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86 Cards in this Set
- Front
- Back
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What does EEG stand for?
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Electroencephalogram…tells you what type of seizure someone is having.
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A seizure can be accompanied by __________ activities such as convulsions or by other neurologic changes.
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Motor
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Describe the aura or postictal state of absence seizures.
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They don't have an aura or postictal state.
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What is another name for an absence seizure?
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Petit Mal
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What is lost in both absence and tonic-clonic seizures?
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Consciousness.
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Is an aura typical in generalized seizures?
If so, what are some possible examples of aura? |
Yes!
Aura Examples : "star lite", nausea, unusual sensitivity to light, odor or sound, possibly numbness |
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Do tonic-clonic seiqures have a longer or shorter period of loss of consciousness compared to absence seizures?
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Longer…but they are usually >1 minute
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Which muscles are most impacted by a tonic-clonic seizure?
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The major or large muscles of the body.
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How does a tonic clonic seizure begin
(what does it look like)? |
Pt falls to the floor and is very rigid followed by jerking of the face, limbs and body.
*After the seizureis over the Pt returns with postictal confusion, headache & drowsiness.* |
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Status epilepticus seizures are continuous tonic-clonic seizures that last longer than ____ minutes.
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5 minutes
*This is a medical emergency!* |
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Due to the constant tonic-clonic activity the Pt may experience ________.
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Hypoxia..Difficulty breathing!
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What are the drugs of choice (the classification) in treating status epilepticus?
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benzodiazepines…such as diazepam 5-10mg
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What is the best way to administer benzodiazepines for a stataus epilepticus Pt?
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Paraenterally (IV or IM)
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Partial or focal epilepsies are called this because they only involve________ of the brain.
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part
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What is it called with the epileptic attack does not involve consciousness is not impared?
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Simple Partial
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What is the attack called when consciousness is impared?
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Complex Partial
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Anticonvulsants drugs have ________ efficacy.
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variable
*Remember there are lots of drugs but nothing works for everyone and some Pt's may have to have their drug regimen changed often.* |
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What system in the body to anticonvulsants supress? What symptoms can this cause?
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CNS Drowsiness or sedation.
Dr's try to find meds that will limit this impact. |
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The ideal anticonvulsant would….
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prevent seizures w/o causing sedation or drowsiness.
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What type of therapeutic index do anticonvulsants have?
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Narrow!
*The therapeutic range is close to the toxic range!* |
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Most anticonvulsants stimulate __________ enzymes. What does this mean for the drug being taken?
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Liver (hepatic microsomal enzymes).
Since the liver enzymes metabolize the drug and more enzymes are being produced…the drug being given won't last very long. They can alos have lots of drug interactions. |
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Depressed CNS function is a common side effect of ______________ drugs.
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anticonvulsant
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What type of behavioral alterations may be experienced when utilizing anticonvulsants>
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Both hyperactivity and sedation.
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What group of drugs has more drug interactions than with any other drug groups?
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Anticonvulsants!
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What are some idiosymcratic reactions of anticonvulsants?
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Rash, Stevens-Johnson syndrome, erythema multiforme
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Do anticonvulsants cause birth defects? (teratogenicity)
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Yes
Often the defects are associated with an alteration in growth |
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What happens if you abruptly quit taking anticonvulsants?
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It can precipitate seizures.
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Carbamazepine is often utilized as an anticonvulsant. Chemically what is happening for this drug to work?
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Its blocking the sodium chanels-->which inturn blocks the propagation of the nerve impulse.
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What are some physical side effects of carbamazepine?
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Dry mouth/Dry skin…these are know as anticholinergic.
**Carbamazepine is also an antidepressant, sedative and muscle relaxant.** |
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Whare are some drug interactions to be aware of with carbamazepine?
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Decreases effect of Oral Contraceptives!
Also decreases evect of some antibiotics along with warfarin (a blood thinner). |
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__________ are a group of anticonvulsants that are NOT structurally related to any other agent.
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Valproates
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What is another name for valproates?
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valporic acid
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What are the most frequent adverse reactions of valproates?
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GI upset…indigestion, nausea & vomiting
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As far as adverse reactions go for valproate, what can be said about bleeding? Birth defects?
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Bleeding time may increase.
Birth defects my increase as well. *Be aware of hepatotoxicity & CNS sedations* |
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Phenobarbital is the _______ __________ barbiturate used in the Tx of __________.
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Most Common
Epilepsy |
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Phenytoin is also used to treat both tonic-clonic & partial seizures w/complex symptoms. What are some Adverse CNS effects of phenytoin?
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Mental confusion, slurred speech, blurred vision, ataxia
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What are some negative dermatologic effects of phenytoin?
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Effects can range from rash to exfoliative dermatitis, lupus erythematous or Stevens-Johnson syndrome.
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What vitamin deficiency may accompany phenytoin use?
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Vitamin D & folate.
Avoid giving this to kids. Can also cause some birth defects (teratogenicity) |
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From a dental perspective, what is a major adversie reaction of phenytoin?
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Gingival enlargement or hyperplasia.
