Ch.16 Anticonvulsants Exam2

Status Epilepticus

Continuous tonic-clonic seizure lasting longer than 30 minutes or recur before the end of the postictal period of the previous seizure.

vitamin D and Folate

Phenytoin has an adverse reaction, vitamin deficiency: vitamin_____ and _______

Somnolence, dizziness, weight gain, dry mouth, abnormal thinking

Pregabalin (Lyrica) side effects

-Brain damage -Infections -Trauma -Tumors -High fever -Degeneration of brain tissue -Genetic -Majority are idiopathic

Seizures can be brought on by what?

Dizziness, tremor, GI problems, fatigue, edema, but does not have significant drug interactions

Side effects of Gabapentin(Neurontin)

True

T/F Patient taking drugs for epilepsy are usually taken for life.

False: It can affect bleeding

T/F Valproate does not affect bleeding

True

T/F: Lamotrigine is preferred over ethosuximide in children with absence seizures because it is better tolerated.

-anorexia -nausea -vomiting

The GI adverse effects to antiepileptic agents are?

1. Partial (focal) 2. Generalized seizures

The International Classification of Epileptic Seizures divides seizures into two major groups what are they?

unknown

The cause of phenytoin gingival enlargement is ____________.

-Begin as painless enlargement of gingival margin -Interproximal papillae become involved -Eventually cover occlusal surfaces -Excellent OH reduces this

The clinical symptoms that occur with gingival enargment may appear as little as a few weeks or as much as a few years after intital drug therapy. What are the symptoms?

Ethosuximide (Zarontin)

The drug of choice for treatment of absence seizures is what?

Tonic-clonic

The generalized ________ ________ seizures include longer periods of loss of consciousness and major motor activity of the large muscles of the body.

Hepatotoxicity

The idiosyncratic toxicity of valproate is ?

idiopathic

The majority of epileptic patients have ____________ epilepsy, this term is used when the cause is unknown.

-Choose another antiepileptic drug -Discontinue phenytoin -Improve oral hygiene -Consider gingivectomy -Consider other drugs

The management of phenytoin-induced gingval enlargement has possible alternatives what are they?

valproate (Depkote)

The mechanism of action may be its effect on sodium and potassium channels, a reduction in aspartate levels, or an increase in the inhibitory neurotransmitter γ-aminobutyric acid (GABA)

absorption; renel

The mechanisms of drug interactions include altering _________ or _______ excretion and inducing or inhibiting metabolism

1. Tonic-clonic 2. Absence

The most common generalized seizures are (1) ________________ and (2) ___________.

hepatic microsomal enzymes.

The most important drug interaction of the antiepileptics invloves stimulation of the ___________ _________ ___________.

Drug Therapy of Patients with Epilepsy

Used singaley or in combination

phenytoin (Dilantin)

Used to treat both tonic-clonic and partial seizures with complex symptoms

-migraine prophylaxis -bipolar diease

What are other uses for valproate (Depakote)

1. simple partial attack 2. complex partial attack

What are the 2 subgroups for partial seizures

Depressed CNS function: -Tolerance often develops to these effects -Behavior alterations can include hyperactivity and sedation -CNS depression additive w/other CNS depressants (like opioids)

What are the CNS Side Effects?

drowsiness, hyperactivity, headache, and hiccups

What are the CNS adverse effects of Ethosuximide (Zarontin)?

anorexia, gastric upset, cramps, pain, diarrhea, and nausea and vomiting

What are the GI adverse effects of Ethosuximide (Zarontin)?

-Narrow TI (therapeutic index) -Drugs are removed by liver microsomal enzymes -The metabolism of anticonvulsants can saturate the liver microsomal enzymes

What are the General Adverse Reactions to Anticonvulsant Agents

Dermatologic side effect-rash, Stevens-Johnson syndrome, exfoliative dermatitis, and erythema multiforme -Drug-induced systemic lupus erythematosus and hematologic effects have been reported

What are the Idiosyncratic reactions to antiepileptic agents ?

