Podcast
Questions and Answers
Which of the following criteria is NOT required for a patient to be diagnosed with epilepsy?
Which of the following criteria is NOT required for a patient to be diagnosed with epilepsy?
Which anti-epileptic drug is represented by the abbreviation 'LTG'?
Which anti-epileptic drug is represented by the abbreviation 'LTG'?
How many unprovoked seizures over 24 hours apart are required for a patient to be diagnosed with epilepsy, based on the given criteria?
How many unprovoked seizures over 24 hours apart are required for a patient to be diagnosed with epilepsy, based on the given criteria?
Which type of antiepileptic drug is associated with chronic and idiosyncratic side effects, and has complex dosing due to saturation kinetics?
Which type of antiepileptic drug is associated with chronic and idiosyncratic side effects, and has complex dosing due to saturation kinetics?
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Which antiepileptic drug is known to cause permanent vision loss as a side effect?
Which antiepileptic drug is known to cause permanent vision loss as a side effect?
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What is the consequence of enzyme-inducing AEDs on newborns?
What is the consequence of enzyme-inducing AEDs on newborns?
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Which of the following is a known trigger for seizures?
Which of the following is a known trigger for seizures?
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What is the aim of antiepileptic therapy?
What is the aim of antiepileptic therapy?
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What characterizes focal (partial) seizures?
What characterizes focal (partial) seizures?
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Which organization published the 'Clinical Guidelines for the Management of Epilepsy in Adults and Children'?
Which organization published the 'Clinical Guidelines for the Management of Epilepsy in Adults and Children'?
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Who is the author of the article 'Antiseizure medications: Mechanism of action, pharmacology, and adverse effects'?
Who is the author of the article 'Antiseizure medications: Mechanism of action, pharmacology, and adverse effects'?
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What is the DOI (Digital Object Identifier) of the article 'Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy'?
What is the DOI (Digital Object Identifier) of the article 'Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy'?
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Who is the publisher of 'UpToDate'?
Who is the publisher of 'UpToDate'?
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What is the title of the article with the ID 1?
What is the title of the article with the ID 1?
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When was the content last reviewed by PharmAchieve Corporation Ltd?
When was the content last reviewed by PharmAchieve Corporation Ltd?
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What is the primary goal during the intercritical gout phase?
What is the primary goal during the intercritical gout phase?
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What is a chronic complication of gout characterized by large, visible bumps/nodules in soft tissue consisting of uric acid crystals?
What is a chronic complication of gout characterized by large, visible bumps/nodules in soft tissue consisting of uric acid crystals?
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What are examples of risk factors that increase the occurrence of hyperuricemia and gout?
What are examples of risk factors that increase the occurrence of hyperuricemia and gout?
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What is the primary aim of therapy for gout?
What is the primary aim of therapy for gout?
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What is the recommended approach to preventing gout attacks?
What is the recommended approach to preventing gout attacks?
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How is gout diagnosed?
How is gout diagnosed?
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What is the recommended treatment for acute gout attacks?
What is the recommended treatment for acute gout attacks?
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What is the primary goal during the intercritical gout phase?
What is the primary goal during the intercritical gout phase?
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What is the most common initial presentation of a gout attack?
What is the most common initial presentation of a gout attack?
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What are tophi/tophaceous gout?
What are tophi/tophaceous gout?
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When does chronic gouty arthritis typically occur?
When does chronic gouty arthritis typically occur?
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Where are uric acid or urate crystal deposits responsible for severe arthritis or joint pain in gout?
Where are uric acid or urate crystal deposits responsible for severe arthritis or joint pain in gout?
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What is the characteristic of intercritical gout phase?
What is the characteristic of intercritical gout phase?
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What are chronic complications of gout characterized by large, visible bumps/nodules in soft tissue consisting of uric acid crystals?
What are chronic complications of gout characterized by large, visible bumps/nodules in soft tissue consisting of uric acid crystals?
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When were significant changes made to slide 10?
When were significant changes made to slide 10?
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What was changed on slide 9 on March 5, 2023?
What was changed on slide 9 on March 5, 2023?
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What was the indication modified to on slide 10?
What was the indication modified to on slide 10?
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When was content reviewed with no changes made?
When was content reviewed with no changes made?
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When were significant changes made throughout the content?
When were significant changes made throughout the content?
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What was added to slide 11 in March 2020?
What was added to slide 11 in March 2020?
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What was added to slide 15 in March 2020?
What was added to slide 15 in March 2020?
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When were formatting changes made throughout the content?
When were formatting changes made throughout the content?
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What significant updates were made to slide 9 on August 15, 2022?
