When the nurse notices gingival hypertrophy, which indicates a side effect of one of the following drugs?

BHU NO - 12 April 2024

Pharmacology

Easy

Appeared in: BHU NO - 12 April 2024

Explanation

Anticonvulsants, particularly phenytoin, are a well-documented cause of gingival hypertrophy.
The mechanism involves the drug's direct stimulatory action on gingival fibroblasts, which leads to an overproduction of collagen in the gum tissue.
This adverse effect is quite common, occurring in 10-30% of patients treated with phenytoin.
Other drug classes known to cause this condition include calcium channel blockers (e.g., nifedipine) and immunosuppressants (e.g., cyclosporine).

Option A: Corticosteroids are not associated with gingival hypertrophy. Their common oral side effects include an increased risk of oral candidiasis (thrush) due to their immunosuppressive effects.
Option B: Oral hypoglycemic agents, used to manage diabetes, are not linked to gingival hypertrophy. Their primary side effects relate to blood sugar levels (hypoglycemia), gastrointestinal upset, or weight changes.
Option D: Lipid-lowering drugs, such as statins, do not cause gingival hypertrophy. Their most significant side effects include muscle pain (myopathy) and potential elevation of liver enzymes.

Clinical Relevance

Nursing practice connection: Knowing Adverse effects of pharmacological agents, specifically drug-induced gingival hypertrophy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a vital role in patient education for those starting anticonvulsant therapy. It is essential to teach them about the risk of gingival hypertrophy and the critical importance of meticulous oral hygiene and regular dental check-ups to prevent or minimize this complication.
A thorough oral assessment should be a routine part of the nursing care plan for any patient on long-term phenytoin or other causative medications.
What if? If the patient were taking nifedipine (a calcium channel blocker for hypertension) instead of an anticonvulsant, the finding of gingival hypertrophy would still be a valid drug-related concern, as this is another major class of medications known to cause this side effect.

How to Approach the Question

First, analyze the image to identify the prominent clinical sign, which is severely swollen and overgrown gums.
Recognize this condition by its medical term: gingival hypertrophy or gingival hyperplasia.
Read the question carefully, which asks to identify the drug class responsible for this specific side effect.
Systematically review the known major side effects of each drug class listed in the options.
Recall the classic and strong association between the anticonvulsant drug phenytoin and gingival hypertrophy.
Eliminate the other options, as corticosteroids, oral hypoglycemics, and lipid-lowering drugs are not known to cause this condition.

Concept Tested & Keywords

Concept Tested: Adverse effects of pharmacological agents, specifically drug-induced gingival hypertrophy.
Stem keywords: gingival hypertrophy, side effect, drug
Lead-in keywords: which indicates
Clinical cues: The visual presentation of swollen, overgrown gums is the key clinical sign.

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E6 Medicine Harrison 22e Part 1 p. 302-304

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 28-30, 27-29