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4
What are the three basic underlying causes of epileptic
Genetic, structural/metabolic, and unknown
seizures?
Use of drugs of abuse is a known risk factor for the devel-
Overdose and withdrawal
opment of seizures, especially when associated with
The phase of the actual seizure activity is called the Ictal phase
The majority of patients with epilepsy experience Partial seizures
The primary mechanism to assess seizure intensity, dura-
The patient's and/or witness's reports
tion, and frequency is often
they are often prescribed multiple concomitant medica-
One of the primary issues regarding epilepsy in elderly
tions, predisposing them to drug interactions and adverse
patients is
ettects
Pregabalin is indicated for what type of seizure? Partial
When a patient is having a seizure, an appropriate action Time the seizure duration, provide for the patient's safety,
is to and stay with the individual until he or she is conscious.
When making decisions regarding driving restrictions for
patients with epilepsy, the most important consideration safety of the patient and others
is the
Studies show that, compared with drug therapies used
in the 1980's, the newest therapies developed for seizure Fewer drug-drug interactions
disorders over the past 10 years have
How many seizures must a patient have before a diagnosis
At least two
of epilepsy is considered?
What is true in regard to Carbamazepine? It can cause life-threatening agranulocytosis
The majority of patients with seizure disorders experience Focal seizures
Burns and bruises
Complications during a seizure can include Abrasions and head injuries
Tongue bites and broken bones
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4 What statement is accurate about the frequency of The problem of seizure onset varied among patients but
seizures in patients with a seizure disorder? was predictable within a given patient.
Focal seizures may progress to involve the entire cerebral
Seizures that evolve bilaterally
tissue. These may be referred to as
Pregabalin is indicated for which of the following types of
Focal
seizures?
Which of the following statements about surgical tech- The reduction in seizures improved over a 5-yr period
niques for management of epilepsy is most accurate? following deep brain stimulation
The risk for sudden unexpected death in epilepsy (SUDEP)
is highest in patients with which of the following type of Generalized tonic-clonic seizures
seizures?
What is the reported prevalence of pain at the end of life? 57 to 65%
What is the most reliable indicator of pain? Patients' self report
Research has shown that pain is Underestimated by healthcare professionals
Generalized pain is usually indicative of Central nervous system damage
What is an objective of pharmacologic management of
Maintaining a consistent dose of the drug over time
pain?
According to the World Health Organization (WHO) lad-
in a manner according to the intensity of the pain
der, pain should be managed
The onset of action of fentanyl transdermal patch is 8-12 hours
What is the most commonly used opioid for step 3? Morphine
What medication is indicated for paroxysmal lancinating
Topiramate
pain?
Octreotide is indicated for the treatment of visceral pain
A patient who lives in a nursing home is evaluated because
his family is concerned that he has inadequately treated
pain.
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4 The patient has moderate dementia.
Patients with dementia are less likely to report pain after
How does pain assessment for patients with dementia
activity
ditter from assessment for cognitively intact patients?
A 72-year-old woman comes to the oflce because for the
past 6 months she has had severe burning pain in her feet
that is worse at night. She recently tried gabapentin but
discontinued it because it caused gait disturbance.
History includes uncontrolled DM, chronic constipation,
and mild cognitive impairment.
Medications include insulin glargine 20 units at night,
Start pregabalin
lisinopril 20 mg/day, docusate sodium 100 mg q12h,
metformin 1,000 mg q12h, and acetaminophen 1,000 mg
q8h.
Her fingerstick glucose levels have been between 180 and
200 in the morning and in the mid-200s at night.
What is the most appropriate next step for improving pain
control?
A 71-year-old woman comes to the oflce because she
has pain from an osteoporotic vertebral fracture. She is
now receiving recommended therapy for osteoporosis.
The pain from the fracture prevents her from gardening. Oxycodone 2.5mg orally q6h as needed.
Conservative measures--such as acetaminophen, physical
therapy, and NSAIDs--have not provided adequate relief.
What do you recommend for her pain?
A 68-year-old man comes into the oflce for follow-up. He
is increasingly sedentary and has gradually gained weight
during the past 3 years. His wife has urged him to in-
crease his physical activity. History--HTN, hyperlipidemia, Risk of falls
right rotator cutt injury, recent cataract surgery. Medica-
tions--Atorvastatin, Losartan, ASA, Acetaminophen. Exam-
ination--Blood pressure is 138/88, and heart rate is 82