tag:blogger.com,1999:blog-8005913307053669259.post8369534436308698842..comments2024-03-10T03:33:29.698-04:00Comments on Medicowesome: Study group discussion: Why more phenytoin is prescribed at night IkaN (Nakeya Dewaswala, M.D.)http://www.blogger.com/profile/03461017124502223040noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-8005913307053669259.post-7491332344563370542015-09-16T07:36:28.226-04:002015-09-16T07:36:28.226-04:00Thank you for sharing this with us! :)Thank you for sharing this with us! :)IkaN (Nakeya Dewaswala, M.D.)https://www.blogger.com/profile/03461017124502223040noreply@blogger.comtag:blogger.com,1999:blog-8005913307053669259.post-21879500262874666432015-09-16T05:27:04.927-04:002015-09-16T05:27:04.927-04:00 The interaction of phenytoin, cyclosporine, and n... The interaction of phenytoin, cyclosporine, and nifedipine with epithelial keratinocytes, fibroblasts, and collagen can lead to an overgrowth of gingival tissue in susceptible individuals. Phenytoin has been shown to induce gingival overgrowth by its interaction with a sub-population of sensitive fibroblasts. Cyclosporine has been suggested to affect the metabolic function of fibroblast (eg, collagen synthesis, breakdown), whereas nifedipine, which potentiates the effect of cyclosporine, reduces protein synthesis of fibroblasts. A review of existing literature shows that a cofactor clearly is needed to induce gingival overgrowth. In fact, several lines of evidence point to a modulation of inflammatory processes.<br />Collagen fibers are degraded by two pathways: the extracelular one, which occurs by secretion of collagenases; and the intracellular one, by collagen phagocytosis by fibroblasts . In this regard, a common property of the 3 main classes of drugs that induce GO—antiepileptic agents, immunosuppressants and calcium channel blockers—is that they affect calcium metabolism. These drugs induce a decrease in the Ca2+ cell influx (due to changes in the sodium-calcium exchange) leading to a reduction in the uptake of folic acid, thus limiting the production of active collagenase. Hence the problem is not overproduction ,but decrease in degradationAnonymoushttps://www.blogger.com/profile/11745235062971628878noreply@blogger.com