-Dizziness, ataxia -Somnolence -Headache, diplopia, -Nausea -Vomiting -Rash -But... more tolerable than carbamazepine and topiramate

What are the adverse reactions of Lamotrigine

-CNS depression -dizziness -vertigo -sleepiness -lack of coordination -confusion -headache -double vision -nausea/vomiting and -diarrhea or constipation

What are the adverse reactions of carbamazepine ?

Lost consciousness No aura No postictal state Little movement Begins early childhood/ends middle age No loss of body tone Patient unaware

What are the characteristics of absence seizures?

Lost consciousness (longer) Aura possible Postictal state Major large muscle movement

What are the characteristics of tonic-clonic seizures?

parenteral benzodiazepines, such as diazepam (Valium)

What are the drug of choice for Status Epilepticus seizures

dry mouth, glossitis, stomatitis

What are the oral effects of carbamazepine ?

Drowsiness Ataxia Behavioral disturbances Adverse neurologic

What are the side effects associated with Clonazepam ?

-Trigeminal neuralgia -Bipolar depression -Seizures

What does carbamazepine (Tegretol) treat?

-carbamazepine (Tegretol) -valproates -phenobarbital -phenytoin (Dilantin) -Miscellaneous agents ethosuximide (Zarontin) benzodiazepines gabapentin (Neurontin) PAGE 197

What drugs are used to tx Epilepsy ?

Seizure begins by body becoming rigid Patient falls to floor Jerking of the face, limbs, and body Patient becomes limp and comatose Consciousness gradually returns with postictal confusion, headache, and drowsiness

What happens during a generalized tonic-clonic seizure?

Variable efficacy

from complete control to reduction of frequency

Partial (focal) seizures

involves only a portion of brain and the area involved determines symptoms

Clonazepam

is used as an adjunct to treat absence seizures not responsive to ethosuximide

MOA

prevent spread of abnormal electric discharges in brain

increase

with phenytoin: results in decreased valproate action and ____________ phenytoin action

decrease

Carbamazepine can _____________ the effect of doxycycline, warfarin, theophylline, and oral contraceptives

liver

Carbamazepine can induce __________ microsomal enzymes

blocking sodium channels

Carbamazepine's mechanism of action involves ________ _____ __________, which then stops the propagation of nerve impules.

Ethosuximide (Zarontin)

Mechanism of action: may involve inhibiting the T-type calcium channels

salivation coated tongue dry mouth sore gums

Oral effects from clonazepam include increased _________, _________ ________, __________ mouth, and sore _______.

simple ; complex

Partial seizures are divided into _________ and __________ attacks.

Aura

Patient may experience _________ before onset of seizure

63%

Pediatric dose contains ________ sugar (carbamazepine)

Valproate

(CNS effects) sedation and drowsiness are adverse reactions of what drug?

Valproate

(GI effects) indigestion, nausea, and vomiting are adverse reactions of what drug?

numbness; nausea light; odor; or sound

Aura may be characterized by ____________, _______, or unusual sensitivity to _________, _________, or __________.

Gingival enlargement **

Another adverse reaction to phenytoin, _________ ______________, occurs in approximately 50% of all chronic users.

CNS

Anti-seizure drugs are _______ depressants

Aura

A brief period of heightend sensory activity

Epilepsy

A group of disorders involving a chronic recurring attack of involuntary behaviors or changes in neurologic function

yes

Are you additive to bleeding risk when using carbamazepine ?

withdrawl

Abrupt _________ of any antiepileptic medication can precipitate seizures.