What significant updates were made to slide 9 on August 15, 2022?
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Which medication is commonly used to treat gout attacks but may have decreased efficacy over time?
Which medication is commonly used to treat gout attacks but may have decreased efficacy over time?
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What is the first-line and mainstay of treatment for gout?
What is the first-line and mainstay of treatment for gout?
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Which medication can be used up to 24 hours from the onset of an acute gout attack when added to NSAIDs?
Which medication can be used up to 24 hours from the onset of an acute gout attack when added to NSAIDs?
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Which medication demonstrated effectiveness in the secondary prevention of major cardiac events after a myocardial infarction?
Which medication demonstrated effectiveness in the secondary prevention of major cardiac events after a myocardial infarction?
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What are patients advised to use for at least 6 months after achieving target serum urate and no tophi on exam?
What are patients advised to use for at least 6 months after achieving target serum urate and no tophi on exam?
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During which period are patients most at risk for recurrent gout flares after initiating ULT?
During which period are patients most at risk for recurrent gout flares after initiating ULT?
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Which medication has equal or superior efficacy to NSAIDs and colchicine, with no greater risks of adverse effects in most patients?
Which medication has equal or superior efficacy to NSAIDs and colchicine, with no greater risks of adverse effects in most patients?
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Study Notes
Understanding Seizures and Antiepileptic Therapy
- Seizures are caused by abnormally excitable neurons firing in synchronization, influenced by potassium, calcium, sodium, and chloride channels in the neuronal membrane.
- Anti-epileptic agents target these channels to prevent firing, while upregulation of Synaptic Vesicle protein 2A (SV2A) is also linked to epilepsy.
- Drug and non-drug causes of seizures include premature birth, perinatal injury, alcohol withdrawal, febrile seizures, family history, stroke, head trauma, and infections.
- Known triggers for seizures include stress, photostimulation, hyperventilation, sleep deprivation, and hormonal changes.
- Antiepileptic therapy aims to prevent seizure recurrence and minimize side effects, and can be discontinued after 2-4 years of achieving seizure freedom.
- Seizure threshold describes the risk of experiencing a seizure, while the postictal period follows a seizure with altered consciousness or behavior.
- Focal (partial) seizures originate from a neural network in only one side of the brain and can have motor and/or non-motor components.
- Various antiepileptic drugs have different properties and mechanisms of action, including enzyme-inducing and non-enzyme-inducing drugs.
- Barbiturates such as phenobarbital and primidone have chronic side effects like behavioral and cognitive problems, mood changes, and sedation.
- Benzodiazepines like clobazam can lead to chronic side effects like depression, and tolerance may develop.
- Different antiepileptic drugs have idiosyncratic side effects and affect metabolic pathways, with implications for drug interactions and efficacy.
- Understanding the properties of antiepileptic drugs is crucial for optimizing therapy and managing side effects in individuals with seizures.
Gout Treatment and Urate-Lowering Therapies
- NSAIDs (indomethacin, naproxen, ibuprofen) are commonly used to treat gout attacks, but their efficacy decreases over time.
- Colchicine, when added to NSAIDs, can be used up to 24 hours from the onset of an acute gout attack, and up to 2-3 days after gout symptoms resolve.
- Colchicine mitigates the inflammatory response by neutrophils that contribute to gout symptoms, with primarily GI side effects.
- A 2019 trial demonstrated that colchicine was effective in the secondary prevention of major cardiac events after a myocardial infarction.
- Corticosteroids (oral, intra-articular, or intramuscular) have equal or superior efficacy to NSAIDs and colchicine, with no greater risks of adverse effects in most patients.
- Allopurinol is the first-line and mainstay of treatment for gout, with specific indications for starting urate-lowering therapy (ULT).
- ULT can be initiated during a gout attack for specific patient characteristics, and patients are advised to use colchicine or low-dose NSAIDs for at least 6 months after achieving target serum urate and no tophi on exam.
- During the first 6 months of ULT initiation, patients are most at risk for recurrent gout flares.
- The text includes references to several resources and guidelines on gout management and urate-lowering therapies.
- The use of ULT is discussed in the context of preventing gout flares and achieving target serum urate levels.
- The text emphasizes the importance of considering patient characteristics and specific indications when starting ULT.
- The information is copyrighted by PharmAchieve Corporation Ltd. and is confidential.
Studying That Suits You
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Description
Test your knowledge of seizures and antiepileptic therapy with this quiz. Explore the causes, triggers, and treatment options for seizures, and learn about different antiepileptic drugs and their side effects. Gain a better understanding of how to optimize therapy and manage side effects for individuals with seizures.
