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Pharmacology > Exam 5-Seizures & Anticonvulsants > Flashcards

Exam 5-Seizures & Anticonvulsants Flashcards

1
Q

What piece of equipment can you use to measure seizure activity?

A

EEG-electroEncephalogram

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2
Q

“_______” = episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change

A

seizure

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3
Q

A MAJORITY of patients have _______ epilepsy = no known cause

A

idiopathic

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4
Q

What are the 2 broad groups of epilepsy? Which one is more common?

A

partial and generalized epilepsies…partial epilepsy

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5
Q

What are the 2 subtypes of partial epilepsies?

A

simple partial and complex partial

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6
Q

What type of epilepsy? ________ = seizures caused by a group of hyperactive neurons confined to a single locus in the brain

A

Simple partial

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7
Q

In partial epilepsy, a seizure lasts for only a few ______, the individual does not _______

A

seconds….lose consciousness

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8
Q

In partial epilepsy, the patient fften exhibits abnormal activity of a ______ or muscle group…May occur at _____ age

A

single limb…any

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9
Q

What type of epilepsy? ________ = seizures exhibit complex sensory hallucinations, mental distortion and loss of consciousness

A

complex partial

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10
Q

In complex partial seizures, the pt gets an AURA and the seizure lasts for _______….Full _______ is slow to return

A

3-5 minutes…consciousness

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11
Q

Complex partial seizures are also known as psychomotor or _______ lobe seizures

A

temporal

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12
Q

DID YOU KNOW…80% of people with complex partial epilepsy experience initial seizure prior to ____ years of age

A

20 years of age

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13
Q

What are the two subtypes of generalized epilepsies?

A

Tonic-Clonic (grand mal) and Absence (petit mal)

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14
Q

In both of the geralized epilepsies, _________ is lost with both types of seizures!

A

consciousness

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15
Q

What is the MOST DRAMATIC FORM of epilepsy?

A

Tonic-clonic (grand mal)

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16
Q

In tonic-clonic (grand mal) seizures, they result in loss of _________, followed by tonic then clonic phases (convulsive ________)

A

consciousness….twitching

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17
Q

Tonic-clonic (grand map) seizures- Major _____ activity = fall to floor, tonic rigidity, chronic jerking of face and limbs – Tonic-clonic seizure is followed by a period of ______ and exhaustion, patient can go _______ if they fall asleep afterward.

A

motor…confusion…comatose

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18
Q

What is this describing???Brief period of heightened sensory activity prior to the onset of the seizure….Characterized by numbness, nausea, or unusual sensitivity to light, odor, sound…SEEMS LIKE I WOULD WANT TO KNOW IF A PT IS FEELING THIS!!

A

An aura

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19
Q

In _________ seizures, they involve an abrupt and brief loss of consciousness (10-30 seconds).

A

absence (petit mal)

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20
Q

In ________ seizures, Onset occurs at 3 to 5 years old and lasts until puberty (disappears in middle adulthood)…..Think: ______

A

absence (petit mal)…CHILDREN

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21
Q

Do you get an aura in absence (petit mal) seizures?

A

nope, No aura; patient stares and has rapid eye- blinking for 3 to 5 seconds; quickly returns to normal

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22
Q

What are seizures are continuous or rapidly recurrent…Can be life-threatening

A

Status epilepticus (yay, Latin!)

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23
Q

When STATUS EPILEPTICUS occurs in dental office,
give injection of _______ (______)*
– May also use ________ (Ativan) and _______ (Versed) parenterally

A

diazepam (Valium)…lorazepam…midazolam

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24
Q

The two goals of drug therapy for epilepsy are To control seizures (_______) and Minimize ______ reactions

A

frequency…adverse

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25
Q

Mechanism of drug therapy for epilepsy….

A

CNS depressants

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26
Q

How long is typical drug therapy for epilepsy?

A

Drugs are usually taken for LIFE: chronic toxicity becomes an important consideration when selecting an agent

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27
Q

Generalized Adverse Reactions to anti convulsants: Narrow _______ index, so we need to titrate dose carefully and monitor blood levels

A

theraputic index

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28
Q

Generalized Adverse Reactions to anti convulsants: Most anticonvulsants stimulate LIVER microsomal _______. (“_______”)

A

enzymes…“inducers”

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29
Q

Generalized Adverse Reactions to anti convulsants: Metabolism of anticonvulsants can _______ liver microsomal enzymes

A

saturate

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30
Q

Generalized Adverse Reactions to anti convulsants: At low doses = _____ order elimination (drug can be removed from body after metabolism)

A

1st

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31
Q

Generalized Adverse Reactions to anti convulsants: After saturation of liver enzymes, metabolism converts to ____ order kinetics = blood level increases abruptly

A

zero

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32
Q

Generalized Adverse Reactions to anti convulsants: At saturation, even a _____ change in dose can lead to ______ increase in blood level of dose

A

small…large

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33
Q

Common anticonvulsant side effects: ______ may develop to these effects (drowsiness) while the anticonvulsant effect remains

A

tolerance

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34
Q

Common anticonvulsant side effects: Impaired ______, cognitive alteration

A

learning

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35
Q

Common anticonvulsant side effects: _______ alteration = hyperactivity, sedation

A

behavioral

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36
Q

Common anticonvulsant side effects: Exacerbation of another ______ type that is not being treated

A

seizure

37
Q

Common anticonvulsant side effects: CNS depression is _______ with other CNS depressants…e.g. ______ in dentistry or alcohol

A

ADDITIVE..opioids

38
Q

Common side effects- GI: __, __, __ occurs with

most anticonvulsants BUT! Effects can be minimized by taking the drug with _____.

