Flashcards in Exam 5-Seizures & Anticonvulsants Deck (89):
What piece of equipment can you use to measure seizure activity?
“_______” = episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change
A MAJORITY of patients have _______ epilepsy = no known cause
What are the 2 broad groups of epilepsy? Which one is more common?
partial and generalized epilepsies...partial epilepsy
What are the 2 subtypes of partial epilepsies?
simple partial and complex partial
What type of epilepsy? ________ = seizures caused by a group of hyperactive neurons confined to a single locus in the brain
In partial epilepsy, a seizure lasts for only a few ______, the individual does not _______
In partial epilepsy, the patient fften exhibits abnormal activity of a ______ or muscle group...May occur at _____ age
What type of epilepsy? ________ = seizures exhibit complex sensory hallucinations, mental distortion and loss of consciousness
In complex partial seizures, the pt gets an AURA and the seizure lasts for _______....Full _______ is slow to return
Complex partial seizures are also known as psychomotor or _______ lobe seizures
DID YOU KNOW...80% of people with complex partial epilepsy experience initial seizure prior to ____ years of age
20 years of age
What are the two subtypes of generalized epilepsies?
Tonic-Clonic (grand mal) and Absence (petit mal)
In both of the geralized epilepsies, _________ is lost with both types of seizures!
What is the MOST DRAMATIC FORM of epilepsy?
Tonic-clonic (grand mal)
In tonic-clonic (grand mal) seizures, they result in loss of _________, followed by tonic then clonic phases (convulsive ________)
Tonic-clonic (grand map) seizures- Major _____ activity = fall to floor, tonic rigidity, chronic jerking of face and limbs – Tonic-clonic seizure is followed by a period of ______ and exhaustion, patient can go _______ if they fall asleep afterward.
What is this describing???Brief period of heightened sensory activity prior to the onset of the seizure....Characterized by numbness, nausea, or unusual sensitivity to light, odor, sound...SEEMS LIKE I WOULD WANT TO KNOW IF A PT IS FEELING THIS!!
In _________ seizures, they involve an abrupt and brief loss of consciousness (10-30 seconds).
absence (petit mal)
In ________ seizures, Onset occurs at 3 to 5 years old and lasts until puberty (disappears in middle adulthood).....Think: ______
absence (petit mal)...CHILDREN
Do you get an aura in absence (petit mal) seizures?
nope, No aura; patient stares and has rapid eye- blinking for 3 to 5 seconds; quickly returns to normal
What are seizures are continuous or rapidly recurrent...Can be life-threatening
Status epilepticus (yay, Latin!)
When STATUS EPILEPTICUS occurs in dental office,
give injection of _______ (______)*
– May also use ________ (Ativan) and _______ (Versed) parenterally
The two goals of drug therapy for epilepsy are To control seizures (_______) and Minimize ______ reactions
Mechanism of drug therapy for epilepsy....
How long is typical drug therapy for epilepsy?
Drugs are usually taken for LIFE: chronic toxicity becomes an important consideration when selecting an agent
Generalized Adverse Reactions to anti convulsants: Narrow _______ index, so we need to titrate dose carefully and monitor blood levels
Generalized Adverse Reactions to anti convulsants: Most anticonvulsants stimulate LIVER microsomal _______. (“_______”)
Generalized Adverse Reactions to anti convulsants: Metabolism of anticonvulsants can _______ liver microsomal enzymes
Generalized Adverse Reactions to anti convulsants: At low doses = _____ order elimination (drug can be removed from body after metabolism)
Generalized Adverse Reactions to anti convulsants: After saturation of liver enzymes, metabolism converts to ____ order kinetics = blood level increases abruptly
Generalized Adverse Reactions to anti convulsants: At saturation, even a _____ change in dose can lead to ______ increase in blood level of dose
Common anticonvulsant side effects: ______ may develop to these effects (drowsiness) while the anticonvulsant effect remains
Common anticonvulsant side effects: Impaired ______, cognitive alteration
Common anticonvulsant side effects: _______ alteration = hyperactivity, sedation
Common anticonvulsant side effects: Exacerbation of another ______ type that is not being treated
Common anticonvulsant side effects: CNS depression is _______ with other CNS depressants...e.g. ______ in dentistry or alcohol
Common side effects- GI: __, __, __ occurs with
most anticonvulsants BUT! Effects can be minimized by taking the drug with _____.
