Seizures and Anti-Epileptic Drugs Flashcards
What percent of medical emergencies in the dental clinic are seizures?
17%
How to manage seizures in the dental clinic?
Head tilt, chin lift.
Medical emergency algorithm and what it stands for.
PABCD:
Position Airway Breathing Circulation Definitive treatment
ASA classification for well-controlled seizures and epilepsy.
II
ASA classification for uncontrolled epilepsy or seizures.
IV
Epilepsy definition
You have 2 or more uncontrolled seizures at least 24 hours apart.
Excessive excitability of neurons in the CNS causes.
Epilepsy/seizures
3 Types of Seizures
1) Generalized Onset
- Tonic Clonic
- Absence
2) Focal Onset
- Aware
- Unaware
3) Unknown Onset
The most common form of generalized seizures.
Tonic clonic
Which drug makes up Diphenylhydantoinate.
Phenytoin/Dilantin
This anti-epileptic drug causes gingival overgrowth.
Phenytoin/Dilantin
Significant side effect of seizures meds.
Gingival hypertrophy (esp. Dilantin/phenytoin).
- Also causes xerostomia
- Increased chance of infection
- Increases the depressant effects of anesthetic agents.
- Delayed healing, bleeding gums, and postoperative bleeding.
T/F: There’s little data to suggest significant differences in effectiveness among available anti-epileptic drugs.
True
All antiepileptic drugs have in common the ability to ________ neuronal excitation or ______ neuronal inhibition.
decrease; increase
MOA for anti-epileptic drugs.
- Decrease Na+ channel activity
- Decrease Ca2+ channel activity
- Decrease glutamate transmission.
- Increase GABA transmission
Broad-spectrum anti-epileptics.
Valproate
Topiramate
Levetiracetam
Narrow-spectrum anti-epileptics.
Phenytoin
Carbamezepine
Pregabalin
Phenytoin MOA
Na channel blocker
Phenytoin is a broad or narrow therapeutic index drug?
Narrow
Adverse effect of Phenytoin
Gingival enlargement
Phenytoin is known to induce what?
CYP3A4, so it increases drug metabolism and drug-drug interactions.
What is the pregnancy category of Phenytoin?
D
What does Pregnancy Category D mean?
The drug causes known harm to the baby, but the benefits to the mother may outweigh the risks if she can’t take any other drug.
Disease associated with Phenytoin
Fetal Hydantoin Syndrome
- Resembles fetal alcohol syndrome
- Includes abnormalities of the skull and facial features, cleft lip, or palate.
A major first-line anti-epileptic.
Carbamezepine
Carbamezepine MOA
Na channel blocker.
Key adverse event associated with Carbamezepine
Xerostomia
These anti-epileptic drugs cause Steven-Johnson Syndrome.
Phenytoin
Carbamezepine
First-line tx for people with absence seizures.
Valproate
What pregnancy category is Valproate?
D
Syndrome caused by Valproate.
Fetal Valproate Syndrome
Which AED has the strongest evidence for risk and Grade 1B recommendation that it should be avoided?
Valproate
Key adverse events associated with Topiramate
BONE LOSS, gingivitis, xerostomia, taste changes,
These are pregnancy C anti-epileptics.
Levi and Lamo
Levetiracetam
Lamotrigine
What is Levetiracetam used for?
Infants with focal seizures.
Advantages of Levetiracetam anti-epileptic.
- High bioavailability.
- Rapid onset of action.
- Is metabolized independently of CYP, so there are no drug interactions.
How to remember what Levi is used for.
“Levi is an infant with focal seizures.”
Levi MOA
Prevents exocytosis, thus inhibiting the CNS.
