Drugs for the treatment of seizure Disorders
which drug is No longer the drug of choice for generalized tonic-clonic seizures due to adverse effects and drug interactions
Phenytoin (dilantin)
which drug is for the Treatment of neurologic pain
Phenytoin (dilantin)
which drug is for the Treatment of status epilepticus
Phenytoin (dilantin)
Which are anti-epileptic agents?
Phenytoin (dilantin) Carbamazepine (tegretol) Levetiracetam (keppra) Lamotrigine (lamictal) Valproate
What is the mechanism of action for Lamotrigine (lamictal)
Sodium channel blocking agent
What is the adverse reaction to phenobarbital?
Stomatitis
What are the drug interactions of Antiepileptic agents
-stimulation of hepatic microsomal enzymes results in a reduction in the blood level of the affected drugs (those metabolized by the liver enzymes) -drug interactions are more common with the older antiepileptic drug
what are the different types of generalized seizures?
-tonic clonic -Absence -Myoclonic -akinetic
What is the alternative drug for Tonic-clonic (generalized seizures)
Topiramate (topamax)
what is the alternative drug for Myoclonic seizure (generalized seizure)
Topiramate (topamax), clonazepam (klonapin)
What is the use of ethosuximide (zarontin)?
Treatment of absence seizures
What is the use of phenobarbital?
Treatment of generalized tonic-clonic and partial seizures
What is the use of Topiramate (topamax)?
Treatment of partial/primary generalized tonic-clonic seizures; migraine prophylaxis
T or F Often painless enlargement of the gingival margin where the gingiva is pink and does not bleed easily unless there are other factors present
True
T/F caries risk due to high sugar content in the chewable form of carbamazepine (Tegretol)
True
Which drug of choice in patients with generalized tonic-clonic seizures: Although not approved by the FDA of this indication is used?
VALPROATE valproic acid valproate sodium Divalproex sodium (depakote)
Which drug is approved for migraine prophylaxis and bipolar disorder?
Valproate
Which drug is used for myoclonic and atonic seizures?
Valproate
which drug Increases the levels of Lamotrigine (lamictal)
Valproate (depakote)
what is the drugs of choice for Tonic-clonic (generalized seizures)
Valproate (depakote), lamotrigine (lamictal), levetiracetam (keppra)
What are the names of the Miscellaneous anticonvulsant agents?
ethosuximide(Zarontin), perampanel (fycompa), Pregablin(lyrica), Gabapentin (neurotin), phenobarbital, Lacosamide (vimpat), Topiramate (topamax).
Patients may experience tooth movement. Edentulous areas are involved? first statement is true, second statement is false both statements are true first statement is false, second statement is true Both statements are false
first statement is true, second statement is false
What happens to the tissue when it enlarges?
it becomes more fibrotic or dense
what is the alternative drug for absence seizure (generalized seizure)
lamotrigine (lamactal), clonazepam (klonopin), levetiracetam (keppra)
What is the drug choice for Complex (partial seizure)?
lamotrigine (lamictal), oxcarbazepine
what is the drugs of choice for secondarily generalized (partial Seizure)?
lamotrigine (lamictal), oxcarbazepine
What is the alternative drugs for secondarily generalized (partial Seizure)?
phenytoin (dilantin), gabapentin (neurontin)
What is fetal hydantoin syndrome?
the congenital abnormality associated with maternal ingestion of the drug
T/F antiepileptic agents has variable efficacy from complete control of all seizures to reduction in frequency of seizures.
true
What happens when a patient feels Gastrointestinal distress from Antiepileptic agents?
use NSAIDS or OPIOIDS with caution due to additive GI effects
what is the drug of choice for Myoclonic seizure (generalized seizure)?
valproate (depakote), lamotrigine (lamictal), clonazepam (klonopin), Levetiracetam (Keppra)
which drug reduces the levels of Lamotrigine (lamictal)
Carbamazepine (tegretol)
Epilepsy
Chronic stereotyped recurrent attack of involuntary behavior or experience or changes in neurologic function, electrical activity in the brain that can be recorded via an electroencephalogram (EEG)
What is the alternative drugs for Complex (partial Seizure)?
Clobazam (ofi)
Which drug is for treatment of absence seizures?
