Anticonvulsants and Stimulants

Question 1

What is the MOA of carbamazepine (Tegretol)?

Answer 1

blocks Na channels = blocks propagation of impluses

decreases pre-synaptic transmission

Question 2

What drug has the following known side effects: aplastic anemia, agranulocytosis, thrombocytopenia, rashes, altered skin pigment, alopecia, hepatoxicity, congestive heart failure, changes in BP?

Answer 2

carbamazepine (Tegretol)

Question 3

Cabamezepine (Tegretol) is a classic inducer of what type(s) of drugs?

Answer 3

Dec. warfarin, doxycycline, theophylline and oral contraceptive effectiveness

Question 4

cabamezepine (Tegretol) increases the hepatotoxicity associated with what medication?

Answer 4

acetaminophen

Question 5

Toxic blood levels of cabamezepine (Tegretol) can occur with simultaneous use of what other drug?

Answer 5

erythromycin-type antibiotics (macrolides)

Question 6

What is the MOA of phenytoin (Dilantin)?

Answer 6

1. Stabilizes neuronal membranes by decreasing the neuronal membrane passage of Na/Ca ions
2. Interferes with Ca mediated release of NT
3. Reduces propagation of abnormal impulses in the brain to reduce the frequency of seizures

Question 7

What medication is associated with the following adverse effects:

1. megaloblastic anemia
2. osteoporosis
3. gingival hyperplasia
4. hirsutism

Answer 7

phenytoin (Dilantin)

Question 8

How does phenytoin (Dilantin) cause megaloblastic anemia?

Answer 8

by interfering with Vit B12 metabolism

Question 9

How does phenytoin (Dilantin) cause osteoporosis?

Answer 9

By creating Vit D and folate deficiencies

Question 10

What is the first symptom of folate deficiency seen as a result of Dilantin use?

Answer 10

oral mucosal ulceration or glossitis

Question 11

T/F gingival hyperplasia associated with Dilantin use will regress with improved OH and drug termination

Answer 11

True

Question 12

What is a recommended tx procedure to prevent gingival hyperplasia in patients taking Dilantin?

Answer 12

carbamazepine is sometimes used before phenytoin to avoid gingival hyperplasia

Question 13

What are the teratogenic effects of Dilantin and what FDA category is is classified as?

Answer 13

Fetal syndrome: includes cleft lip, cleft palate, congenital heart disease

FDA category D

Question 14

What is the MOA of GABAmimetic agents?

Answer 14

release of GABA from presynaptic interneurons = increase GABA fusion w/ presynaptic neurons

inhibit release of ACH from presynaptic neurons

Question 15

What is the MOA of phenobarbital (Luminal)?

Answer 15

reduces Na/K transport along axonal membranes

potentiates inhibitory effects of GABA mediated neurons

Question 16

What drug can produce hyperactivity in children and increases bleeding time?

Answer 16

valproic acid (Depakene)

Question 17

What is the drug of choice for tx of absence seizures (petit mal)?

Answer 17

ethosuximide (Zarontin)

Question 18

What drug is not effective in treating absence seizures (petit mal)?

Answer 18

phenytoin (Dilantin)

Question 19

What two benzo can be used for tx to seizures?

Answer 19

clonazepam (Clonipin): all types of seizures

diazepam (Valium): status epilepticus and local anesthetic induced

Question 20

When would a person use gabapentin (Neurontin)?

Answer 20

partial seizures and tonic-clonic
chronic pain
post-herpetic neuralgia (shingles)

Question 21

What is a major side effect of gabapentin (Neurontin)?

Answer 21

oral mucositis

Question 22

T/F gabapentin (Neurontin) has many drug interactions

Answer 22

False - it has very few since it is not metabolized

Question 23

What is the MOA of lamotrigine (Lamictal)?

Answer 23

inhibit release of glutamate (excitatory amino acid)
inhibits voltage sensitive Na channels
stabilize neuronal membranes
weakly inhibits serotonin receptors

Question 24

Which anticonvulsants act as hepatic cytochrome P450 inducers?

Answer 24

phenytoin (Dilantin)
phenobarbital (Luminal sodium)
carbamazepine (Tegretol)

Question 25

How does metabolism of anticonvulsants differ based on doses?

Answer 25

Low dose = first order | High doses/liver enzyme saturation = zero order

Question 26

T/F anticonvulsants cure epilepsy

Answer 26

False - drugs are used for symptomatic tx

Question 27

T/F when adding additional anticonvulsants you must change the metabolism of all anticonvulsants

Answer 27

True

Question 28

What drug is able to tx the following conditions: 1. simple and complex partial seizures 2. management of bipolar depression 3. management of chronic pain 4. Dental: trigeminal neuralgia (tic douloureux)

Answer 28

carbamazepine (Tegretol)

Question 29

what are indications for phenytoin (Dilantin) use?

