LO 16-17 Flashcards
Anticonvulasants and psychotherapeutics (59 cards)
1
Q
Describe Epilepsy
A
- group of disorders characterized by recurrent seizures caused by electrical activity in the brain that can be recorded via an electroencephalogram (EEG)
- Can be localized or generalized
- 1% of the population
2
Q
List the possible causes of epilepsy
A
- Idiopathic: most common
- Genetic or birth influences
- Cancer
- Trauma, Infection
- circulatory disturbances, metabolic or nutritional alterations
- toxicity to exogenous agents, degenerative diseases
3
Q
Describe the 2 major groups of Epilepsy and their sub-types
A
- Partial: simple and complex attacks
- Generalized seizures: tonic-clonic and absence seizures
4
Q
Describe auras that occur before seizures
A
- The patient may experience an aura before the onset of the seizure
- May be characterized by numbness, nausea, or unusual sensitivity to light, odor, or sound
- Service dogs can detect aura (when the person can’t)
5
Q
Describe Partial (Focal) Epilepsies
A
- Partial epilepsies involve activation of only part of the brain, and the location of the activity determines the clinical manifestations
- Simple attack: consciousness is not impaired
- Complex attack: consciousness is impaired - Also called: psychomotor or temporal-lobe seizures
6
Q
Describe Generalized: Absence Seizures (Petit Mal)
A
- brief, complete loss of consciousness with characteristic EEG waves and little movement
- Absence seizures usually begin during childhood and disappear during middle age
- The patient is usually unaware that these seizures are occurring, and body tone is not lost
- No aura
7
Q
Describe Generalized: Tonic-Clonic Seizures (Grand Mal)
A
- longer periods of loss of consciousness and major motor activity of the large muscles of the body - jerking
- The seizure begins by the body becoming rigid and the patient falling to the floor
- Tonic rigidity is followed by clonic (spasm/rhythmic) jerking of the face, limbs, and body
- Finally, the patient becomes limp and comatose
- Consciousness gradually returns with postictal (altered state of consciousness): confusion, headache, and drowsiness
- Foaming around the mouth
8
Q
Describe Status Epilepticus
A
Status epilepticus seizures are continuous tonic-clonic seizures that last longer than 30 minutes or recur before the end of the postictal period of the previous seizure
9
Q
What are the general adverse reactions of epilepsy medication?
A
- Narrow TI
- CNS - depressants, tolerance, behaviour changes such as hyperactivity and sedation
- GI - upset stomach - take with food
- Withdrawal - gradual, otherwise seizure precipitate
- Renal & Hepato - liver microsomal enzymes STIMULATORS. Resulting in the decrease effect of some drugs; Toxicity
- Teratogenic - likely to cause fetal anomalies
- Oral - gingival hyperplasia, xerostomia, increase bleeding
- Idiosyncratic - Stevens- Johnson’s like lesions; lupus-like symptoms
10
Q
What drugs do epilepsy medications tend to react with?
A
- opioids
- alcohol
- anti-anxiety
- antipsychotics
- antidepressants
- Other anticonvulsants
- NSAIDs
11
Q
What is the trade name for phenytoin and what type of drug is it?
A
- Dilantin
- quinidine-like anti-arrhythmic - epilepsy med
12
Q
List the adverse reactions of phenytoin/Dilantin
A
- gingival hyperplasia
- oral ulcers
- dizziness/insomnia
- lupus-like symptoms
- Stevens-Johnson-like symptoms
- Fetal hydantoin syndrome - microcephaly and mental retardation
13
Q
Other than epilepsy, what is phenytoin/Dilantin used in the treatment of?
A
Trigeminal neuralgia
14
Q
What is the trade name for carbamazepine and what type of drug is it?
A
- Tegretol
- Related to TCA Na+ Ch. blocker
15
Q
What are the adverse reactions of carbamazepine/Tegretol
A
- Caries - esp. children b/c of sugar content
- Xerostomia (anticholinergic)
- Glossitis
- Fatal blood dyscrasias
16
Q
Other than epilepsy, what is carbamazepine/Tegretol used in the treatment of?
A
- Bipolar
- Trigeminal neuralgia
- Migraines
17
Q
What is the trade name for valproic acid?
A
Depakote
18
Q
What are the adverse reactions for valproic acid/Depakote?
A
- Increase bleeding
- Sedation/drowsiness
- Teratogenic
19
Q
What should valproic acid/Depakote NEVER be mixed with?
A
NEVER mix w/ Warfarin & Aspirin/ASA
20
Q
What barbiturate is used in the treatment of epilepsy?
A
Pheno-barbital
21
Q
What are the adverse reactions of Pheno-barbital?
A
- Sedation
- Skin reactions
22
Q
What Benzo-diazepine is used in the treatment of epilepsy?
