USMLE Step 2 Review 20 02 Drugs of Choice Seizure Meds

USMLE Step 2 Review 20 02 Drugs of Choice Seizure Meds

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Begin 20 02 Drugs of Choice Seizure Meds Transcription

There are 3 main types of generalized seizures:

  • Absence, myoclonic, and tonic-clonic.

Which is the type seen virtually only in children, characterized by brief moments of loss of consciousness?

  • Absence seizures.

What’s the old name?

  • Petit mal.

What is the drug of choice for absence seizures?

  • Ethosuximide.

Trade name?

  • Zarontin.

And what is the second choice drug for absence seizures, which may also be used for many types of generalized seizures?

  • Valproic acid.

Two trade names?

  • Depakote or Depakene.

Which of these 2 tends to be better tolerated?

  • Depakote.

What is the generalized seizure characterized by muscle jerking without preceding tonic rigidity?

  • This is generalized myoclonus.

And the drug of choice?

  • Valproic acid.

Trade names?

  • Depakote, Depakene.

Finally, what is the generalized seizure which starts with tonic rigidity and is followed by loss of consciousness and then progresses to clonic jerking?

  • Generalized tonic-clonic.

And the old name for generalized tonic-clonic?

  • Grand mal seizure.

What are the 2 alternatives for drug of choice for tonic-clonic seizures?

  • Either Carbamazepine or Phenytoin.

And the trade name for Carbamazepine?

  • Tegratol.

And the trade name for Phenytoin?

  • Dilantin.

What category of seizures begin with a motor, sensory, or autonomic phenomena?

  • For example, there may be movement of a single muscle group, there might be a sound, there might be a hallucination, or there might be flushing or sweating or pallor.

What’s the term?

  • These are partial seizures- they used to be called focal seizures.

What is characteristic of simple partial seizures?

  • Consciousness is maintained.

Unless what follows the simple partial seizure?

  • A secondary generalization, which may produce both tonic-clonic seizure and loss of consciousness. However, what matters is how the seizure began in terms of treatment.

And what is the characteristic of a complex partial seizure?

  • This is a partial seizure in which consciousness is impaired but not lost.

What part of the brain is often involved in complex partial seizures?

  • The temporal lobe.

What are the 2 alternatives for drug of choice for partial seizures, whether they are simple or complex partial seizures?

  • Phenytoin or Carbamazepine.

Trade name for Phenytoin?

  • Dilantin.

Trade name for Carbamazepine?

  • Tegratol.

Young children, 3 months to 5 years of age, frequently develop seizures with illness, accompanied by what?

  • High fever.

And these are called?

  • Febrile seizures.

What type of seizure is a febrile seizure, usually?

  • A generalized tonic-clonic.

With what sort of duration?

  • Short duration.

While febrile seizures may be frightening to the parents, they are?

  • Benign.

When medication is felt to be required, what is the drug of choice?

  • Phenobarbital.

What is the term for the medical emergency where the patient is in convulsive seizures, either repeatedly or constantly, and they do not regain consciousness?

  • Status epilepticus.

Unless convulsions are stopped, what may result?

  • Permanent brain damage.

What are the 2 choices for drug of choice for treating status epilepticus?

  • Phenytoin or Diazepam.

Trade name for Phenytoin?

  • Dilantin.

Trade name for Diazepam?

  • Valium.

What is the most common treatable cause of pharyngitis in children?

  • Group A beta-hemolytic Strep pharyngitis.

What are the peak ages for this?

  • Four to 11 years.

While no set of symptoms or signs is perfectly specific for Group A Beta-hemolytic Strep, there are 2 signs, which taken together, are strongly diagnostic. What are they?

  • A combination of pharyngitis with scarletiniform rash.

What possible sequelae of Group A Beta-hemolytic Strep pharyngitis is cause for concern and cause for effective diagnosing and treating the Strep pharyngitis in the first place?

  • Rheumatic fever.

Which class of antibiotic is Group A beta-hemolytic Streptococcus highly sensitive to?

  • Penicillin.

Is there evidence of developing resistance to penicillin?

  • No, despite decades of use, there is no evidence of in vitro resistance.

A single dose of intramuscular penicillin is effective treatment. What formulation is used, especially with children because it causes less pain?

  • The combination of Penicillin G Benzathine and Penicillin G Procaine.

And what’s the trade name for this?

  • Bicillin.

Oral penicillin is a good alternative.

Which penicillin may be given PO?

  • Penicillin V.

Two trade names?

  • Pen VK and Veetids.

What are 4 alternatives to penicillin for children when they have a penicillin allergy?

  • Erythromycin, Cephalosporins, Clindamycin, Azithromycin.

What is the advantage of using penicillin, however, as much as possible?

  • Penicillin is the only one that has been demonstrated conclusively to do a good job of preventing rheumatic fever.

What are 3 trade names for Erythromycin in a syrup form suitable for pediatrics?

  • EryPed, Ilosone, and Pediazole.

What else is in Pediazole?

  • Sulfonamide.

What is Pediazole specifically indicated for?

  • Acute otitis media.

Due to?

  • H. influenzae.

Trade name for Clindamycin?

  • Cleocin.

And trade name for Azithromycin?

  • Zithromax.

****END OF TRANSCRIPTION****

 

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