pharmacology: ch 14 drugs for the treatment of seizure disorders
•Oldest epilepsy medicine still in use •Used to treat most forms of seizures and is known for its effectiveness and low cost •Side effects can be sleepiness or changes in behavior a. phenobarbital b. felbamate c. phenytoin d. gabapentin
a
•Tonic-clonic •Myoclonic •Akinetic •Absence a. generalized seizures b. partial seizures c. miscellaneous
a
•valproic acid •valproate sodium •divalproex sodium (Depakote) a. valproates b. lamotrigine c. carbamazepine d. oxcarbazepine
a
What is the approximate prevalence of seizure disorders in the general population? a. 5% of population b. 1% of population c. 10% of population d. less than 0.01% of population
b
What is the drug of choice for treatment of absence seizures? a. valproic acid b. Ethosuximide c. phenobarbital d. gabapentin e. phenytoin
b
Which antiseizure medication is associated with a syndrome causing congenital abnormality associated with maternal ingestion? a. valproate b. phenytoin c. gabapentin d. Carbamazepine e. phenobarbital
b
Which is the primary advantage of oxcarbazepine compared to carbamazepine? a. induction of own metabolism b. Less induction of hepatic enzymes c. long half-life d. greater induction of hepatic enzymes e. short half-life
b
what is the management to a tonic-clonic seizure? a. no concern for management due to little movement and need for restraint b. lower dental chair and protect patient from personal damage, by clearing area. Make no attempts to restrain the person. After convulsion assess and monitor airway, administer oxygen, monitor and record vital signs c. emergency situation and rapid therapy is required especially if the seizure has produced hypoxia
b
which of the following is not a dermatologic side effect from anticonvulsants that is due to an idiosyncractic reaction? a. rash b. decreased melanin c. steven-johnsons syndrome d. exfoliative dermatitis e. erythema multiforme
b
•Loss of consciousness, long period of time or awareness •Major movement of large muscle groups •Tonic rigidity followed by clonic jerking of face, limbs and body...then becoming limp/comatose •Aura...numbness, nausea, sensitivity to light, odor/sound •Slow recovery, with confusion, headache, drowsiness a. absence seizure b. tonic-clonic c. petit mal seizure d. status epilepticus
b
•Well tolerated by elderly patients, newly diagnosed with partial/generalized seizures •Preferred over ethosuximide in children with absence seizures because better tolerated •Off Label! •Can be used for bipolar disorder maintenance therapy •and improve depression in patients with epilepsy a. valproates b. lamotrigine c. carbamazepine d. oxcarbazepine
b
_______ is used for the non-seizure use of being FDA approved for neuropathic pain and fibromyalgia a. carbamazepine and phenytoin b. valproic acid c. gabapentin d. topiramate
c
drug of choice for treatment of absence seizures a. phenytoin b. lamotrigine c. ethosuximide (Zarontin) d. carbamazepine (tegretol)
c
exact mechanism of _____ is unknown and is used as monotherapy for partial-onset and generalized tonic-clonic seizures as well as being effective in children with absence seizures a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine
c
treatment to status epilepticus? a. no concern for management due to little movement and need for restraint b. lower dental chair and protect patient from personal damage, by clearing area. Make no attempts to restrain the person. After convulsion assess and monitor airway, administer oxygen, monitor and record vital signs c. emergency situation and rapid therapy is required especially if the seizure has produced hypoxia
c
what is are the choice of drugs to control a status eplilecpticus? a. Ethosuximide/Valproate b. Valproate, lamotrigine, and levetiracetam c. parenteral benzodiazepines d. lamotrigine, carbamazepine, levetiracetam and oxcarbazepine
c
what is the cause of the majority of epileptic patients? a. infection b. trauma c. idiopathic d. neoplasms
c
what is the main concern of absence seizures in the dental office? a. lots of movements calls for restraints b. all the hazardous things around one in the dental office c. adverse reactions from using drugs to treat the disease (ethosuximide/valproate)
c