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The better a Pt's oral hygiene the ________ severe gingival hyperplasia is likely to be.
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Less severe.
*This condition is hard to control even with good oral hygiene.* |
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The etiology of phenytoin is ________.
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unknown.
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What is the drug of choice for absence seizures?
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Ethosuximide.
If this drug doesn't work the clonazepam is often utilized. |
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Which drug should be reserved for use only if the seizures are refractory to other anticonvulsant agents?
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Felbamate
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What drug has an advantage over other anticonvulsants because it is not metabolized?
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Gabapentin
(Its eliminated unchanged by the renal system-->this med is good if Pt has liver problems or is using other medications…won't interact with them since not metabolized.) |
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Several anticonvulsants are used to manage ________ pain syndromes.
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chronic pain syndromes.
They are also used in the Tx of certain mental disorders! |
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What is an inverse agonist?
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It causes the opposite action of the agonist.
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What is the only agonist-antagonist opiod available in oral form?
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pentazocine
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What is an agonist?
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It binds to the receptor and fully activates it according to its ligand.
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What are some non-seizure related used of anticonvulsants?
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Neurologic pain & Psychiatric use
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What are some of the possible etiologies for seizure?
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Infection,
trauma, toxcity to exogenous agents, genetic or birth influences |
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Most Pt's have __________ epilepsy; the cause is unknown.
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idiopathic
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If it’s the first time a Pt has had a seizure, where do they need to go?
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To the Hospital!
Need to determine what happened to have a seizure. |
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What are the 2 major groups of epileptic seizures?
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Generalized & Partial
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How are partial seizures classified? (2 classes)
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Simple Partial & Complex Partial
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What are the 2 most common types of generalized seizures?
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Tonic-Clonic & Absence seizures
*Remember-->Tonic=Rigid & Clonic=Shaking* |
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What are the classic signs of an absence seizure?
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A brief loss of consciousness and little movement.
(There are EEG waves) |
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What population is usually affected by absence seizures?
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Childhood…they tend to disappear during middle age. *Remember the Pt is usually unaware they are haviang these seizures.*
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Describe the aura or postictal state of absence seizures.
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They don't have an aura or postictal state.
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What is another name for an absence seizure?
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Petit Mal
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What is lost in both absence and tonic-clonic seizures?
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Consciousness.
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What are the 2 most common types of generalized seizures?
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Tonic-Clonic & Absence seizures
*Remember-->Tonic=Rigid & Clonic=Shaking* |
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Which muscles are most impacted by a tonic-clonic seizure?
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The major or large muscles of the body.
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What are some non-seizure related uses of anticonvulsants?
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Neurologic Pain & Psychiatric use
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What are the classic signs of an absence seizure?
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A brief loss of consciousness and little movement.
(There are EEG waves) |
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What population is usually affected by absence seizures?
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Childhood…they tend to disappear during middle age.
*Remember the Pt is usually unaware they are haviang these seizures.* |
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What is another name for an absence seizure?
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Petit Mal
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Antagonist?
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Substance that binds but does not activate it.
(2 types Competitive and Non-competitive) |
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What is a mixed opioid?
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It has both agonist and antagonist properties.
*Their place in dentistry is unclear.* |
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What is mixed with pentazocine to give it the antagonist properties?
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naloxone (Narcan)
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naloxine is effective ____________ but not orally because it is deactivated by stomach enzymes.
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parenterally.
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What is the 1st and only partial agonist?
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What is the 1st and only partial agonist?
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naloxine (Narcan) is a ______ opioid antagonist.
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PURE.
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What is the drug of choice for Tx anonist or mixed opioid overdoses?
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naloxone (Narcan) It will reverse opioid-induced respiratory depression.
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What is the duration of naloxone?
What does this mean if the opiod drug you're reversing has a longer duration? |
45 minutes
Will need to give more naloxine otherwise the opioid will re-attach to the receptor site and be activated again. |
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Which receptor sites is naloxine impacting?
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Mu, Kappa & Delta….will reverse any drug attached to them.
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The advent of __________ (type of drug) has changed the use of opioids in dental practice.
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NSAID's
*Most dental pain can be managedwith NSAID's . In Pt's that are contraindiated for NSAIDS then an opiod can be utilized.* |
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Tylenol is another name for ___________.
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Acetaminophen!
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______________ is the only memberof the p-aminophenols currently available for clinical use?
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acetaminophen
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Where is acetaminophen rapidly and completely absorbed from?
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The GI track
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Asprin has the same __________ & __________ effects as acetaminophen?
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antipyretic & analgesic
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With large doses of tylenol a _________ is produced that is thought to be _________toxic.
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(intermediate) metabolite hepatotoxic.
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What is the limiting factor of vicodin?
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Acetaminophen!
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What can be said about the anti-inflammatory effect of tylenol?
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Doesn't have any real anti-inflammatory effect.
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How should toxic doses of tylenol be treated?
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With a lavage (flushing of the system) 20-25grams can create toxicity.
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Tylenol is especially useful in Pt's who have _________ hypersensitivity?
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Asprin
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What is a good target, "sweet-spot" dose of tylenol?
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500-1000mg's
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