Gabapentin(Neurontin)

Adjunct against partial and generalized seizures

Mental confusion, nystagmus, ataxia, slurred speech, blurred vision, diplopia, amblyopia, dizziness, and insomnia

Adverse Reactions of Phenytoin (CNS effects)

Skin reactions range from rash to exfoliative dermatitis, lupus erythematosus, or Stevens-Johnson syndrome Some patients have hypertrichosis on the trunk and face

Adverse Reactions of Phenytoin (Dermatologic effects)

Reactions are not uncommon

Adverse Reactions of Phenytoin (GI EFFECTS)

Status epilepticus

Dangerous due to potential for hypoxia and Immediate medical attention required

epilepsy

Dental Treatment of the Patient with Epilepsy: Do not treat without reviewing management of patient with __________, including procedures for handling patient experiencing tonic-clonic seizures

CNS

Depressed ____________ function is a common side effect of the antiepileptic agents.

Yes (teratogenicity effect), fetal hydantoin syndrome

Does usage of valporate increase birth defects and if so what kind?

themselves; each other; other drugs

Drug interactions can occur with antiepileptics. They may interact with ___________, with ______ ________, or ___________ _______.

Narrow terapeutic indexes.

Drug interactions with the older antiepileptics, such as phenytoin, carbamazepine, and valproate, are more significant than those with other drug groups bc of these agents ____________ ________ _______.

phenobarbital

Drug interation: Valproate inhibits metabolism of _____________, producing excessive sedation

seizure

Each epilepsy episode is termed a ___________.

generalized

Epilepsy can be localized or _____________.

Cause, symptoms, duration, aura

Epilepsy is classified based on __________, ___________, ____________, _____________.

-Effects can be minimized by taking the drug with food -Prescribe NSAIDS & opioids cautiously

How can you minimize the side effects of the GI when taking antiepileptic drugs?

Toxic levels then can result

If Enzymes can not clear the drug quickly enough what can occur ?

Impairment of learning and cognitive

Impairment of what may occur in some patients

Yes, in both types

Is consciousness lost in generalized seizures?

gingival enlargement and swelling of tongue

What is an oral side effect when using Ethosuximide (Zarontin)?

Miscellaneous

What is the 3rd group of epilepsy?

-Abnormal growth and development of both fetus and developing infant -Associated with alteration in growth

What is the Teratogenicity/growth side effects from antiepileptic agents?

bleeding time may be prolonged

What is the bleeding side effect to using valproate ?

ethosuximide, valproate

What is the drug of choice for absence seizures?

: valproate, lamotrigine,levetiracetam

What is the drug of choice for tonic-clonic seizures ?

to prevent epileptic seizures without causing excessive drowsiness

What is the goal for tx of patient with epilepsy ?

-moving the patient to the floor if possible -tilting the patient's head to one side to prevent aspiration -removing objects from the patient's mouth before the seizure to prevent fractured teeth

What is the managment for dental tx of the patient with epilepsy ?

-Bipolar disorder -improve depression in some patients with epilepsy

What is the other use for Lamotrigine ?

Complex partial attack

When consciousness is impaired, lasts minutes, sometimes aura occurs. (AKA psychomotor or temporal lobe seizure)

simple partial attack

When consciousness is not impaired, the attack is called_____________.

carbamazepine

Which drug is an anticonvulsant, anticholinergic, antidepressant, sedative, and muscle relaxant and Blocks sodium channels, which blocks the propagation of nerve impulses

Because it has fewer adverse cognitive effects

Why is Lamotrigine more tolerable than carbamazepine and topiramate?

Fetal hydantoin syndrome (pregnancy risk)

_______ _________ __________ is the term given to the congential abnormality associated with maternal ingestion of phenytoin.

Absence

___________ seizures usually begin during childhood and disappear in middle age. The patient is usually unaware that these seizures are occurring, and body tone is not lost.

Lamotrigine

______________ appears to be as effective as carbamazepine and better tolerated in elderly patients newly diagnosed with partial or generalized seizures.

valproate (Depkote)

______________ are a group of anticonvulsants that are not structurally related to any other agents

Lamotrigine

_______________ belongs to the class of a sodium channel blocking antiepileptic drugs.

Postictal state

altered state of consciousness after a seizure