N,V,D (nausea, vomiting, diarrhea)...food
Common side effects- Prescribe agents that can irritate the GI tract cautiously in patients taking anticonvulsants....FOR EXAMPLE don't Rx _______ in dentistry
Which anticonvulsant? Mechanism of action: blocking sodium channels in neurons, which blocks propagation of impulses, inhibition of high-frequency repetitive firing in neurons, HIGHLY effective for SIMPLE and COMPLEX PARTIAL seizures
Some other uses of the anticonvulsant Car-BAM-az-ep-ine a re for _______ depression and IN DENTISTRY-chronic pain, namely ________ (_________).
bipolar....trigeminal neuralgia (tic douloureaux)
Car-BAM-az-ep-ine: adverse drug reactions: Hematologic: Causes _______ anemia (wipes out bone marrow), agranulocytosis, thrombocytopenia..YIKES
Car-BAM-az-ep-ine: adverse drug reactions: Has potential for inducing serious _____ toxicity
Car-BAM-az-ep-ine: adverse drug reactions: dental application ________!!!
Car-BAM-az-ep-ine: Drug interactions = classic “______”....Decreases effectiveness of warfarin (Coumadin), doxycycline, theophylline (bronchodilator for asthma), oral contraceptives
Car-BAM-az-ep-ine: Other drug interactions – _________-type antibiotics (________) increase carbamazepine blood levels (toxicity) carbamazepine may increase HEPATOtoxicity of the analgesic _________ (______).
ERYTHROMYCIN....MACROLIDES; acetaminophen (Tylenol)
What on earth drug might this be??????Mechanism of action = decrease the neuronal membrane passage of sodium ions Reduces propagation of abnormal impulses in the brain to reduce the FREQUENCY of seizures
phenytoin (Dilantin) is effective for all _______ seizures (simple and complex)...This drug kicks ass because its Highly effective for ________ seizures and its also effective for the BIG boy: ________.
Which seizure type is phenytoin (Dilantin) NOT effective for?
absence seizures (petit mal)
What dental implication is phenytoin (Dilantin) indicated for?
What are the two anticonvulsant drugs that are used to treat trigeminal neuralgia?
phenytoin (Dilantin) & Car-BAM-az-e-pine (TegRetOL)
Phen-y-to-in (Dilantin) HAS SOME MAJOR ORAL ADVERSE EFFECTS: what are they? (3)
1.Loss of taste 2.oral mucosal ulceration/glossitis from Vit D & folate deficiencies 3.GINGIVAL HYPERPLASIA
What % of Pt's taking phenytonin (Dilantin) experience the dreaded GINGIVAL HYPERPLASIA?
Can oral hygiene have an effect on the gingival hyperplasia caused by phenytoin (Dilantin)? Does it go away after patient is taken off?
Yes, good OH reduces the extent and severity...it reduces SLOWLY after patient is off of phenytoin (Dilantin)
WARNING: mothers given phenytoin (Dilantin) during pregnancy-there have been ________ effects seen. The FDA places it in their ____ category and it can produce ________ and ______ in the fetus.
teratogenic...D.....left lip....cleft palate
How does phenytoin interact with other drugs?
Phenytoin INCREASES the metabolism of many drugs, a cytochrome P450 INDUCER
_________ agents cause release of GABA from presynaptic interneurons, which intern INHIBITS the release of _______ in the presynaptic neuron.
MANY seizures are caused by TREMENDOUS release of _________ across synapses in cortex, therefore ______ is a INHIBITORY neurotransmitter.