A

N,V,D (nausea, vomiting, diarrhea)…food

39
Q

Common side effects- Prescribe agents that can irritate the GI tract cautiously in patients taking anticonvulsants….FOR EXAMPLE don’t Rx _______ in dentistry


A

NSAIDs

40
Q

Which anticonvulsant? Mechanism of action: blocking sodium channels in neurons, which blocks propagation of impulses, inhibition of high-frequency repetitive firing in neurons, HIGHLY effective for SIMPLE and COMPLEX PARTIAL seizures

A

Car-BAM-az-ep-ine (Teg-Ret-ol)

41
Q

Some other uses of the anticonvulsant Car-BAM-az-ep-ine a re for _______ depression and IN DENTISTRY-chronic pain, namely ________ (_________).

A

bipolar….trigeminal neuralgia (tic douloureaux)

42
Q

Car-BAM-az-ep-ine: adverse drug reactions: Hematologic: Causes _______ anemia (wipes out bone marrow), agranulocytosis, thrombocytopenia..YIKES

A

Aplastic

43
Q

Car-BAM-az-ep-ine: adverse drug reactions: Has potential for inducing serious _____ toxicity

A

Liver

44
Q

Car-BAM-az-ep-ine: adverse drug reactions: dental application ________!!!

A

Xerostomia

45
Q

Car-BAM-az-ep-ine: Drug interactions = classic “______”….Decreases effectiveness of warfarin (Coumadin), doxycycline, theophylline (bronchodilator for asthma), oral contraceptives

A

“INDUCER”

46
Q

Car-BAM-az-ep-ine: Other drug interactions – _________-type antibiotics (________) increase carbamazepine blood levels (toxicity) carbamazepine may increase HEPATOtoxicity of the analgesic _________ (______).

A

ERYTHROMYCIN….MACROLIDES; acetaminophen (Tylenol)

47
Q

What on earth drug might this be??????Mechanism of action = decrease the neuronal membrane passage of sodium ions Reduces propagation of abnormal impulses in the brain to reduce the FREQUENCY of seizures

A

phen-y-to-in (Di-lan-tin)

48
Q

phenytoin (Dilantin) is effective for all _______ seizures (simple and complex)…This drug kicks ass because its Highly effective for ________ seizures and its also effective for the BIG boy: ________.

A

partial….tonic-clonic…status epilepticus

49
Q

Which seizure type is phenytoin (Dilantin) NOT effective for?

A

absence seizures (petit mal)

50
Q

What dental implication is phenytoin (Dilantin) indicated for?

A

trigeminal neuralgia

51
Q

What are the two anticonvulsant drugs that are used to treat trigeminal neuralgia?

A

phenytoin (Dilantin) & Car-BAM-az-e-pine (TegRetOL)

52
Q

Phen-y-to-in (Dilantin) HAS SOME MAJOR ORAL ADVERSE EFFECTS: what are they? (3)

A

1.Loss of taste 2.oral mucosal ulceration/glossitis from Vit D & folate deficiencies 3.GINGIVAL HYPERPLASIA

53
Q

What % of Pt’s taking phenytonin (Dilantin) experience the dreaded GINGIVAL HYPERPLASIA?

A

50-60%!!!

54
Q

Can oral hygiene have an effect on the gingival hyperplasia caused by phenytoin (Dilantin)? Does it go away after patient is taken off?

A

Yes, good OH reduces the extent and severity…it reduces SLOWLY after patient is off of phenytoin (Dilantin)

55
Q

WARNING: mothers given phenytoin (Dilantin) during pregnancy-there have been ________ effects seen. The FDA places it in their ____ category and it can produce ________ and ______ in the fetus.

A

teratogenic…D…..left lip….cleft palate

56
Q

How does phenytoin interact with other drugs?

A

Phenytoin INCREASES the metabolism of many drugs, a cytochrome P450 INDUCER

57
Q

_________ agents cause release of GABA from presynaptic interneurons, which intern INHIBITS the release of _______ in the presynaptic neuron.

A

GABAmimetic…AcetylCHoline

58
Q

MANY seizures are caused by TREMENDOUS release of _________ across synapses in cortex, therefore ______ is a INHIBITORY neurotransmitter.

A

acetylcholine..GABA

59
Q

What is the most common barbiturate used as an anticonvulsant? How does it work again?

