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AED Treatment
| Question | Answer |
|---|---|
| Because 2/3 of patients with Epilepsy will be treatment responsive and remain on medication for several years, what must the prescriber base his AED selection on? | Most tolerable, lowest potential for harm and least negative impact of quality of life |
| What are some causes of seizures? | congenital abnormalies, hypoxia (lack of O2) at birth, alcohol or benzondiazepine withdrawal, uremia, hypo/hyperglycemia,head trauma, cancer/brain tumor vascular disease, stroke, alzheimers, infectious diseases, febrile seizures in children |
| Does having a single seizure contitute a diagnosis of epilepsy? | No, only if the underlying cause of the seizure is permanent, epilepsy may result |
| How long do normal seizures usually last? | 30 seconds-2 mins |
| Because 2/3 of patients with Epilepsy will be treatment responsive and remain on medication for several years, what must the prescriber base his AED selection on? | Most tolerable, lowest potential for harm and least negative impact of quality of life |
| What are some causes of seizures? | congenital abnormalies, hypoxia (lack of O2) at birth, alcohol or benzondiazepine withdrawal, uremia, hypo/hyperglycemia,head trauma, cancer/brain tumor vascular disease, stroke, alzheimers, infectious diseases, febrile seizures in children |
| Does having a single seizure contitute a diagnosis of epilepsy? | No, only if the underlying cause of the seizure is permanent, epilepsy may result |
| How long do normal seizures usually last? | 30 seconds-2 mins |
| What do the specific symptoms of a seizure depend on | the part of the brain that is involved |
| what are some symptoms that may indicate a seizure | change in alertness, mood changes, change in sensations of the skin, vision changes, falling, loss of muscle control, muscle twitching spreading up and down the arm, muscle tension or tightness, shaking of entire body, tasting a bitter or metallic flavor |
| When a seizure occurs, where should you lay the person and what is the main goal? | Lay the person on the floor in a safe are, clear of all surrounding objects because the main goal is to protect the person from injury |
| What should be done to avoid injury during a seizure | cushion the persons head, lossent tight clothing, turn them on their side, look for a medical ID bracelet with seizure instructions, and monitor vital signs until they recover or medical help arrives |
| If a person is having a seizure should your restrain them or try to make them stop convulsing | No, they have no control over the seizure and are not aware of what is happening |
| Should you put anything in a persons mouth during a seizure (meds, finger, etc) | No! They may choke on medication of bite your finger |
| Should you move a person who is having a seizuer? | Only if they are near dangerous objects that could cause potential harm |
| What should you do if a person has a seizure for over 2-5 minutes, does not awaken or behave normally after, or another seizure begins soon after the first? What is this called? | CALL 9-1-1!!! These things indicate Status epilepticus, a neurological emergency that can cause brain damage/death |
| If a person has just had their first seizure, they do not have a medical ID bracelet, or has a seizure that is different from usual, is it appropriate to call 9-1-1 | Yes! |
| If a person is pregnant, injured, has diabetes or is in the water at the time of a seizure, what would be the most appropriate form of action? | Call 9-1-1 |
| What medical treatment is used for status epilepticus? | maintenance of airway (dextrose IV, lorazepam IV, or rectal/IV diazepam) and a prophylactic agent |
| What are the two most common prophylactic agents given for status epilepticus | Phenytoin or fosphenytoin |
| What should you tell a patient if they begin to break out in a rash after starting AEDs? | They need to go see their doctor because rashes from AED medication have the potential to turn into Steven-Johnson or TEN |
| What treatment would be used for a mild AED rash? | a quick taper while transitioning to a new AED and antihistamines for the rash |
| What are the symptoms associated with Steven-Johnson sydrome? | blisters, fever, sore throat, chills, and fatigue |
| What are symptoms associated with TEN and how are they treated? | Blisters and skin sloughing and the prescriber will immidiately stop AED! |
| What is the major excitatory neurotransmitter in the cerebral cortex that is blocked by some AEDs? | glutamate |
| What channels are blocked by some AEDs to treat absense seizures? | Calcium Channels |
| GABA attaches to neuronal membranes and opens which channels to slow them down and prevent seizures? | Chloride channels |
| What are the general adverse effects of AEDs? | drowsiness, sedation, lethargy, confusion, cognitive impariment, nystagmus (eye tremors), diplopia (double vision), ataxia (movement awkwardness), vertigo, dizziness, osteoporosis (w/ chronic use), drug induced rash (mild, SJS, TEN) |
| What are common Drug Interactions of the AEDs | cytochrom p450 with other medications and synergistic CNS depressant effects w/ other CNS depressants |
| Why do AEDs cause chronic osteoporosis? | They speed up liver metabolism and decrease vitamin D (cytochrom p450) and also speed up estrogen in woment to inhibit osteoblast which helps build bone |
| The AED Primidone (Mysoline) is used to treat what? | essential tremors rather than epilepsi |
| What is the mechanism of action of Primidone (Mysoline) | enhances binding of GABA and is a direct acting agonist of GABA and is similar to barbiturates |
| Which AED is commonly used for epilepsi? | Phenytoin (Dilantin) |
| Which AED is in injection form and is not water soluble, irritating to veins | Fosphenytoin (Cerebyx) |
| What other disorder are AEDs commonly used to treat? | Bipolar disorder |
| What oral AED is used for bipolar disorder? | Valporic Acid, Valporate (Depankene, Depakote) |
| Which newer AED on the market is is being investigated for false advertisement and is used mainly for fibromyalgia? | Gabapentin (Neuronitn) |
| What are the adverse effects of the newer AEDs (Gabapentin (neuronitn) and Pregabalin (lyrica)) | Weight gain and peripherad edema (heart failure), and Paradoxical responses in chldren and elderly |
| What is the mechanism of action of Gabapentin and Pregabalin (Lyrica) | enhances GABA activity and blocks calcium channels |
| What type of pain management can be treated with AEDs | Neuropathic pain, post herpetic neuralgia, trigeminal neuralgia, HIV neuropathy, migraine prophylaxis, and fibromyalgia pain |
| What neuromuscular disorders are treated with AEDs | Essential tremors and restless leg syndrome |
| What psychiatric disorders can be treated by the use of AEDs | Bipolar disorder, anxiety disorder, insomnia, and impulsivity and aggression |
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aamoore2245
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