when phenytoin is used, it is often in conjunction with a. aspirin b. anticholinergics c. phenobarbital d. sedative
c
•Drug of choice for the treatment of absence seizures •GI adverse effects: Anorexia, gastric upset, cramps, pain, diarrhea, and nausea and vomiting •CNS adverse effects: Drowsiness, hyperactivity, headache, and hiccups •Blood dyscrasias a. phenytoin b. lamotrigine c. ethosuximide (Zarontin) d. carbamazepine (tegretol)
c
•Status epilepticus •Unilateral seizures •Unclassified seizures a. generalized seizures b. partial seizures c. miscellaneous
c
locks sodium channels, which blocks the propagation of nerve impulses...therefore, slows down electrical activity in the brain. it is also structurally related to tricyclic antidepressants a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine e. carbamazepine (tegretol)
e
which of the following are the main two concerns of drug interactions with an anti-epileptic? a. interaction with other anti-epileptic drugs or other drugs b. induce/inhibit hepatic microsomal enzymes c. reducing blood levels of other drugs d. stimulating hepatic microsomal enzymes e. C and D
e
which of the following is not one of the GI side effects associated with anticonvulsants? a. GI distress b. anorexia c. nausea d. vomiting e. increased intestinal motility
e
which of the following would be used in trigeminal neuralgia? a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine e. carbamazepine (tegretol)
e
Which would be appropriate dental management techniques for patients taking antiepileptic agents? a. Prescribe antianxiety medication to avoid precipitation of seizure due to stress. b. Take a thorough medical history, including medications and frequency of seizures. c. Place a bite block in the mouth of a patient experiencing seizure. d. all of the above
b
______ is used for the non-seizure use for migraine headache prophylaxis a. carbamazepine and phenytoin b. valproic acid c. gabapentin d. topiramate
b
anti-convulsant drugs are only taken a few weeks following the first seizure and never taken for life a. true b. false- they are taken for life
b
anticonvulsants cause a. cholinergic effects/ atropine like actions b. anticholinergic effects/ atropine like actions
b
anticonvulsants cause a. hypersalivation b. xerostomia
b
anticonvulsants do NOT cause teratogenicity/ growth or fetal anomalies and alteration in growth a. true b. false
b
anticonvulsants have a a. wide therapeutic index b. narrow therapeutic index
b
are there are clinically significant drug interactions to have been reported with levetiracetam (keppra)? a. yes b. no
b
carbamazepine _____ lamotrigine levels a. increases b. reduces
b
carbamazepine can _____ liver microsomal enzymes a. decrease b. induce
b
carbamazepine does cause gingival hyperplasia a. true b. false- it does not
b
carbamazepine_______ the effect of doxycycline, warfarin, theophylline, and oral contraceptives a. increases b. decreases
b
dental team should observe the oral cavity in a patient taking carbamazepine with which side effects in mind? a. gingival hyperplasia b. petechiae and infection c. ulcers and increased bleeding d. infection and hypersalivation
b
involve an electrical discharge in only **part of the brain a. absence seizure b. partial epilepsies c. petit mal seizure d. status epilepticus
b
newer anticonvulsant •FDA indications include adjunct or monotherapy for partial seizures •Bone marrow depression - agranulocytosis, aplastic anemia •Severe hepatitis a. phenobarbital b. felbamate c. phenytoin d. clonazepine
b
what are the choice of drugs for a tonic-clonic seizure? a. Ethosuximide/Valproate b. Valproate, lamotrigine, and levetiracetam c. parenteral benzodiazepines d. lamotrigine, carbamazepine, levetiracetam and oxcarbazepine
b
what is the goal of drug therapy for patients with epilepsy? a. to never have another seizure again b. control seizures by slowing down abnormal electrical activity in the brain c. control seizures by re-wiring the electrical activity in the brain
b
what is the main adverse reaction to valproate? a. nausea and vomiting b. hypersalivation c. sedation/drowsiness d. hepatotoxicity
b
•GI effects •Nausea, vomiting, gastric distress •Abdominal pain •Diarrhea, constipation •Anorexia •Hematologic effect •Fatal blood dyscrasias a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine e. carbamazepine (tegretol)