A
Clonazepam - used as an adjunct to treat absence seizures
23
Q
Describe the Non-seizure Uses of Anticonvulsants
A
- Neurologic Pain - Several anticonvulsants are used to manage chronic pain syndromes
- Psychiatric Use - Carbamazepine, valproic acid, clonazepam, and gabapentin have been used in the treatment of certain mental disorders. They can be used to “level out” (stabilize) the mood in patients with bipolar disorder
24
Q
Which 2 anticonvulsants can also be used to treat trigeminal neuralgia?
A
- phenytoin/Dilantin
- carbamazepine/Tegretol
25
Which 2 anticonvulsants can also be used to treat bipolar?
1. carbamazepine/Tegretol
2. valproic acid/Depakote
26
Which 2 anticonvulsants can also be used to treat migraines?
1. carbamazepine/Tegretol
2. valproic acid/Depakote
27
List DDS considerations for seizure risk patients?
1. Good med history
2. detailed seizure information
3. During seizure - lower chair, do NOT stabilize head, withdraw all instruments
4. decrease stress
5. do not use tongue blade - unneeded sharp tool in mouth causes risk
28
Describe psychosis
1. Schizophrenia, the most common type of psychosis, is an extensive disturbance of personality function with a loss of the perception of reality
2. Delusions or paranoia so severe that the illness could lead to committing serious crimes
3. Positive symptoms of psychosis include: auditory hallucinations
4. Negative effects include: flat affect and apathy
29
What should an RDH consider when working with a psychosis client?
1. Communication: comments or movement may be perceived as threatening/conspiracy
2. Compliance: patients often do not take their medicine as prescribed. OH compliance?
3. Suicidal
30
Describe antiphsychotics
1. Divided into two major groups, depending on their ability to target both the positive and the negative symptoms of schizophrenia
2. Conventional antipsychotics & Newer “atypical” antipsychotics
31
Describe Newer “atypical” antipsychotics
1. These agents produce more nausea and fewer anticholinergic and sedative effects compared with conventional antipsychotics
2. Patients who were previously resistant to conventional agents have been managed with these new drugs
3. Overall - improved efficacy and fewer side effects
32
Provide and example of a conventional antipsychotic
phenothiazine
33
Describe conventional antipsychotics
1. Antipsychotic
2. Antiemetic
3. Potentiation of opioids: used in opioid withdrawal Tx - (can cut the dose in half by introducing phenothiazine)
34
List the adverse reactions of conventional antipsychotics
1. Sedation
2. Orthostatic hypotension
3. Tachycardia
4. Seizures
5. Anticholinergic effects
6. blood dyscrasias, cholestatic jaundice, skin eruptions, and photosensitivity
**Extrapyramidal effects**
1. muscle spasms of face, tongue, neck, and back
2. Parkinsonism like symptoms of resting tremor, rigidity, and akinesia (difficulty moving)
3. Increased compulsive muscular activity
4. Tardive dyskinesia: involuntary movements involving tongue, lips, face, and jaw
5. Extrapyramidal side effects of conventional antipsychotics can cause severe intermittent pain in the region of the temporomandibular joint (TMJ) - Force should not be exerted to open the patient’s mouth for dental treatment
35
List the adverse reactions of Atypical antipsychotics
1. Nausea, vomiting
2. Agranulocytosis: clozapine (Clozaril)
3. Weight gain - e.g. 80lbs in 3-6 months
4. Sedation, headaches
36
Describe drug interactions of Conventional Antipsychotics
1. CNS depressants - additive or potentiation effect
2. Epinephrine - can be used, but should not be used to treat vasomotor collapse because it could cause a further decrease in blood pressure - Caused by predominant α -agonist (vasodilating) activity of epinephrine in the presence of conventional antipsychotics (α-blockers)
2. Anticholinergic effects - conventional antipsychotic therapy often must be combined with anti-Parkinson medication of the anticholinergic type - This combination exacerbates anticholinergic effects anti-SLUD
37
List the medical uses for Conventional antipsychotics
1. Antipsychotic effects
2. Antiemetic effects
3. Other effects: Tx of intractable hiccups and drug withdrawals
38
What are the dental implications of antipsychotics?
