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