e
The drug group of choice for the treatment of status epilepticus seizures is parenteral a. Phenobarbital (Primidone) b. Valproate (Depakote) c. Carbamazepine (Tegretol) d. Phenytoin (Dilantin) e. Ethosuximide (Zarontin) f. Diazepam (Valium)
f
FDA approved for migraine prophylaxis and bipolar disorder a. valproate b. lamotrigine c. carbamazepine d. oxcarbazepine
a
Increase in the inhibitory neurotransmitter γ-aminobutyric acid (GABA)...so it enhances GABA levels which are inhibitory neurotransmitters that slow down electrical activity in the brain a. valproate b. lamotrigine c. carbamazepine d. oxcarbazepine
a
Medications used for the management of seizure disorders include all except: a. Amantadine (Symmetrel) b. Clonazepam (Klonopin) c. Valproates (Depakote) d. Phenytoin (Dilantin) e. Carbamazepine (Tegretol)
a
Partial epilepsies are broken down further, depending on whether a person's awareness or consciousness is affected. a. true b. false
a
Range from: •Barely noticeable staring or a lack of attention -to- •A full tonic-clonic seizure with unconsciousness, muscle jerking, tongue biting, and incontinence a. epilepsy b. myocardial infarction
a
The most important drug interaction of the anticonvulsants involves a. Stimulation of hepatic microsomal enzymes b. Inhibition of hepatic microsomal enzymes c. Renal reabsorption in the loop of Henle d. plasma binding
a
Which is the mechanism of action of carbamazepine (Tegretol) in the treatment of epilepsy? a. Blocking sodium channels, blocking nerve impulse propagation b. Opening sodium channels, enhancing nerve impulse propagation c. Depression of the central nervous system at the brainstem d. Gamma-aminobutyric acid agonist, inhibiting excitatory impulses
a
Which is the most difficult aspect of treating patients with seizure disorders with regard to their medications? a. chronic toxicity b. compliance c. cost of medicine d. lack of efficacy
a
____ partial attack is where consciousness is not impaired; ______ partial attack is where consciousness is impaired a. simple; complex b. complex; simple
a
_____ comprises a group of disorders that involve a chronic stereotyped recurrent attack of involuntary behavior or experience or changes in neurologic function caused by electrical activity in the brain that can be recorded via electroencephalography a. epilepsy b. grand mal seizure c. tonic-clonic seizure d. petit mal
a
______ inhibits the metabolism of phenobarbital producing excessive sedation a. valproates b. lamotrigine c. carbamazepine d. oxcarbazepine
a
_______ seizures begin with a widespread electrical discharge that involves both sides of the brain at once. a. generalized seizures b. partial seizures c. miscellaneous
a
________ is used for the non-seizure use of for trigeminal neuralgia and atypical facial pain a. carbamazepine and phenytoin b. valproic acid c. gabapentin d. topiramate
a
anticonvulsants can also be used for neurologic pain and psychiatric use a. true b. false
a
anticonvulsants have dental complications a. true b. false
a
does the management of an absence seizure pose any problem for the dental office? a. no- little movement and lack of need for restraint b. yes
a
first agent to treat patients with generalized tonic-clonic seizures a. valproate b. lamotrigine c. carbamazepine d. oxcarbazepine
a
nerve cell activity in epilepsy can be localized/ generalized a. true b. false
a
used to treat tonic-clonic and partial seizures, no longer drug of choice because of complicated pharmacokinetics and works by blocking voltage-dependent neuronal sodium channels a. phenytoin b. lamotrigine c. levetiracetam (keppra) d. carbamazepine (tegretol)
a
valproate _____ lamotrigine levels a. increases b. decreases
a
what are the drugs of choice to treat an absence seizure? a. Ethosuximide/Valproate b. Valproate, lamotrigine, and levetiracetam c. parenteral benzodiazepines d. lamotrigine, carbamazepine, levetiracetam and oxcarbazepine
a
what was the first drug found to be effective for epilepsy or tonic clonic seizures in 1912? a. phenobarbital (luminal) b. lamotrigine c. clonazepine d. gabapentin
a
which drug causes often painless enlargement of the gingival margin (cause is unknown) that occurs in approx 50% of all chronic users.. this enlargement causes interproximal papilla involvement and coalesce to cover the occlusal surfaces of the teeth. a. phenytoin b. lamotrigine c. levetiracetam (keppra) d. carbamazepine (tegretol)
