Chapter 16: Drugs for the Treatment of Seizure Disorders
bleeding, increase in birth defects if taken during pregnancy, hepatotoxicity & hepatic failure, indigestion, nausea, hypersalivation
Side effects of valproate
aura
a brief period of heightened sensory activity that can occur before the onset of a seizure
True
True of false: reports have shown that growth and development of a fetus can be affected when antiepileptic drugs are taken during pregnancy
False
True or False: Gradual withdrawal of antiepileptic drugs is not necessary
Gingival enlargement or hyperplasia mostly around anterior teeth
What are the oral complications associated with phenytoin?
gingival enlargement and swelling of the tongue
What are the oral side effects of ethosuximide (Zarontin)
depressed CNS function; impaired cognitive abilities; hyperactivity or sedation
general adverse reactions of antiepileptic agents
Steven Johnson syndrome, rash, dermatitis, erythema mulitforme, systemic lupus erythematous
idiosyncratic reactions
ataxia
lack of muscle coordination
amblyopia
lazy eye
Phenobarbital (Luminal)
newer anticonvulsant medication; side effects include sedation or excitement and hyperactivity in children
complex partial attack
occurs when consciousness is impaired during a partial seizure
simple partial attack
occurs when consciousness is not impaired during a partial seizure
Vitamin D
osteomalacia can result from a deficiency of this vitamin as a result of a drug interaction with phenytoin
partial seizure
seizure involving only limited areas of the brain with localized symptoms
Generalized seizures
seizures that involve the entire brain; two groups (tonic-clonic & absence)
tonic-clonic seizure
stiffening-jerking; a major motor seizure involving all muscle groups for long periods of time; previously termed grand mal (big bad) seizure
status elipticus
type of seizure: lasting **>30 mins; emergency situation requiring rapid therapy; treated with benzodiazepines & diazepam (Valium)
CNS depression, GI problems, and fatal blood dyscrasias (aplatic anemia, agranulocytosis), rash, skin pigmentation,
Most common side effects of carbamazepine
xerostomia, glossitis, stomatitis
Oral side effects of carbamazepine
increased salivation, coated tongue, dry mouth, sore gums
Oral side effects of clonazepam
Valproate (Depakote)
Anticonvulsant used in the treatment of generalized tonic-clonic seizures; also commonly used to treat migraines and bipolar disorder
Absence seizures (petit mal)
10 to 30 sec loss of consciousness with eyelid fluttering, abruptly stop activity; typically seen in children
Lamotrigine (Lamictal)
Antiepileptic that inactivates sodium channels used to treat partial and tonic-clonic seizures; side effects include dizziness, headache, nausea, rash, and rarely Stevens-Johnson syndrome;
Phenytoin (Dilantin)
Anticonvulsant drug that works by blocking the repetitive firing of action potentials; used to treat both tonic-clonic and partial seizures; associated with gingival enlargement; used to be the number one drug of choice to treat epilepsy
Gabapentin (Neurontin)
Anticonvulsant that is used to treat neuropathic pain and fibromyalgia
Clobazam (Onfi)
Anticonvulsant used as an adjunctive to treat seizures in patients with Lennox-Gestaut syndrome; can cause amnesia, ataxia, somnolence, lethargy, drooling, and constipation
Clonazepam (Klonopin)
Benzodiazepine that is used to treat absence seizures in the event that ethosuximide does not work
mental confusion, slurred speech, blurred vision, diplopia, amblyopia, insomnia
CNS effects of phenytoin
anorexia, nausea, vomiting
GI effects of antiepileptic agents
Fetal hydantoin syndrome
What term is given to the congenital abnormality associated with maternal ingestion of phenytoin?
Partial (focal) seizures
affect single area of brain most commonly originate in temporal lobe often preceded by seizure aura can generalize 2 types: simple, complex
Carbamazepine (Tegretol)
antiepileptic drug used in the treatment of trigeminal neuralgia; simple partial seizures and bipolar disorder; blocks sodium channels thus stopping the propagation of nerve impulses
Levetiracetam (Keppra)
antiepileptic drug used to treat partial and generalized tonic-clonic, and absence seizures; side effects include dizziness; irritability; hallucinations, behavior changes, and psychosis
Oxcarbazepine (Trileptal)
antiepileptic drug used to treat partial seizures; side effects include dizziness, diplopia, somnolence; nausea; rarely Stevens-Johnson syndrome
Epilepsy
chronic brain disorder characterized by recurrent seizure activity
rash, exfoliative dermatitis, lupus erythematosus, Stevens-Johnson syndrome, hirsutism (excessive hairiness)
dermatological effects of phenytoin
decreases the effect of doxycycline, warfarin, theophylline, and oral contraceptives; increases effect when taking erythomycin & calcium channel blockers
drug interactions of carbamazepine
increased production of hepatic microsomal enzymes which lower the amount of the drug in the blood; older antiepileptic drugs have more interactions than newer drugs
drug interactions with antiepileptic agents
Ethosuximide
drug of choice for the treatment of absence seizures
valproate, lamotrigine, and levetiracetam
drugs of choice in treating tonic-clonic seizures