NMS 2 Exam 3
Terms
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- Anecephaly
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- Neural Tube Defect
No brain - Spina Bifida
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- Neural Tube Defect
Midline defect in spine - Encephalocele
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- Neural Tube Defect
Meninges and brain tissue protrude through the skull
- Congenital Dermal Sinus
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- Neural Tube Defect
Dimpling of skin over lumbosacral area - Polymicrogyria
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- Forebrain Disorder (can be associated with MR)
increase # of small gyri - Pachygyria
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- Forebrain Disorder (can be associated with MR)
Broad and thick gyri - Heterotopias
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- Forebrain Disorder (can be associated with MR)
Clusters of abnormal n.n in white mater --> seizures
Due to failure of migration - Porencephaly
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- Forebrain Disorder (can be associated with MR)
Cysts in brain from ventricle to subarachnoid space - Holoprosencephaly
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- Forebrain Disorder (can be associated with MR)
Hemispheres fail to divide --> failure of optic/olfactory/etc.
AD inhertance with Sonic Hedghog Gene (SHH)
- Most common developmental anomalies of the forebrain - Megalencephaly
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- Forebrain Disorder (can be associated with MR)
Brain is larger than normal (> 1.8 kg).. may not have MR - Microencephaly
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- Forebrain Disorder (can be associated with MR)
Brain is smaller (< .9 kg).. increase MR.. 5 associated genes (ASPM is !) - Lissencephaly
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- Forebrain Disorder (can be associated with MR)
Smooth brain, decrease # of gyri - Arnold-Chiari Malformation
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Type II Chiari
Small posterior fossa, changein midline, downard vermis, elongation of medulla/pons/4th ventricle, beak-shaped colliculi, aqueduct stenosis --> hydrocephalus - Dandy-walker Malformations
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Larger Posterior Fossa
Malformation of vermis (increase midline cysts) and lateral displacement of cerebellum by larger 4th ventricle - Syringomyelia
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Common at cervical levels
Decrease pain and touch in hands - Phenytoin
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*Prolongs inactivation state of Na+ channels*
Liver metabolism: workson CYP3A4
24 hr half life
90% bound to albumin
Th. range between 10-20 mcg/mL
(around 400mg/day dose CYP3A4 enzymes become saturated and dose becomes toxic!)
Causes hirsutism/osteopenia/decreased cognition/teratogenic to people who don't have epoxide hydrolase - Carbamazepine
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Blocks reactivation of Na+ channels and blocks NE reuptake (useful for bipolar)
**has an active metabolite and it induces CYP450 and its own metabolism**
AE: transient benign leukopenia, stevens johnson rash
increased risk of SJ syndrome in Hahn's chinese people with HLAB*1502 genotype - Oxcarbazepine (Trileptal)
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Keto analog of carbamazepine
prodrug converted to active metabolite.. causes less enzyme induction than CBZ
*used for partial seizures like phenytoin, CBZ, zonisamide, pregabalin (lyrica), gabapentin - Lamotrigine (lamictal)
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Decreases reactivation of Na+ channels
AE: steven johnson syndrome along with valproic acid and CBZ
used for refractory partial, generalized, and chronic pain - Valproate (depakote)
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Broad spectrum of action!!
- inhibits Na+ channels, inhibits t-type Ca2+ channels, may increase GABA syntehsis and decrease GABA degeneration
AE: menstural irregularity, rare pancreatitis, most teratogenic of common anticonvulsants! - Ethosuximide (zarontin)
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Inhibits t-type Ca2+ channels in thalamic neurons
**and only used for absence seizures in kids**!
- Zonisamide (Zonegran)
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Acts like Valproate!
- inhibits t-type Ca2+ channels
- prolongs inactivation of Na+ channels
Excreted by kidney so no DDI
AE: renal stones - Gabapentin (neurontin)
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GABA analog.. interacts with alpha-2 subunits of L type Ca2+ channels
- Excreted UNCHANGED in urine, therefore no DDIs!!!
- primarily used for chronic pain - Pregabalin (Lyrica)
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Structural analog of GABA.. blocks v-gated Ca2+ channels
Schedule V drug
90% kidney excretion
Uses: fibromyalgia, neuropathic pain, partial seizures - Topiramate (Topamax)
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Potentiates GABA response, decreases glutamate receptor activity, blocks Na+ channels
= excreted unchanged by kidneys
AE: somnolence (daytime sleepiness), weight LOSS, kidney stones, metabolic acidosis
Uses: migranes!!!, chornic pain, bipolar, multiple seizures - Levetiracetam (Keppra)
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Anti-convulsive, unknown MOA
- approved for refractory partial seizures in adults when added with other drugs
- excreted by kidneys.. No known DDIs - Benzodiazepines
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Diazepam or lorazepam
..given IV to treat for acute status epilepticus and given for seizures of eclampsia