clonic seizures
52
What seizures does carbamazepine make worse?
absence and myoclonic seizures
53
Carbamazepine: What needs to be monitored?
Labs: - CBC: especially WBC - Drug level: 4-12 mcg/mL Monitor drug levels, sodium, CBC, LFTs, and BUN/Cr especially in those with renal impairment
54
Carbamazepine: Side effects
- Neuro: headache, diplopia, ataxia, drowsiness, sedation - N/V - hyponatremia - decreased blood counts (neutropenia and thrombocytopenia) - rashes can be common - watch for SJS - increases suicidal thoughts * take with food * cannot abruptly discontinue
55
Oxycarbazepine (trileptal): How does it work? What class?
Sodium channel blocker - same efficacy as carbamazepine but is better tolerated
56
Oxycarbazepine (trileptal): What seizures is it used for and NOT used for? Considerations?
- used as adjunctive therapy or monotherapy for partial seizures in children and adults - NOT used for absence and myoclonic - makes them worse Considerations: - increase risk of suicidal ideations - decreases efficacy of oral contraceptives
57
Valproic Acid/Valproate (Depakote): How does it work? What class? Indications?
GABA enhancer; inactivation of fast sodium channels Indications: really any seizure activity - absence, myoclonic, tonic-clonic, partial, neonatal seizures - used to control symptoms of acute mania in bipolar disorder
58
Valproic Acid/Valproate (Depakote): Administration and monitoring Can give with? Monitor what? Therapeutic range?
- can be given with phenytoin - take with food - can cause liver toxicity, need to monitor LFTs - **narrow therapeutic range** -- need to check levels (50-100 mcg/mL) - must be diluted when given IV with at least 50mL NSS or D5W -- give over an hour (no more than 20mg/min) - avoid sudden withdrawal - monitor CBC because can cause thrombocytopenia
59
Valproic Acid/Valproate (Depakote): side effects
- N/V - sedation/dizziness - pancreatitis - increased ammonia levels - thrombocytopenia (monitor CBC) - suicidal thoughts - can cause liver toxicity (watch LFTs)
60
Gabapentin (Neurontin): Action? Seizure indications?
Thought to act on the calcium channels to decrease glutamate and increase GABA in the brain Indications: - partial seizures - new onset epilepsy - MAY MAKE MYOCLONIC SEIZURES WORSE
61
Gabapentin (neurontin): off-label uses
- chronic neuropathic pain - anxiety - hot flashes/night sweats - headaches - hiccups - alcohol withdrawal
62
Gabapentin (Neurontin): side effects
- fatigue: given at night often - **mental cloudiness** - leukopenia - weight gain - edema - emotional lability - tremors - GI side effects - suicidal thoughts
63
Gabapentin (Neurontin): Administration considerations
- reduced dose in renal patients: monitor BUN/Cr - caution in those with addiction history - no drug monitoring needing b/c wide therapeutic range - withdrawal slowly - doses will be very high for pain control
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