Answer 29

1. simple and complex partial seizures 2. tonic-clonic seizures 3. status epilepticus 4. dental: trigeminal neuralgia

Question 30

What drug has the following indications for use: 1. anticonvulsant 2. tonic-clonic seizures 3. partial seizures

Answer 30

phenobarbital (Luminal sodium)

Question 31

What drug is the most common barbiturate used as an anticonvulsant?

Answer 31

phenobarbital (Luminal sodium)

Question 32

What are the indications of use for primidone (Mysoline)?

Answer 32

partial seizures | tonic-clonic seizures

Question 33

What are the indications of use for Valproates (Depakote)?

Answer 33

tonic-clonic seizures (grand mal) | generalized seizures: absence (petit mal), myoclonic

Question 34

What is the first drug of choice for absence (petit mal) seizures? (think children)

Answer 34

ethosuximide (Zarontin)

Question 35

What type(s) of seizures can the benzo clonazepam (Clonipin) be used to tx?

Answer 35

All types!

Question 36

What are the indications for gabapentin (Neurontin)?

Answer 36

partial seizures tonic-clonic chronic pain post-herpetic neuralgia (shingles)

Question 37

What are the indications for lamotrigine (Lamictal)?

Answer 37

partial seizures tonic-clonic part of tx for bipolar disorder

Question 38

What convulsant is used for provocative dx of epilepsy?

Answer 38

pentylenetetrazole (Metrazole)

Question 39

Valium is indicated in what 2 situations?

Answer 39

1. local anesthetic induced seizures in dental office | 2. status epilepticus

Question 40

When would a stimulant be used in medicine?

Answer 40

antidote for depression: analeptics | reverse respiratory, cardiac and CNS depression

Question 41

What are the 3 primary classes of stimulants?

Answer 41

Xanthenes Centrally acting sympathomimetics Convulsants

Question 42

What is the main effect of Xanthenes and its tx use?

Answer 42

bronchodilators | asthma tx

Question 43

What is the main effect of centrally acting sympathomimetics and its tx indications?

Answer 43

amphetamine | tx: hyperkinetic children, diet pills

Question 44

What is the main purpose of convulsant medications?

Answer 44

diagnostic

Question 45

What are the common xanthene medications?

Answer 45

aminophylline theophylline caffeine

Question 46

At what dosages of caffeine are the following structures effected: 1. cerebral cortex 2. brain stem 3. spinal cord

Answer 46

1. 50-200 mg 2. > 250 mg 3. 100 mg

Question 47

T/F caffeine and theophylline are equally effective on the CNS?

Answer 47

True

Question 48

Theophylline produces (more/less) effects on blood vessels, heart, smooth muscle, diuresis than caffeine does

Answer 48

Theophylline produces more than caffeine Theophylline > Caffeine

Question 49

Theophylline produces (more/less) effects on skeletal muscle than caffeine does

Answer 49

Theophylline produces less than caffeine Theophylline

Question 50

What what dosage does caffeine toxicity occur?

Answer 50

300 mg

Question 51

What type of caffeine in take results in physical dependence?

Answer 51

5+ cups/day

Question 52

What type of medication can be used to tx acute pulmonary edema and apnea in perterm infants?

Answer 52

Xanthenes: increases perfusion, decreases peripheral resistance causing bronchiodilation

Question 53

CNS sympathomimetics increase or decrease the following: 1. fatigue 2. mood, motor activity, performance, wakefulness 3. REM sleep 4. appetite 5. satiety center 6. medullary respiratory center

Answer 53

1. decrease 2. increase 3. decrease 4. decrease 5. increase 6. increase

Question 54

What drug type(s) have the following indications of use: 1. narcolepsy 2. hyperkinetic syndrome

Answer 54

CNS sympathomimetics

Question 55

What is the popular drugs used for the management of children with hyperkinetic disorders?

Answer 55

Centrally acting sympathomimetics (amphetamine)

Question 56

Why vasoconstrictors (epinephrine) must be used with caution in dental patients taking CNS sympathomimetics?

Answer 56

CNS sympathomimetics block reuptake of dopa and NE inhibit MAO Enhances sympathomimetic response of Epi/NE

Question 57

What is the MOA of cocaine?

Answer 57

blocks Na/K ATPase reuptake mechanism dopa and NE remain in synapse crosses blood brain barrier

Question 58

What 4 things do cocaine clinically increase?

Answer 58

1. sympathetic system responses 2. peripheral resistance 3. cardiac output 4. energy expenditure

Question 59

What is the MOA of pentylenetetrazol (Metrazole)?

Answer 59

decreases neuronal recovery time by increasing K+ permeability used for provocative dx of epilepsy

Question 60

What is the MOA of strychnine?

Answer 60

blocks glycine receptors on Renshaw cells (postsynaptic inhibition) produces generalized convulsion → non-spontaneous, simultaneous tonic convulsion of flexors and extensors

Question 61

What drug causes OD when added to heroin?

Answer 61

strychnine (rat poison)

Question 62

What are the effects of nicotine based on dosage level?

Answer 62

Low doses: stimulates nicotinic receptors in brainstem and cortex High doses: tremor, emesis and stimulation of respiratory center Higher doses: convulsions (can be fatal)