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Pharmocology > Chapter 16 > Flashcards

Chapter 16 Flashcards

1
Q

Anticonvulsants:

A
  • epilepsy
  • drug therapy of patients with epilepsy
  • dental treatment of the patient with epilepsy
  • Nonseizure uses of anticonvulsants
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2
Q

Epilepsy:

A
  • generalized seizures

- Partial (focal) seizures

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3
Q

Nonseizure uses of anticonvulsants:

A
  • Neurological pain

- Psychiatric pain

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4
Q

Define Epilepsy:

A

A group of disorders involving a chronic stereotype recurrent attack of involuntary behavior or experience or changes in neurological function caused by electrical activity in the brain that can be recorded via an electroencephalogram (EEG)

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5
Q

International Classification of Epileptic Seizures:

A
  • Generalized Seizures
  • Partial Seizures
  • Miscellaneous
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6
Q

Generalized Seizures:

A
  • Tonic Clonic

- Abscence

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7
Q

Partial Seizures:

A
  • Simple

- Complex

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8
Q

Miscellaneous Seizures:

A

-Status epilepticus

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9
Q

Tonic Clonic Seizures:

A
  • Loss of consciousness for longer period of time
  • Major movement of large muscle groups
  • Aura and postictal state
  • Slow recovery
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10
Q

Drugs of choice for Tonic Clonic Seizures:

A
  • Valproate
  • Lamotrigine
  • levetiracetam
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11
Q

Absence Seizures:

A
  • Brief loss of consciousness
  • Little movement
  • Body tone is not lost
  • No aura or postical state
  • Quick recovery
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12
Q

Drug of choice for absence seizures:

A

Ethosuxumide

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13
Q

Status epilepticus:

A
  • Continuous Tonic-Clonic Seizures that last longer than 30 minutes OR
  • Recur before the end of the postical period of the previous seizure
  • Emergency situation
  • Parenteral benzodiazepines
    • Diazepam (Valium)
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14
Q

Partial (Focal) Seizures:

A
  • Involve activation of only part of the brain and the location of the activity determines the clinical manifestations
  • Simple partial attack-Consciousness is not impaired
  • Complex partial attack- consciousness is impaired; may have aura and slow recovery
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15
Q

Drug of choice for partial (focal) Seizures:

A
  • Iamogotrigine
  • Carbamazepine
  • Levetiracetam
  • oxcarbazepine
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16
Q

Drug therapy of patients with epilepsy: General Adverse Reactions

A
  • Central nervous system depression:
  • tolerance to sedative effects
  • impaired learning and cognitive abilities
  • hyperactivity and sedation
  • Exacerbation of different seizure type
  • Gastrointestinal distress-anorexia, nausea, or vomiting
  • Drug interactions:
  • Stimulation of hepatic microtonal enzymes
  • More interactions with older drugs including phenytoin due to narrow TI
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17
Q

Drug therapy of patients with epilepsy: general adverse reactions, drug interactions, idiosyncratic reactions

A
  • Dermatoligic side effects:
    • Rash
    • Stevens-Johnson’s syndrome
    • Exfoliative dermatitis
    • erythema mutliforme
    • Drug-induced systemic lupus erythematosus
    • Hematologic effects
  • Teratogenicity/growth
  • Withdrawal-abrupt withdrawal can precipitate a seizure
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18
Q

Valproate: Mechanism of Action

A
  • Effect on Sodium and potassium channels
  • Reduction in aspirate levels
  • Increase in the inhibitory neurotransmitter gamma aminobutyric (GABA)
19
Q

Adverse reactions of Valporate GI Effects:

A
  • Indigestion, Nausea, Vomiting
  • Hypersalivation
  • Anorexia
  • Increased appetite
  • Cramping
  • Diarrhea
  • Constipation
20
Q

Adverse reactions of Valproate CNS effects:

A
  • Sedation and drowsiness
  • Rarely: Ataxia, headache, nystagmus
  • Hyperactivity, aggression, behavioral disturbances
  • Weight gain
  • Increased appetite
21
Q

Adverse reactions of Valproate:

A
  • Hepatotoxicity; liver function tests should be performed. Black box warning
  • Prolonged bleeding time
  • Teratogenicity
22
Q

Drug interactions of Valproate:

A
  • additive CNS depressant effect
  • Inhibits the metabolism of phenobarbital > Excessive sedation
  • Drug interactions with phenytoin > decrease Valproate action and Increased PHENYTOIN action
  • Bleeding; prolongs bleeding time
23
Q

Lamotrigine (Lamictal): uses

A
  • Elderly Patients, newly diagnosed with partial or generalized seizures
  • Children with absence seizures
  • Bipolar disorder maintenance therapy
  • Improved depression in patients with epilepsy
24
Q

Lamotrigine (lactimal) Adverse Reactions:

A
  • Dizziness
  • ataxia
  • somnolence
  • headache
  • dislopia
  • nausea
  • vomiting
  • rash
  • insomnia
  • in coordination
  • Steven-Johnson’s syndrome
25
Q

Lamotrigine (lactimal): Drug interactions

A

-Carbamazepine reduces Lamotrigine levels

Valproate increases Lamotrigine levels

26
Q

Levetiracetam (Keppra): uses

A
  • Monotherapy for Partial- onset and generalized Tonic-Clonic Seizures
  • Children with absence seizures
27
Q

Levetiracetam (Keppra): Adverse Reactions

A
  • dizziness
  • somnolence
  • weakness
  • suicide ideation
  • Agressive behavior
  • Irritability
  • Hostility
  • Psychosis
  • Steven-Johnson’s Syndrome
28
Q