Levetiracetam (keppra)
Which monotherapy drug is for partial-onset and generalized tonic-clonic seizures?
Levetiracetam (keppra)
Which drug is the Treatment of myoclonic seizures?
Levetiracetam (keppra) and Valproate
What is the use of perampanel?
Monotherapy and adjunctive treatment for partial onset seizures in patients ≥ 12 years of age
What is the use of Lacosamide (vimpat)?
Monotherapy or adjunctive therapy for adults with partial onset seizures
What is the use of Clobazam (onfi)?
Orally as adjunctive treatment for seizures associated with Lennox-Gestaut syndrome
What are the drug interactions with Valproate
-Additive CNS depressant effect -Inhibits the metabolism of phenobarbital which leads to excessive sedation -Drug interactions with phenytoin (Dilantin) leads to decreased valproate (Depakote)action and increased phenytoin (Dilantin)action -Bleeding
Dental management with Valproate
-Additive bleeding is a risk: use caution with drugs that can alter coagulation • Signs of petechiae, bruising, hematoma -Hypersalivation
What is the patient management for Phenytoin (dilantin)?
-Avoid other drugs that are gastric irritants -Monitor for gingival enlargement -Provide extensive oral hygiene instruction -Schedule more frequent recall appointments
what are the general adverse reactions of Antiepileptic agents?
-CNS depression -GI distress -Teratogenicity/growth -withdrawal
What is the dental management for Carbamazepine (tegretol)?
-Check for dry mouth, glossitis, stomatitis -Additive bleeding is a risk: use caution with drugs that can alter coagulation -Consider drug interactions -Perform appropriate lab tests if this drug is being prescribed for trigeminal neuralgia -Stress oral hygiene, especially with chewables
what are the three types of seizures?
-Generalized seizure -Partial -miscellaneous
what are the different types of partial seizures?
-simple -complex -secondarily generalized -temporal lobe
What are the different types of miscellaneous seizures?
-status epilepticus -unilateral seizure -unclassified
what are the different types of miscellaneous seizures?
-status epilepticus -unilateral seizures -unclassified seizures
Which drug is for the Treatment of both tonic-clonic and partial seizures with complex symptomatology
Phenytoin (dilantin)
Where do you see gingival enlargement?
-Interproximal papillae involvement is present that eventually coalesce to cover occlusal surfaces of the teeth -More common in the anterior than the posterior areas -More common on the buccal surfaces than the lingual surfaces -Maxillary anterior facial > mandibular anterior facial > maxillary posterior buccal > mandibular posterior buccal
What is the use of clonazepam (klonopin)?
-Orally in the treatment of absence seizures not responsive to ethosuximide (Zarontin) -Treatment of mental illnesses
What are the names of Antiepileptic agents: VALPROATE?
-Valproic acid -valproate sodium -Divalproex sodium (depakote)
What is an adverse reaction for Phenytoin (dilantin)?
-Vitamin D and folate deficiency (evidenced by oral mucosal changes such as ulcerations and glossitis), osteomalacia (soft bones) may result -Fetal hydantoin syndrome is the term given to the congenital abnormality associated with maternal ingestion of the drug
Which are benzodiazepines are anticonvulsant agents?
-clonazepam (klonopin) -Clobazam (onfi) -diazepam (valium), lorazepam (ativan), midazolam (versed)
What is Complex (partial seizure)?
-consciousness is impaired for several minutes -aura possible -consciousness slow to return
What is status epilepticus (miscellaneous)?
-continuous tonic-clonic seizures that longer than 30 minutes or recur before the end of the postictal period of the previous seizure -emergency situation that can produce hypoxia
What happens when a patient feels CNS depression from Antiepileptic agents?
-exacerbation of different seizure type -additive with other CNS depressants such as opioids
what is tonic clonic?
-loss of consciousness for longer periods -major movement of large muscle groups -patient may bite the cheeks or tongue - Prodromal period, but not a true aura -Slow recovery with confusion, headache, drowsiness.
What is an absence seizure (generalized seizure)?
-loss of consciousness is brief (seconds) -little movement -begin in childhood and disappear in middle age -no aura; no postictal state -quick.
What happens when a patient feels idiosyncratic reactions from Antiepileptic agents?
