Seizures and Anti-Epileptic Drugs

Question 1

What percent of medical emergencies in the dental clinic are seizures?

Answer 1

17%

Question 2

How to manage seizures in the dental clinic?

Answer 2

Head tilt, chin lift.

Question 3

Medical emergency algorithm and what it stands for.

Answer 3

PABCD:

Position
Airway
Breathing
Circulation
Definitive treatment

Question 4

ASA classification for well-controlled seizures and epilepsy.

Answer 4

II

Question 5

ASA classification for uncontrolled epilepsy or seizures.

Answer 5

IV

Question 6

Epilepsy definition

Answer 6

You have 2 or more uncontrolled seizures at least 24 hours apart.

Question 7

Excessive excitability of neurons in the CNS causes.

Answer 7

Epilepsy/seizures

Question 8

3 Types of Seizures

Answer 8

1) Generalized Onset
- Tonic Clonic
- Absence

2) Focal Onset
- Aware
- Unaware

3) Unknown Onset

Question 9

The most common form of generalized seizures.

Answer 9

Tonic clonic

Question 10

Which drug makes up Diphenylhydantoinate.

Answer 10

Phenytoin/Dilantin

Question 11

This anti-epileptic drug causes gingival overgrowth.

Answer 11

Phenytoin/Dilantin

Question 12

Significant side effect of seizures meds.

Answer 12

Gingival hypertrophy (esp. Dilantin/phenytoin).

• Also causes xerostomia
• Increased chance of infection
• Increases the depressant effects of anesthetic agents.
• Delayed healing, bleeding gums, and postoperative bleeding.

Question 13

T/F: There’s little data to suggest significant differences in effectiveness among available anti-epileptic drugs.

Answer 13

True

Question 14

All antiepileptic drugs have in common the ability to ________ neuronal excitation or ______ neuronal inhibition.

Answer 14

decrease; increase

Question 15

MOA for anti-epileptic drugs.

Answer 15

• Decrease Na+ channel activity
• Decrease Ca2+ channel activity
• Decrease glutamate transmission.
• Increase GABA transmission

Question 16

Broad-spectrum anti-epileptics.

Answer 16

Valproate
Topiramate
Levetiracetam

Question 17

Narrow-spectrum anti-epileptics.

Answer 17

Phenytoin
Carbamezepine
Pregabalin

Question 18

Phenytoin MOA

Answer 18

Na channel blocker

Question 19

Phenytoin is a broad or narrow therapeutic index drug?

Answer 19

Narrow

Question 20

Adverse effect of Phenytoin

Answer 20

Gingival enlargement

Question 21

Phenytoin is known to induce what?

Answer 21

CYP3A4, so it increases drug metabolism and drug-drug interactions.

Question 22

What is the pregnancy category of Phenytoin?

Answer 22

D

Question 23

What does Pregnancy Category D mean?

Answer 23

The drug causes known harm to the baby, but the benefits to the mother may outweigh the risks if she can’t take any other drug.

Question 24

Disease associated with Phenytoin

Answer 24

Fetal Hydantoin Syndrome

• Resembles fetal alcohol syndrome
• Includes abnormalities of the skull and facial features, cleft lip, or palate.

Question 25

A major first-line anti-epileptic.

Answer 25

Carbamezepine

Question 26

Carbamezepine MOA

Answer 26

Na channel blocker.

Question 27

Key adverse event associated with Carbamezepine

Answer 27

Xerostomia

Question 28

These anti-epileptic drugs cause Steven-Johnson Syndrome.

Answer 28

Phenytoin

Carbamezepine

Question 29

First-line tx for people with absence seizures.

Answer 29

Valproate

Question 30

What pregnancy category is Valproate?

Answer 30

D

Question 31

Syndrome caused by Valproate.

Answer 31

Fetal Valproate Syndrome

Question 32

Which AED has the strongest evidence for risk and Grade 1B recommendation that it should be avoided?

Answer 32

Valproate

Question 33

Key adverse events associated with Topiramate

Answer 33

BONE LOSS, gingivitis, xerostomia, taste changes,

Question 34

These are pregnancy C anti-epileptics.

Answer 34

Levi and Lamo

Levetiracetam
Lamotrigine

Question 35

What is Levetiracetam used for?

Answer 35

Infants with focal seizures.

Question 36

Advantages of Levetiracetam anti-epileptic.

Answer 36

• High bioavailability.
• Rapid onset of action.
• Is metabolized independently of CYP, so there are no drug interactions.

Question 37

How to remember what Levi is used for.

Answer 37

“Levi is an infant with focal seizures.”

Question 38

Levi MOA

Answer 38

Prevents exocytosis, thus inhibiting the CNS.