1. Sedation
2. Anticholinergic effects (watch for xerostomia)
3. Toxic reactions
4. Orthostatic hypotension
5. Epinephrine should be avoided in the management of acute hypotensive crisis in patients taking antipsychotics
6. TMJ pain: muscles of mastication may be in spasm dyskinesia
7. Tardive dyskinesia: involuntary repetitive movements (aka tics)
39
List the common Conventional antipsychotics
1. High potency - haloperidol (Haldol)
2. Medium potency - loxapine (Loxitane)
3. Low potency - mesoridazine besylate (Serentil)
40
List the common Atypical antipsychotics
1. aripiprazole (Abilify)
2. clozapine (Clozaril)
3. olanzapine (Zyprexa)
4. risperidone (Risperdal)**
41
Describe Antidepressants
Used for depression and a variety of other uses, such as chronic pain adjuvant and migraine headaches prophylaxis
42
Describe Tricyclic Antidepressants TCA
1. first-generation antidepressants
2. Pharmacologic effects - feeling of well-being, elevation of mood, and a dulling of depressive ideation are noted; Sedation, but tolerance to this effect often develops
43
List the Adverse Reactions of Tricyclic Antidepressants
(Resemble those of antipsychotic agents)
1. CNS depression: sedation
2. Anticholinergic effects
3. Cardiac: toxicity, myocardial infarction and congestive heart failure
4. No psychic or physical dependence
44
List the drug interactions of Tricyclic Antidepressants
1. Amphetamines and other CNS stimulants - potentiation effect
2. Beta and alpha agonists (sympathomimetics) - potentiation effect (limit epinephrine)
3. MAOIs
4. Poisoning: associated with overdose
45
What are the uses of Tricyclic Antidepressants
1. Treatment of depression - When sedation is desired, **amitriptyline (Elavil)** is used; When less sedation is needed, nortriptyline (Pamelor, Aventyl) or protriptyline (Vivactil) can be tried
2. may be combined with antipsychotics
3. Certain antidepressants are used for specific indications
46
What Tricyclic Antidepressant is used to control nocturnal enuresis in children?
imipramine (Tofranil)
47
What Tricyclic Antidepressant is used for treatment of obsessive-compulsive disorder?
clomipramine (Anafranil)
48
What Tricyclic Antidepressant is used when an antianxiety effect is desired?
doxepin (Adapin, Sinequan)
49
Describe the Dental Implications of Tricyclic Antidepressants
1. May potentiate epin - **LIMIT EPIN to 0.04mg**
2. Xerostomia: additive anticholinergic effects with other anticholinergic meds
50
What is a commonly used Tricyclic Antidepressant and what do you need to know about it?
1. Tricyclic: tertiary amines - amitriptyline (Elavil)
2. Need to limit epinephrine
51
Describe Second-Generation Antidepressants
1. Newer antidepressants with fewer side effects than TCAs
2. Fewer anticholinergic effects and less cardiotoxicity, some have less sedation effect
52
What are the adverse reactions of SSRIs?
1. CNS: tend to produce stimulation rather than depression
2. Gastrointestinal (GI): nausea and diarrhea in 15% to 30% of patients
3. Oral: xerostomia, taste changes, aphthous stomatitis, glossitis
4. Other: excessive sweating, palpitations
53
List the common SSRIs
1. citalopram (Celexa)
2. fluoxetine (Prozac)
3. sertraline (Zoloft)
4. paroxetine (Paxil)
54
Describe bupropion(Wellbutrin, Zyban)
1. Used for Smoke cessation, Tx of major depressive disorder add on SSRI and SAD (seasonal affective disorder)
2. No sexual dysfunction
3. small number of people experience seizures
4. Reserved for patients who are not responsive to other agents
5. GI effects occur in about 20% of patients
6. Neurologic effects, dry mouth, headache, excessive sweating, ant tremors have been reported
7. Agitation and dizziness occur often
55
What is a new antidepressant agent?
venlafaxine (Effexor)
56
Describe MAOIs
1. A large variety of drugs that have the ability to inhibit monoamine oxidase
2. Many, many adverse effects, and an overdose can lead to a severe toxic reaction
3. The action of any exogenous sympathomimetic amine is potentiated LIMIT EPIN
4. Interact with many drugs, such as amphetamines, and with foods such as cheeses, wines, and fish, precipitation in a hypertensive crisis and even death. CONSULT CPS (compendium of pharmaceuticals and specialties)
57
Describe Drugs for Treatment of Bipolar Depression
1. Lithium was the major drug used in treatment of bipolar depression
2. Other agents commonly used today include anticonvulsants, including carbamazepine and valproate
58
Describe lithium (Eskalith, Lithobid)
1. Used for bipolar (manic) depression
2. Side effects include polyuria, fine hand tremor, thirst
3. In more severe cases, slurred speech, ataxia, nausea, vomiting, and diarrhea
4. CNS symptoms include muscle rigidity, hyperactive deep reflexes, excessive tremor, and muscle fasciculations
5. Oral: xerostomia but in some pts can also produce sialorrhea
6. **Changes in sodium levels can affect lithium levels: heat and salt intake**
59
What drugs interact with lithium?
naproxen (NSAIDs) increases Li toxicity