-rash -stevens-johnson syndrome -exfoliative dermatitis -erythema multiforme -Drug-induced lupus erythematosus -Hematologic effects
What happens when a patient feels Withdrawal from Antiepileptic agents?
-should be gradual
what are the different types of partial (focal) seizures?
-simple -complex -secondarily generalized -temporal lobe
What is the use of pregabalin (lyrica)?
Adjunctive therapy for partial seizures in adults; approved for the treatment of neuropathic pain and fibromyalgia
What is the use of Gabapentin (Neurontin)?
Adjunctive treatment of partial seizures with and without secondary generalizations; treatment of bipolar disorder; treatment of neuropathic pain
Which drug is for the Treatment of bipolar depression?
Carbamazepine (tegretol)
what is the mechanism of action for Carbamazepine (tegretol)?
Blocks sodium channels, inhibits high-frequency repetitive firing in neurons, decreases synaptic transmission
What is the mechanism of action of phenytoin (dilantin)?
Blocks the sustained high-frequency repetitive firing of action potentials
What is the alternative drug for Simple (partial seizure)?
Brivaracetam (Briviact)
What does carbamazepine induce?
Can induce liver microsomal enzymes
Which drug is Structurally related to tricyclic antidepressants?
Carbamazepine (tegretol)
Which drug is for Treatment of simple partial seizures?
Carbamazepine (tegretol)
Which drug is for Treatment of trigeminal neuralgia?
Carbamazepine (tegretol)
What is the adverse reaction to pregabalin (Lyrica)?
Dry mouth
What is the adverse reactions of Carbamazepine (tegretol)?
Dry mouth, glossitis, stomatitis, petechiae (sign of hematologic effects), infection (sign of hematologic effects)
Which drug has no drug interaction because it does not inhibit CYP-450 enzymes?
Levetiracetam (keppra)
Which drug is for Treatment of complex partial seizures?
Levetiracetam (keppra)
Which drug is for the Treatment of children with Lennox-Gestaut syndrome?
Levetiracetam (keppra)
Which drugs increase the effects of carbamazepine?
Erythromycin and Calcium channel blockers
what is the drug of choice for absence seizure (generalized seizure)?
Ethosuximide (zarontin), valproate (depakote)
T/F drug interactions are not more common with the older antiepileptic agents?
False They are more common
T/F Older patients are more at risk for gingival enlargement?
False Younger patients are
T/F Short term toxicity is important to consider.
False. It is LONG term toxicity because patients take anti-epileptic agents for life.
Which is a MAJOR adverse reaction from phenytoin (dilantin)?
Gingival enlargement
What is the adverse reaction to ethosuxmide?
Gingival enlargement and swelling of the tongue
what is the cause of epilepsy?
Idiopathic, the cause is unknown
What is an adverse reaction to clonazepam (klonopin)?
Increased salivation, coated tongue, dry mouth, sore gums
Which drug can improve depression in patients with epilepsy?
Lamotrigine (lamictal)
Which drug is the Treatment of children with absence seizures?
Lamotrigine (lamictal)
Which drug is the Treatment of elderly patients, newly diagnosed with partial or generalized seizures?
Lamotrigine (lamictal)
Which drug is the Treatment of generalized seizures of the Lennox-Gestaut syndrome in children?
Lamotrigine (lamictal)
Which drug is the Treatment of primary generalized tonic-clonic seizures?
Lamotrigine (lamictal)
which drug is More tolerated than ethosuximide(Zarontin), carbamazepine (Tegretol), topiramate (Topamax)?
Lamotrigine (lamictal)
which drug is an Adjunctive therapy for partial seizures
Lamotrigine (lamictal)
which drug is the Treatment of bipolar disorder maintenance therapy?
Lamotrigine (lamictal)
what is the drug of choice for Simple (partial seizure)?
carbamazepine (tegretol)
what is epilepsy classified based on?
causes, symptoms, duration, precipitating factors, postictal state, and aura
what is simple (Partial seizures)?
consciousness is not impaired
what is the drugs of choice for status epilepticus (miscellaneous Seizure)?
diazepam (valium), phenytoin (dilantin), phenobarbital (luminal)
Which drugs does Carbamazepine (tegretol) decreases the effect of
doxycycline, warfarin (Coumadin), theophylline, and oral contraceptives.