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26 Cards in this Set
- Front
- Back
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About _____ of people in US with epilepsy are well controlled
Most that are not well controlled have what is termed ... |
80%
partial seizures versus generalized seizures |
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How is Phenytoin distributed through the body?
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Given PO and IV (for emergency seizures)
Crummy and extremely variable PO absorption |
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What is actually an extended release form of phenytoin?
How is Phenytoin bound in the body? What describes the metabolism of Phenytoin? |
Dilantin
Highly PP bound - primarily to albumin Non-linear |
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What is the main use of Phenytoin?
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Most effective AEDs against Tonic-Clonic and Partial Seizures
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What is the Mode of Action for Phenytoin?
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Alters multiple channels, Na+ and to a lesser extent Ca++
Antiarrhythmic activity |
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What are the adverse reactions of using Phenytoin?
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- Drowsiness
- Gingival hyperplasia – Ca++effects - Nystagmus (changes in eye muscle movements) - Hirsuitism (hair growth) - Skin rash and fever (hypersensitivity) - Lympadenopathy can be fatal and may look like leukemia |
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What are the interactions to be aware of with Phenytoin?
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Potent inducer of many liver enzymes (P450s, MFOs)
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How is Ethosuximide (Zarontin) metabolized?
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Through the liver to hydroxylated metabolites
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What are the uses of Ethosuximide (Zarontin)
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Drug of choice in absence siezures
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What is the mode of action for Ethosuximide (Zarontin)?
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Interacts calcium currents (maybe in thalamus)
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What is the most common Adverse reaction associated with Ethosuximide (Zarontin)?
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GI Distress
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What is the chemistry which describes Carbamazepine?
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- Closely related to tricyclic antidepressents
- Tablet form has crummy absorption and dissolution - Strong inducer of a number of liver enzymes |
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What is the mode of action of Carbamazepine?
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Alters conductance through several channels esp. sodium channels of neurons
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What are the adverse effects of using Carbamazepine?
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Diplopia (double vision) and ataxia
Also: Memory loss with long-term use |
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What are the drug interactions to be aware of when using Carbamazepine?
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↑↑ metabolism of valproic acid, TCAs, haloperidol, lamotrigine
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What drug is used in the broadest spectrum of antiepileptic drugs?
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Valproate (valproic acid)
A drug of C |
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What are the major uses of Valproate (valproic acid)?
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Drug of choice in Absence and Atypical Absence seizures
Also used in migraine, bipolar disorder |
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What is the Mode of action of Valproate (valproic acid)?
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Affects sodium channels and ↑ GABA availability to synapse
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What are the adverse reactions associated with Valproate (valproic acid)?
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GI upset – drug just sits in stomach and gut and is directly irritating to GI tract
Divalproex is a enteric-coated tablet with less chance of upset - Rare, poss. fatal hepatoxicity and thrombocytopenia |
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What is the use of Lamotrigine?
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A drug of choice for Atypical Absence and Partial Seizures
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What is the mode of action of Lamotrigine?
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Alters conductance through several channels, in particular sodium channels of neurons
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What are the adverse reactions associated with Lamotrigine?
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- Dizziness, blurred vision, runny/stuffy nose
- Less cognitive ADRs vs earlier agents Hypersensitivity (Stevens-Johnson syndrome ) |
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What are the uses of the drug Gabapentin?
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Back-up in partial siezures
Also useful for treating chronic pain, bipolar disorder, etc. |
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What is the Mode of Action of Gabapentin?
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- Does NOT act on GABA receptor
- May alter GABA metabolism, transport or re-uptake (pretty unclear) |
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What are the adverse reactions associated with Gabapentin use?
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Most common: ataxia, drowsiness, dizziness, fatigue
Overall: less incidence of ADRs vs. most AEDs |
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What are the implications for dentistry with regards to the Antiepileptic drugs?
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First aid for seizing patient
Drugs and even fear can ↓ seizure threshold CNS depression Blood dyscrasias |
