Deck 16: Drugs for the Treatment of Seizure Disorders

Question 1

_____ is noted for having cross-sensitivity with carbamazepine in 20% to 30% of patients.

A) Lamotrigine
B) Valproate
C) Levetiracetam
D) Oxcarbazepine

Answer 1

Oxcarbazepine

Question 2

Which agent has a narrow therapeutic index because its metabolism is a saturable process?

A) Gabapentin
B) Phenobarbital
C) Phenytoin
D) Valproic acid
E) Clonazepam

Answer 2

Phenytoin

Question 3

Gingival enlargement as a consequence of phenytoin therapy most commonly affects the _____ facial gingiva.

A) maxillary anterior
B) maxillary posterior
C) mandibular anterior
D) mandibular posterior

Answer 3

maxillary anterior

Question 4

Seizures characterized by a duration for longer than 30 minutes are called _____ seizures.

A) akinetic
B) complex
C) status epilepticus
D) myoclonic
E) simple (Jacksonian)

Question 5

Fetal hydantoin syndrome is associated with maternal ingestion of:

A) carbamazepine.
B) phenobarbital.
C) phenytoin.
D) gabapentin.

Question 6

Which antiepileptic medication has been known to produce osteomalacia?

A) Carbamazepine
B) Phenytoin
C) Ethosuximide
D) Gabapentin
E) Lamotrigine

Question 7

Which of the following drugs is often used first for treating patients with generalized tonic-clonic seizures even though it is not Food and Drug Administration (FDA)approved for this use?

A) Lamotrigine
B) Valproate
C) Levetiracetam
D) Oxcarbazepine

Question 8

Which of the following seizures are categorized as generalized seizures?

A) Absence seizures
B) Simple (Jacksonian)seizures
C) Tonic-clonic seizures
D) Both a and c
E) Both b and c

Question 9

Valproate is associated with toxicity of which of the following organs?

A) Heart
B) Kidney
C) Liver
D) Pancreas

Question 10

Performing laboratory tests is necessary to monitor patients who are taking carbamazepine. The dental team should observe the oral cavity for petechiae or signs of infections.

A) Both the statement and the reason are correct and related.
B) Both the statement and the reason are correct, but they are not related.
C) The statement is correct, but the reason is not.
D) The statement is not correct, but the reason is accurate.
E) Neither the statement nor the reason is correct.

Question 11

Lamotrigine (Lamictal)belongs to which of the following classes of antiepileptic drugs?

A) Inhibitor of uptake of GABA
B) Inactivates sodium channels
C) Stabilizes neuronal membranes
D) Antagonist to glycine
E) Unknown mechanism of action

Question 12

Which of the following antiepileptic drugs is commonly used as monotherapy for partial onset and generalized tonic-clonic seizures and may be effective for children with Lennox-Gastaut syndrome?

A) Levetiracetam (Keppra)
B) Carbamazepine (Tegretol)
C) Oxcarbazepine (Trileptal)
D) Phenytoin (Dilantin)

Question 13

Gingival enlargement may occur in what percentage of chronic users of phenytoin?

A) 10%
B) 30%
C) 50%
D) 90%
E) None of the above

Question 14

Which of the following statements is true of absence seizures and tonic-clonic seizures?

A) Both types of seizures involve the loss of consciousness.
B) Consciousness returns gradually after an absence seizure, which is a major problem for the dental team.
C) Tonic-clonic seizures are not treated with medication.
D) Both a and b are true.
E) Both b and c are true.

Question 15

Alopecia may be observed as an adverse effect of phenytoin, and carbamazepine can cause hirsutism.

A) Both parts of the statement are true.
B) Both parts of the statement are false.
C) The first part of the statement is true; the second part is false.
D) The first part of the statement is false; the second part is true.

Question 16

All of the following statements are true of absence seizures except which one?

A) Seizures last a few seconds.
B) No loss of body tone occurs.
C) The patient us usually unaware that the seizure is happening.
D) A drug of choice for treatment is ethosuximide.
E) To avoid trauma, tongue blades should not be used in the oral cavity.

Question 17

Which of the following statements is true concerning epilepsy?

A) Epileptic seizures can be recorded on electrocardiogram.
B) Seizure activities are estimated to affect approximately 10% of the population.
C) The majority of epileptic patients have idiopathic epilepsy.
D) The most common generalized seizures are temporal lobe (psychomotor).

Question 18

Which of the following agents interferes with platelets?

A) Carbamazepine
B) Valproic acid
C) Ethosuximide
D) Both a and b
E) Both a and c

Question 19

Which antiepileptic agent is commonly prescribed for trigeminal neuralgia?

A) Lamotrigine
B) Phenytoin
C) Gabapentin
D) Carbamazepine
E) Valproic acid

Question 20

Which of the following statements is true regarding adverse reactions to antiepileptic agents?

A) These medications have a broad therapeutic index.
B) CNS depression is a common side effect of antiepileptic agents.
C) Central nervous system (CNS)depression will antagonize that of other sedative agents.
D) Both a and b are true.
E) Both b and c are true.

Question 21

Which of the following antiepileptics may be used to manage trigeminal neuralgia?

A) Phenytoin
B) Carbamazepine
C) Ethosuximide
D) Valproic acid

Question 22

The cause of phenytoin gingival enlargement is:

A) inhibition of fibroblast activity.
B) accumulation of hemosiderin.
C) alteration of chemotaxis.
D) unknown.

Question 23

The better the patient's oral hygiene is, the less likely that lesions associated with use of phenytoin will occur.

Question 24

Which of the following are true regarding the dental management of patients taking antiepileptic agents? (Select all that apply.)

A) Antiepileptic agents will exacerbate CNS depression due to other drugs.
B) Antiepileptic agents may cause additive gastrointestinal adverse reactions.
C) Antiepileptic agents may cause some other drugs to be metabolized more slowly causing cumulative effects.
D) Antiepileptic agents will not interact with pain medications or antibiotics used in dentistry.

Question 25

Clonazepam (Klonopin)is:

A) a chemical analogue carbamazepine.
B) used parenterally to treat status epilepticus.
C) used as an adjunct to treat ethosuximide-resistant absence seizures.
D) not effective in akinetic seizures.
E) an inhibitor of sodium channels.

Question 26

Surgical intervention to reduce phenytoin-induced gingival enlargement should wait until at least 18 months after cessation of therapy because:

A) the drug remains in circulation for at least 2 years.
B) some patients experience additional reduction in the enlargement after the 1-year period.
C) excessive sclerosis will result from earlier intervention.
D) treating the situation earlier than that will lead to excessive hemorrhage.

Question 27

A patient experiencing tonic-clonic seizures should be managed by:

A) lowering the patient's head in the dental chair until it is even with the heart.
B) tilting the patient's head to one side to prevent aspiration.
C) placing a tongue blade or a pencil between the patient's teeth.
D) having the patient place his or her head between the knees.

Question 28

Vitamin C is an effective adjunctive therapy for gingival enlargement.

Question 29

Ethosuximide is the drug of choice for the treatment of _____ seizures.

A) generalized tonic-clonic
B) generalized absence
C) partial simple
D) partial complex

Question 30

Lamotrigine is an effective treatment for myoclonic seizures.