A

pheno-barbital (Luminal sodium)…potentiates effects of GABA-mediated neurons (GABA mimetic)

60
Q

What 2 types of seizures is phenoBarbital indicated for?

A

tonic-clonic and all partial seizures

61
Q

Side effects of phenoBarbital- _______ may indicate onset of cutaneous reactions, some of which have been FATAL (so Discontinue drug if any skin reaction occurs)…AND a common one is plain ole ______.


A

Stomatitis…sedation

62
Q

Drug interactions of phonoBarbital- its another strong “______”, especially with these 3 medications….

A

“INDUCER”….oral contraceptives, macrolides, and warfarin

63
Q

Weird, phenobarbital enhances the hepatotoxicity of ________.

A

acetaminophen (this drug is just like car-BAM-az-epine)

64
Q

And yet again, phenoBarbital has _______ CNS effects when mixed with alcohol, narcotics, anti-depressants, bezo’s

A

ADDITIVE

65
Q

What is the phenoBarbital PRECURSOR (metabolized to phenoBarbital once it passes through the liver).

A

PRIM(ary)…Prim-id-one (Mysoline)

66
Q

What class of anticonvulsants has the unique mechanism of action of causing increased availability of GABA to neurons?

A

Val-pro-ates

67
Q

What 3 seizure types can valproic acid treat?

A

Tonic-clonic (grand mal), generalized: absence (petit mal) and myoclonic

68
Q

What are 2 adverse reactions that cause Valprotates to not be administered as much?

A

1.hepatotoxicity (significant) 2.increases bleeding time (inhibits platelet aggregation)

69
Q

T/F Valproates are teratogentic.

A

True

70
Q

3 main drug interactions with Valproates:

A

1.macrolide antibiotics (weird) (they inhibit the metabolism of Val acid) 2.aspirin (displace val acid from binding sites and increase hepatotoxicity) 3.ADDITIVE effect with other CNS drugs.

71
Q

What is the first choice in treating absence (petit mal) seizures?

A

etho-sux-imide (Zar-on-tin)

72
Q

What are 4 side effects of the drug ehtosuximide (Zarontin) ? (hint 2 are oral)

A

1.Hirsutism (hair growth) 2.SLE (lupus) 3.GINGIVAL HYPERPLASIA 4.Swelling of the tongue

73
Q

Review, what was the drug of choice for Status Epilepticus?

A

diazepam (Valium)

74
Q

Which anticonvulsant is used for partial seizures and tonic-clonic, is structurally related to GABA, but DOES NOT interact with GABA receptors (mech of action unknown)?

A

gaba-pent-in (Neurontin)

75
Q

Which anti convulsant is a great option because it is not metabolized and therefore has limited drug interactions?

A

gaba-pent-in (Neruontin)

76
Q

Which anti convulsant is also used for chronic pain (shingles) and has the side effect of oral mucositis?

A

gaba-pent-in (Neurontin)

77
Q

Who am I? Used for partial seizures and tonic-clonic…Mechanism of action = inhibits the release of GLUTAMATE (an excitatory amino acid)….Weakly inhibits SEROTONIN receptors (tx of bipolar too)

A

lame-O!! lam-o-tri-gine (Lamictal)

78
Q

Tx Considerations for seizures: Drugs are used for ________ treatment, Initial therapy is to ______ increase dose, Usually patients receive _____ drug therapy.

A

symptomatic…slowly….multiple

79
Q

HERE COMES THE BOOM-the 6 drugs for tonic-clonic (grand mal) seizures are…..

A

valproic acid, phenytoin, phenobarbital, primidone, gabapentin, lamotrigine

80
Q

HERE COMES THE BOOM-the 2 drugs for absence seizures are….

A

ethosuximide and valproic acid

81
Q

HERE COMES THE BOOM-the 6 drugs for partial seizures are….

A

carbamazepine, phenytoin, phenobarbital, primidone, gabapentin, lamotrigine

82
Q

Good to know…_________ is sometimes used before phenytoin to avoid gingival hyperplasia

A

car-BAM-az-epine

83
Q

ALWAYS ask patients when they have had their most recent seizure and if they have known ______.

A

triggers (dental handpiece? light??)

84
Q

Remember-P_______ and P_______ are classic P450 inducers.

A

phen-y-to-in (Dilantin) and pheno-barb-ital

85
Q

Remember- liver toxicity is a concern with _______ and ________.

A

car-BAM-az-epine and valproic acid

86
Q

What are the three ways we can trigger a seizure in the dental clinic?

A
  1. light 2.startle (sound/light) 3.anesthetic
87
Q

What is a convulsant that is used for provocative diagnosis of epilepsy and keeps people awake?

A

pentyl-en-et-etra-zole (Metrazole)

88
Q

Which convulsant is found in rat poison, blocks glycine receptors and is added to heroin (causes OD)?

A

strychnine

89
Q

Which convulsant blocks GABA receptors and therefore blocks presynaptic inhibition?

A

pic-ro-toxin

Pharmacology (23 decks)

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