a
•GI effects...to reduce take with food •CNS effects •Mental confusion, ataxia, slurred speech, blurred vision, dizziness, and insomnia •Dermatologic effects •Skin reactions range from rash to exfoliative dermatitis •Vitamin D and folate deficiency •Teratogenicity/growth •Fetal hydantoin syndrome •Craniofacial anomalies, microcephaly, nail or digit hypoplasia, limb defects, growth deficiency, and mental retardation •Thickening of facial structures a. phenytoin b. lamotrigine c. levetiracetam (keppra) d. carbamazepine (tegretol)
a
•Indigestion, nausea, vomiting •Hypersalivation •Anorexia •Increased appetite •Cramping •Diarrhea •Constipation •Usually causes sedation/drowsiness •Hepatotoxicity •Prolonged bleeding time •Teratogenicity •Some children may have hyperactivity, aggression, behavioral disturbances all adverse reactions to a. valproates b. lamotrigine c. carbamazepine d. oxcarbazepine
a
•Infection •Trauma •Toxicity to exogenous agents •Genetic or birth influences •Circulatory disturbances •Metabolism or nutritional alterations •Neoplasms •Hereditary factors •Fevers •Degenerative diseases •Majority of epileptic patients have idiopathic epilepsy; cause is unknown ALL of the above are causes to epilepsy a. true b. false
a
•Loss of consciousness, brief or awareness •Little movement •No aura •Quick recovery •Begin during childhood/disappear in middle age •Patient unaware of seizure, body tone not lost, quickly return to normal activity a. absence seizure b. tonic-clonic c. petit mal seizure d. status epilepticus
a
Adverse Reactions •Dizziness •Ataxia (lack of muscle control) •Somnolence (sleepy) •Headache •Diplopia (double vision) •Nausea •Vomiting •Rash •Insomnia •Incoordination •Stevens-Johnson syndrome a. valproates b. lamotrigine c. carbamazepine d. oxcarbazepine
b
Clonazepam and clobazam used orally as anticonvulsant adjuvants. Diazepam, lorazepam, and midazolam used parenterally to treat recurrent tonic-clonic seizures or status epilepticus. a. The first statement is true; the second statement is false. b. both statements are true c. both statements are false d. The first statement is false; the second statement is true.
b
Simple Complex Secondarily generalized Temporal lobe a. generalized seizures b. partial seizures c. miscellaneous
b
The _______ state is the altered state of consciousness after an epileptic seizure a. prodromal b. postictal
b
Adverse Reactions •Dizziness •Somnolence •Weakness •Suicide ideation •Aggressive behavior •Irritability •Hostility •Psychosis •Stevens-Johnson syndrome a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine
c
All are indications for carbamazepine (Tegretol) except: a. Trigeminal neuralgia (tic douloureux) b. bipolar depression c. muscle spasticity d. seizure disorder
c
Fatal blood dyscrasias, including aplastic anemia and agranulocytosis, have been reported related to phenytoin therapy. Aplastic anemia occurs within 4 days and is most common in children. a. The first statement is true; the second statement is false. b. both statements are true c. both statements are false d. The first statement is false; the second statement is true.
c
Generalized seizures involve no loss of consciousness. Partial seizures cause a total loss of consciousness. a. The first statement is true; the second statement is false. b. both statements are true c. both statements are false d. The first statement is false; the second statement is true.
c
Many of the antiepileptic drugs are used to manage a. infections b. brain damage c. chronic pain syndromes d. all of the above
c
Which antiseizure medication is most likely to cause gingival enlargement? a. Phenobarbital (Primidone) b. Diazepam (Valium) c. Phenytoin (Dilantin) d. Valproate (Depakote) e. Carbamazepine (Tegretol)
c
Carbamazepine is better tolerated than lamotrigine in elderly patients who are newly diagnosed with partial or generalized seizures. Lamotrigine is better tolerated than ethosuximide in children with absence seizures. a. The first statement is true; the second statement is false. b. both statements are true c. both statements are false d. The first statement is false; the second statement is true.