Carbamazepine (Tegretol)

A
  • Related to tricyclic antidepressants
  • Uses:
  • Trigeminal neuralgia
  • Bipolar depression
  • Pharmilogical effects:
  • Blocking sodium channels
  • Inhibition of High-frequency repetitive firing in neurons
  • Decrease in synaptic transmission
29
Q

Carbamazepine (tegretol): Adverse Reactions, CNS effects

A
  • Dizziness
  • Vertigo
  • Drowsiness
  • Fatigue
  • ataxia
  • Confusion
  • Headache
  • Nystagmus
  • Visual (diplopia) and speech disturbances
  • Latent psychosis
  • abnormal involuntary movements
  • depression
  • peripheral neuritis
30
Q

Carbamazepine (tegretol): Adverse Reactions

A
  • GI effects:
  • Nausea, vomiting, gastric distress
  • abdominal pain
  • Diarrhea, constipation
  • anorexia
  • Hematologic effect:
  • Fatal Blood dyscrasias such as aplastic anemia have been reported in the first 4 months of treatment of the elderly
31
Q

Carbamazepine (tegretol): Adverse Reactions (Cont.)

A
  • Dermatologic Effects:
  • Rashes
  • Urticaria
  • Photosensitivity Reactions
  • Altered skin pigmentation
  • erythema multiforme
  • erythema nodosum
  • Aggrevation of systemic lupus erythematous
  • Alopecia
32
Q

Carbamazepine (tegretol): Adverse Reactions (cont.)

A
  • Oral Effects:
  • Dry mouth
  • Glossitis
  • Stomatitis
  • Chewable Carbamazepine-63% sugar
33
Q

Carbamazepine (tegretol): Drug interactions

A
  • Carbamazepine can induce liver microsomal enzymes
  • Decreases the effect of doxycycline, warfarin, theophylline, and oral contraceptives
  • Effects may be increased by erythromycin, isoniazid, and calcium channel blockers
34
Q

Phenytoin (Dilantin)

A
  • Used to treat Tonic-Clonic and partial seizures
  • GI Effects
  • CNS Effects:
  • Mental confusion, nystagmus,ataxia, slurred speech, blurred vision, diplopia, amblyopia, Dizziness, and insomnia
  • Dermatologic Effects:
  • Skin Reactions range from rash to exfoliate dermatitis, lupus erythematous, or Steven-Johnson’s syndrome
  • Hypertrichosis on the trunk and face
35
Q

Phenytoin (Dilantin): Adverse Reactions

A 
Vitamin Deficiency:
-Vitamin D and folate 
-Osteomalacia May result
Teratogenicity/growth:
-Fetal hydantion syndrome
-craniofacial anomalies, microcephaly,nail or digit hypoplasia, limb defects, growth deficiency, and mental retardation
-Thickening of facial structures
36
Q

Phenytoin: Adverse Reactions

A

Gingival enlargement symptoms

  • Often painless enlargement of the gingival margin
  • interproximal papillae involvement
  • Coalesce to cover occlusal surfaces of the teeth
  • Occurs in approx. 50% of patients using the medication long term
  • More common in anterior than posterior
  • More common on buccal than lingual/palatial
  • Rarely involves edentulous areas
  • gingival does not bleed easily
37
Q

Gingival enlargement:

A

-Drug induced gingival overgrowth is a side effect associated principally with 3 types of drugs: anticonvulsants (phenytoin), immunosuppressant (cyclosporine A), and various calcium channel blockers (nifedipine, verapamil, diltiazem)

38
Q

Phenytoin: Adverse Reactions Gingival enlargement

A
  • Unknown etiology
  • Management:
  • Choose another anti epileptic drug
  • Discontinue phenytoin
  • Improve oral hygiene
  • Consider gingivectomy
  • Consider other drugs
39
Q

Miscellaneous Anticonvulsant Agents: Ethosuxumide (Zarontin)

A
  • Mechanism of action: Inhibiting the T-type calcium channels
  • GI Adverse Effects: Drowsiness, hyperactivity, headache, and hiccups
  • Blood dycrasias, systemic lupus erythematous, Steven Johnson’s syndrome, hirsutism, gingival enlargement, and swelling of the tongue
40
Q

Miscellaneous Anticonvulsant Agents: Benzodiazepines

A
  • Clonezepam (Klonopin) uses:
  • Absence Seizures not responsive to ethosuximide
  • Mental Illnesses
41
Q

Anti epileptic Agents:

A

Gabapentin (Neurontin)

  • Mechanism of Action: GABA analog but does not interact with GABE receptor
  • Use: adjunct treatment of partial seizures, with and without generalized in adults and children 3 years of age and older
  • Adverse Reactions: Somnolence, Dizziness, fatigue, ataxia, nystagmus, blurred vision, and confusion. Edema weight gain and movement disorders have been reported.
42
Q

Nonseizure Uses of Anti-epileptics:

A
  • Chronic Pain Management (Neurontin)
  • Trigeminal Neuralgia (Carbamazepine
  • Migraine Headache Prophylaxis (Valproice Acid)
43
Q

Dental treatment of the patient with Epilepsy:

A 
Preventive measures:
-Detailed Seizures history
-Thoughtful treatment planning
-Education of entire staff
Management:
-Move patient to the floor if possible
-Tilt Patients head to one side
-Remove objects from the Patients mouth

Pharmocology (12 decks)

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