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Pharmacology > Specific Anticonvulsants > Flashcards

Specific Anticonvulsants Flashcards

1
Q

What is the mechanism of action for carbamazepine (Tegretol)?

A

Blocking sodium channels in neurons, which blocks propagation of impulses

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2
Q

What is carbamazepine (Tegretol) known for?

A

Highly effective for simple and complex partial seizures

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3
Q

What are some other clinical uses for carbamazepine (Tegretol) and why is it of special interest in the field of dentistry?

A
  • Bipolar depression
  • Chronic pain
  • Treatment of trigeminal neuralgia
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4
Q

What are the adverse drug reactions of Tegretol?

A
  • Hematologic - causes aplastic anemia (wipes out bone marrow)
  • Liver toxicity (potential)
  • Congestive heart failure, altered blood pressure
  • Xerostomia
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5
Q

What are the drug interactions of Tegretol?

A
  • It’s a classic “inducer”
  • Decreases effectiveness of warfarin, doxycycline, theophylline, oral contraceptives
  • Erythromycin-type antibiotics
  • Carbamazepine may increase hepatotoxicity of acetaminophen
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6
Q

What is the mechanism of action for phenytoin (Dilantin)?

A

Stabilizes neuronal membranes by decreasing the neuronal membrane passage of sodium ions.

Reduces propagation of abnormal impulses in the brain to reduce the frequency of seizures

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7
Q

What is characteristic of all anticonvulsants, with just about the very first dose?

A

Xerostomia

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8
Q

What are some characteristics of phenytoin (Dilantin)?

A
  • Highly effective for all partial seizures
  • Highly effective for tonic-clonic seizures
  • Effective for status epilepticus
  • NOT effective for absence seizures (petit mal)
  • Dental use - trigeminal neuralgia
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9
Q

What are some adverse effects of phenytoin (Dilantin)?

A
  • Loss of taste
  • Oral mucosal ulceration or glossitis associated with Vitamin D and folate deficiencies
  • **Gingival hyperplasia **
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10
Q

What can reduce the extent/severity of the adverse effects of phenytoin (Dilantin)?

A

Good oral hygiene

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11
Q

What anticonvulsant is known to cause gingival hyperplasia?

A

phenytoin (Dilantin) -

50-60% of people that take it will experience it

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12
Q

How is phenytoin (Dilantin) rated the FDA category?

A
  • Category D
  • Teratogenic
  • Fetal syndrome - cleft lip, cleft palate, congenital heart disease
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13
Q

What drug interactions does phenytoin (Dilantin) have and why?

A
  • Many drug interactions
  • Increases metabolism of many drugs
  • Cytochrome P450 “inducer”
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14
Q

What do GABAmimetic agents cause?

A

Release of GABA from presynaptic interneurons

They encourage GABA fusion with presynaptic neuron - inhibit the release of acetylcholine

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15
Q

What is GABA?

A

Inhibitory neurotransmitter (presynaptically)

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16
Q

What does phenobarbital (Luminal) do?

A
  • General depressent to CNS
  • Limits the spread of seizure discharge in the brain
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17
Q

What is the mechanism of action of phenobarbital (Luminal)?

A

Reduces Na and K tranport along axonal membranes, potentiates the inhibitory effects of GABA-mediated neurons (GABAmimetic)

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18
Q

What is the most common barbituate used as an anticonvulsant?

A

phenobarbital (Luminal sodium)

19
Q

What is phenobarbital (Luminal) indicated for?

A
  • Tonic-clonic and partial seizure types
20
Q

What are some side effects of phenobarbital (Luminal)?

A
  • Most common - sedation
  • Rare - stomatitis may indicate onset of cutaneous reactions, some of which have been fatal
21
Q

What do you do if a patient develops a skin reaction while taking phenobarbital (Luminal)?

A

Discontinue drug - may be fatal

22
Q

What are the drug interactions of Luminal?

A
  • Strong inducer
  • Additive CNS effects
  • Enhances hepatoxicity of acetaminophen
23
Q

What is chemically related to phenobarbital that is metabolized in liver to phenobarbtial (precursor to phenobarbital)?

A

primidone (Mysoline)

24
Q

What drugs fall under the family name Valproates?

A
  • valproic acid (Depakene)
  • valproate sodium (Depacon)
  • divalproex sodium (Depakote)
25
Q

What is the mechanism of action for valproates?

A

Causes increased availability of GABA to neurons - enhances action of or mimics the effects of GABA presynaptically

26
Q

What is valproic acid (Depakene) used for?

A
  • Tonic-clonic seizures (grand mal)
  • Generalized seizures
    • Absence (petit mal)
    • Myoclonic
27
Q

What are the adverse reactions of valproates?

A
  • Hepatotoxicity - not used as often as other drugs, monitor liver function
  • Increases bleeding time - inhibition of platelet aggregation
28
Q

What are the drug reactions to valproates?

A
  • Macrolide antibiotics - inhibit metabolism of valproic acid
  • Aspirin and other salicylates - displace valproic acid from protein-binding sites, leading to acute toxicity
29
Q

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

A

ethosuximide (Zarontin)

30
Q

What’s a main side effect of Zarontin?

A

Oral gingival hyperplasia - swelling of tongue

31
Q

What benzodiazepines are used seizures?

A
  • clonazepam (Clonipin) - all types of seizures
  • diazepam (Valium) - local anesthetic induced seizures reliever
32
Q

What is the drug of choice for local anesthetic induced seizures in dental office and the drug of choice for status epilepticus?

A

diazepam (Valium)

33
Q

What drug is used for partial seizures and tonic-clonic, chronic pain and shingles and is NOT metabolized?

A

gabapentin (Neurontin)

34
Q

What drug weakly inhibits serotonin receptors and is used as a part of treatment for bipolar disorder, it also inhibits the release of glutamate?

A

lamotrigine (Lamictal)

35
Q

Anticonvulsants

  1. Drugs are used for ________ treatment.
  2. Initial therapy is to _____ increase dose, because all these drugs can cause ______.
  3. No drug affords control in _________.
  4. Usually patients receive ______ drug therapy.
  5. Multiple drug ___________.
A
  1. symptomatic
  2. slowly, sedation
  3. all patients
  4. multiple
  5. interactions
36
Q

What drugs are used for tonic-clonic (grand mal)?

A
  • valproic acid
  • phenytoin
  • phenobarbital
  • primidone
  • gabapentin
  • lamotrigine
37
Q

What drugs are used for Absence seizures?

A
  • ethosuximide
  • valproic acid
38
Q

What drugs are used for partial seizures?

A
  • carbamazepine
  • phenytoin
  • phenobarbital
  • primidone
  • gabapentin
  • lamotrigine
39
Q

What is sometimes used before phenytoin to avoid gingival hyperplasia?

A

carbamazepine

40
Q

What do you ask a patient that has had seizures?

A
  1. Most recent seizure
  2. Any known triggers
41
Q

What are the classic P450 inducers?

A
  • phenobarbital
  • phenytoin (Dilantin)
42
Q

Which anticonvulsants pose a liver toxicity concern?

A
  • carbamazepine (Tegretol)
  • valproic acid (Depakene)
43
Q

What things in the dental office can trigger a seizure?

A
  • Flicking light into patients eyes
  • Moving light around
  • Startling patient
  • Local anesthetic overdose will!

Pharmacology (25 decks)

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