What is the most common barbiturate used as an anticonvulsant? How does it work again?
pheno-barbital (Luminal sodium)...potentiates effects of GABA-mediated neurons (GABA mimetic)
What 2 types of seizures is phenoBarbital indicated for?
tonic-clonic and all partial seizures
Side effects of phenoBarbital- _______ may indicate onset of cutaneous reactions, some of which have been FATAL (so Discontinue drug if any skin reaction occurs)...AND a common one is plain ole ______.
Drug interactions of phonoBarbital- its another strong "______", especially with these 3 medications....
"INDUCER"....oral contraceptives, macrolides, and warfarin
Weird, phenobarbital enhances the hepatotoxicity of ________.
acetaminophen (this drug is just like car-BAM-az-epine)
And yet again, phenoBarbital has _______ CNS effects when mixed with alcohol, narcotics, anti-depressants, bezo's
What is the phenoBarbital PRECURSOR (metabolized to phenoBarbital once it passes through the liver).
What class of anticonvulsants has the unique mechanism of action of causing increased availability of GABA to neurons?
What 3 seizure types can valproic acid treat?
Tonic-clonic (grand mal), generalized: absence (petit mal) and myoclonic
What are 2 adverse reactions that cause Valprotates to not be administered as much?
1.hepatotoxicity (significant) 2.increases bleeding time (inhibits platelet aggregation)
T/F Valproates are teratogentic.
3 main drug interactions with Valproates:
1.macrolide antibiotics (weird) (they inhibit the metabolism of Val acid) 2.aspirin (displace val acid from binding sites and increase hepatotoxicity) 3.ADDITIVE effect with other CNS drugs.
What is the first choice in treating absence (petit mal) seizures?
What are 4 side effects of the drug ehtosuximide (Zarontin) ? (hint 2 are oral)
1.Hirsutism (hair growth) 2.SLE (lupus) 3.GINGIVAL HYPERPLASIA 4.Swelling of the tongue
Review, what was the drug of choice for Status Epilepticus?
Which anticonvulsant is used for partial seizures and tonic-clonic, is structurally related to GABA, but DOES NOT interact with GABA receptors (mech of action unknown)?
Which anti convulsant is a great option because it is not metabolized and therefore has limited drug interactions?
Which anti convulsant is also used for chronic pain (shingles) and has the side effect of oral mucositis?
Who am I? Used for partial seizures and tonic-clonic...Mechanism of action = inhibits the release of GLUTAMATE (an excitatory amino acid)....Weakly inhibits SEROTONIN receptors (tx of bipolar too)
lame-O!! lam-o-tri-gine (Lamictal)
Tx Considerations for seizures: Drugs are used for ________ treatment, Initial therapy is to ______ increase dose, Usually patients receive _____ drug therapy.
HERE COMES THE BOOM-the 6 drugs for tonic-clonic (grand mal) seizures are.....
valproic acid, phenytoin, phenobarbital, primidone, gabapentin, lamotrigine
HERE COMES THE BOOM-the 2 drugs for absence seizures are....
ethosuximide and valproic acid
HERE COMES THE BOOM-the 6 drugs for partial seizures are....
carbamazepine, phenytoin, phenobarbital, primidone, gabapentin, lamotrigine
Good to know..._________ is sometimes used before phenytoin to avoid gingival hyperplasia
ALWAYS ask patients when they have had their most recent seizure and if they have known ______.
triggers (dental handpiece? light??)
Remember-P_______ and P_______ are classic P450 inducers.
phen-y-to-in (Dilantin) and pheno-barb-ital
Remember- liver toxicity is a concern with _______ and ________.
car-BAM-az-epine and valproic acid
What are the three ways we can trigger a seizure in the dental clinic?
1. light 2.startle (sound/light) 3.anesthetic
What is a convulsant that is used for provocative diagnosis of epilepsy and keeps people awake?
Which convulsant is found in rat poison, blocks glycine receptors and is added to heroin (causes OD)?