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Flashcards in Anticonvulsants Deck (29)
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1

Define epilepsy.

A seizure disorder of sudden discharge of cerebral neurons

2

What is an episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change called?

Seizure

3

What's etiology for epilepsy?

Majority of patients have idiopathic epilepsy - no known cause

4

What are the 2 broad groups of epilepsy?

  • Partial epilepsies
  • Generalized epilepsies

5

What is the most common type of epilepsy?

Partial Epilepsy

6

What are the 2 subtypes of partial epilepsy?

  • Simple partial 
  • Complex partial

7

Define Simple partial epilepsy.

Seizures caused by a group of hyperactive neurons confined to a single locus in the brain

8

Describe some characteristics of simple partial epilepsy.

  • Seizure lasts for only a few seconds
  • Individual does not lose consciousness
  • Often exhibits abnormal activity of a single limb or muscle group
  • Can occur at any age

9

Define complex partial epilepsy.

Seizures exhibit complex sensory hallucinations, mental distortion and loss of consciousness

10

What are some characteristics of complex patial epilepsy?

  • Aura, seizure lasts for 3-5 minutes
  • Full consciousness is slow to return
  • AKA psychomotor or temporal lobe seizures
  • 80% have initial seizure prior to 20 years of age

11

What are the 2 subtypes of generalized epilepsies, and what's common about generalized epilepsies?

  • Tonic-clonic (grand mal)
  • Absence (petit mal)

Consciousness is lost with both types of seizures

12

What is the most dramatic form of epilepsy?

Tonic-clonic (grand mal)

13

What's a characteristic of tonic-clonic (grand mal)?

After seizure with loss of consciousness, it's followed by tonic then clonic phases (convulsive twitching)

14

What do the terms tonic and clonic mean?

  • Tonic - producing/restoring normal tone, continuous tension
  • Clonic - contraction/relaxation of muscle

15

What's the major motor activity of tonic-clonic (grand mal) epilepsy?

Fall to the floor, tonic rigidity, chronic jerking of face and limbs

16

What is a tonic-clonic seizure followed by?

A period of confusion and exhaustion, comatose, headache, drowsiness

17

What is an aura?

Brief period of heightened sensory activity prior to the onset of the seizure, characterized by numbness, nausea or unusual sensitivity to light, odor, sound

18

Define absence (petit mal).

Seizures involve an abrupt and brief loss of consciousness (10-30 seconds)

 

19

What are the characteristics of absence (petit mal)?

  • Onset occurs at 3-5 years old and lasts until puberty 
  • Children
  • No aura, patient stares and has rapid eye-blinking for 3-5 seconds, quickly returns to normal

 

20

What is status epilepticus?

Seizures are continuous or rapidly recurrent, and can be life-threatening

21

What happens when you have a patient that has status epilepticus in your dental office?

Give injection of diazepam (Valium)

May also use lorazepam (Ativan) and midazolam (Versed) parenterally

22

What are the goals for the drug therapy for epilepsy?

  • To control seizures (frequency)
  • Minimize adverse reactions

23

What is the mechanism of the drug therapy for epilespy?

Prevent the spread of abnormal electric discharges in the brain without causing excessive drowsiness

CNS depressents 

24

What type of drugs are drugs used to treat epilepsy?

CNS depressents - a life long medication

25

What are the dosing considerations of anti-convulsants?

  • Narrow therapeutic index - titrate dose carefully, monitor blood levels
  • Most anticonvulsants stimulate liver microsomal enzymes (inducers)

26

What can the metabolism of anticonvulsants do?

Saturate liver microsomal enzymes 

27

What happens to the elimination kinetics of anticonvulsants?

  • At low doses - 1st order elimination
  • After saturation - converts to zero order and blood level increases abruptly

28

What are the common side effects of anticonvulsants?

  • CNS depression - impaired learning, tolerance, behavioral alteration, exacerbation of another seizure not being treated
  • CNS depression is additive with other CNS depressents - opioids, alcohol = bad! 
  • GI effects - Nausea, vomiting, diarrhea

29

What would you prescribe a patient for dental pain if he or she is taking anticonvulsants?

NSAIDS - but may be gastric irritants