Gingival hyperplasia

Phenytoin s absorption is slow and variable yet almost complete absorption eventually occurs after po dosing. More than 90% of the dmg is bound to plasma protein. Peak plasma concentrations are achieved in 1.5—3 h. Therapeutic plasma concentrations are 10—20 lg/mL but using fixed po doses, steady-state levels are achieved in 7—10 days. Phenytoin is metabolized in the fiver to inactive metabolites. The plasma half-life is approximately 22 h. Phenytoin is excreted primarily in the urine as inactive metabolites and <5% as unchanged dmg. It is also eliminated in the feces and in breast milk (1,2). Prolonged po use of phenytoin may result in hirsutism, gingival hyperplasia, and hypersensitivity reactions evidenced by skin rashes, blood dyscrasias, etc... 

Amlodipine Hypotension, dependent peripheral edema, gingival hyperplasia BP every shift during oral administration during hospitalization, then every 6 months following hospital discharge dental exam and teeth cleaning every 6 months... 

Cyclosporine (Sandimmune , 4-5 mg/kg by mouth twice Neurotoxicity, gingival hyperplasia, Sandimmune ... 

Gingival hyperplasia + + Patient education appropriate dental... 

Hypertension Calcium channel blockers ACE inhibitors ARBs Diltiazem, verapamil inhibit CSA/TAC metabolism Dihydropyridines may potentiate CSA-gingival hyperplasia May exacerbate hyperkalemia monitor K+, SCr to assess for renal allograft vascular disease may be useful in posttranplant erythrocytosis (hematocrit greater than 55%)... 

Phenytoin Nystagmus, gingival hyperplasia, ataxia, hirsutism... 

The answer is g. (KatzungT pp 399-400J Phenytoin is one of the most commonly used antiepileptic agents. Chronic administration has been reported to cause adverse reactions, such as ataxia, dizziness, nystagmus, gingival hyperplasia, hirsutism, and megaloblastic anemia. 

Cyclosporine reduces production of cytokines involved in T-cell activation and has direct effects on B cells, macrophages, bone, and cartilage cells. Its onset appears to be 1 to 3 months. Important toxicities at doses of 1 to 10 mg/kg/day include hypertension, hyperglycemia, nephrotoxicity, tremor, GI intolerance, hirsutism, and gingival hyperplasia. Cyclosporine should be reserved for patients refractory to or intolerant of other DMARDs. It should be avoided in patients with current or past malignancy, uncontrolled hypertension, renal dysfunction, immunodeficiency, low white blood cell or platelet counts, or elevated Ever function tests. 

Short-acting nifedipine may rarely cause an increase in the frequency, intensity, and duration of angina in association with acute hypotension. This effect may be obviated by using sustained-released formulations of nifedipine or other dihydropyridines. Other side effects of dihydropyridines include dizziness, flushing, headache, gingival hyperplasia, and peripheral edema. Side effects due to vasodilation such as dizziness, flushing, head-... 

Cyclosporine demonstrates immunosuppressive activity by inhibiting the first phase of T-cell activation. It also inhibits release of inflammatory mediators from mast cells, basophils, and polymorphonuclear cells. It is used in the treatment of both cutaneous and arthritis manifestations of severe psoriasis. The usual dose is between 2.5 and 5 mg/kg/day given in two divided doses. Adverse effects include nephrotoxicity, hypertension, hypomagnesemia, hyperkalemia, alterations in liver function tests, elevations of serum lipids, GI intolerance, paresthesias, hypertrichosis, and gingival hyperplasia. Cumulative treatment for more than 2 years may increase the risk of malignancy, including skin cancers and lymphoproliferative disorders. 

Common but usually transient side effects are lethargy, incoordination, blurred vision, higher cortical dysfunction, and drowsiness. At concentrations greater than 50 mcg/mL, phenytoin can exacerbate seizures. Chronic side effects include gingival hyperplasia, impaired cognition, hirsutism, vitamin D deficiency, osteomalacia, folic acid deficiency, carbohydrate intolerance, hypothyroidism, and peripheral neuropathy. 

Gingival hyperplasia Antiepileptics (phenytoin), immunosuppressant drugs, calcium channel antagonists (felodipin, amlodipin, nifedipin)... 

Coarse facial features, gingival hyperplasia, macroglossia... 

Gastroenteritis inflammatory condition of the stomach Gingival hyperplasia gum tissue overgrowth Glaucoma a raised intraocular pressure... 

Gingival hyperplasia Gingival hyperplasia occurs frequently with phenytoin. 

Cyclosporine has no myelotoxicity but the drug is nephrotoxic. It is because of this nephrotoxicity that cyclosporine has a narrow therapeutic index that makes blood level monitoring necessary. Other toxicities include hypertension, hepatotoxicity, neurotoxicity, hirsutism, gingival hyperplasia and gastrointestinal disturbances. 

Acne, leg cramps, gingival hyperplasia (marked by red, bleeding, and tender gums), paresthesia, diarrhea, nausea, vomiting, headache Rare (less than 1 %)... 

Drowsiness, lethargy, confusion, slurred speech, irritability, gingival hyperplasia, hypersensitivity reaction, including fever, rash, and lymphadenopathy, constipation, dizziness, nausea Occasional... 

Adverse effects include headache ankle edema, hypotension, dizziness, flushing, weight gain, nausea, GI disturbances including anorexia, nausea, vomiting, constipation diarrhoea and taste disturbances. Occasionally there is gingival hyperplasia, skin rash and transient elevation in liver enzyme values. 

Adverse effects include nephrotoxicity, hypertension, tremor, seizures, increased incidence of infections, gingival hyperplasia, hirsutism, flushing, paraesthesias, tinnitus, headache, gynaecomastia and conjunctivitis. It has no toxic effects on bone marrow and RE system. 

---