d
Gabapentin (Neurontin) has been approved by the Food and Drug Administration (FDA) for control of seizures. Other indications for gabapentin include treatment of neuropathic pain. a. The first statement is true; the second statement is false. b. both statements are true c. both statements are false d. The first statement is false; the second statement is true.
d
Tonic-clonic seizures that last longer than 30 minutes or recur before the postictal period of the previous seizure. a. absence seizure b. grand-mal seizure c. petit mal seizure d. status epilepticus
d
________ has been FDA approved for non-seizure use for migraine prophylaxis a. carbamazepine and phenytoin b. valproic acid c. gabapentin d. topiramate
d
abrupt withdrawal of an antiseizure agent can cause a. CNS depression b. respiratory depression c. nothing d. seizure
d
drug of choice to treat a partial (focal) epilepsies? a. Ethosuximide/Valproate b. Valproate, lamotrigine, and levetiracetam c. parenteral benzodiazepines d. lamotrigine, carbamazepine, levetiracetam and oxcarbazepine
d
what is the most common CNS side effect due to anticonvulsants? a. headaches b. vision loss c. green/yellow vision d. CNS depression
d
what is the problem with chewable carbamazepine? a. it gets stuck in interproximal areas which leads to increased caries b. it causes hypersalivation c. it causes ulcers d. it causes caries because of the high amounts of sugar
d
which of the following drug would be used if an absence seizure is unresponsive to ethosuximide and also used in the emergency room to stop a seizure? a. phenobarbital b. oxcarbazepine c. phenytoin d. clonazepine
d
which of the following is not a drug interaction of anti-epileptic drugs? a. interaction with other anti-epileptic drugs or other drugs b. induce/inhibit hepatic microsomal enzymes c. reducing blood levels of other drugs d. gastric bleeding
d
which of the following is not an oral effect caused by carbamazepine? a. xerostomia b. glossitis c. caries d. gingival hyperplasia e. stomatitis
d
which of the following is not one of the main side effects associated with anticonvulsants? a. dizziness b. drowsiness c. CNS depression d. diarrhea e. xerostomia
d
which of the following is not one of the uses for carbamazepine (tegretol)? a. anticonvulsant (partial seizures) b. anticholinergic c. antidepressant / bipolar depression d. analgesia e. sedative and muscle relaxant
d
•Absence seizures not responsive to ethosuximide •drowsiness and ataxia can happen •increased saliva, coated tongue, dry mouth, sore gums •Used in emergency room to stop a seizure (particularly status epilepticus which can occur following local anesthetic overdose) a. phenobarbital b. oxcarbazepine c. phenytoin d. clonazepine
d
•Use: Adjunct treatment of partial seizures •"OFF" Label •bipolar disorder, psychosomatic pain, tinnitus, migraine headaches and agitation •Adverse reactions: Somnolence, dizziness, ataxia, fatigue, blurred vision, and confusion. •Edema weight gain and movement disorders have been reported. a. phenobarbital b. felbamate c. phenytoin d. gabapentin
d
General adverse reactions of antiepileptic medications include all except: a. Dermatologic effects (erythema multiforme, Steven-Johnson's syndrome) b. GI distress c. Teratogenicity (fetal development) d. CNS depression e. CNS excitation
e
adverse reactions •Dizziness •Vertigo •Drowsiness •Fatigue •Ataxia •Confusion •Headache •Nystagmus •Visual (diplopia) and speech disturbances •Latent psychosis •Abnormal involuntary movements •Depression •Peripheral neuritis a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine e. carbamazepine (tegretol)
e
first choice for partial, generalized tonic-clonic and mixed seizures) a. valproates b. lamotrigine c. levetiracetam (keppra) d. oxcarbazepine e. carbamazepine (tegretol)
e
