Anti-Convulsant Meds

Question 1

Tonic-Clonic Seizures

Answer 1

• Tonic: muscle stiffening
• Clonic: muscle jerking
• Tonic-clonic seizure: motor seizure involving muscle stiffening (tonic phase) and jerking (clonic phase)
  
  • Generalized onset
  • Involves both brain hemispheres
  • Results in impaired awareness

Question 2

Valproic Acid MOA

Answer 2

Suppresses sodium/Na+ influx into cells ⇒ inhibits action potentials excitatory neurons ⇒ stabilizes cell membranes ⇒ reduces neuronal firing and limits seizures

Question 3

Carbamazepine Electrolyte Imbalances

Answer 3

↑ risk for HYPOnatremia bc it’s suppressing sodium influx ⇒ monitor Na+ lvls

Question 4

General Nurs Considerations for Anti-Epileptic Drugs (AED)

Answer 4

• Oral contraceptive effectiveness decreased
• Monitoring plasma drug lvls: make sure it’s therapeutic (within range)
• Promoting pt adherence: same time, same day, everyday
• Prevent abruptly stopping AEDs: need to be gradually tapered off bc withdrawals will occur
  
  • In severe withdrawal cases → need to be put in medically induced coma to calm brain down
• Suicide risk monitoring: some AEDs linked to suicidal thoughts, depression, anxiety ⇒ requires prompt intervention
• Avoid EtOH

Question 5

Phenytoin (Sodium Channel Blocker) Nurs Considerations

Answer 5

• Need to draw frequent blood tests to assess therapeutic range
• Gingival hyperplasia risk ⇒ encourage good oral care & dental visits
• Avoid milk and antacids bc they decrease Phenytoin absorption
• Take w/ food
• Toxicity signs: ataxia, slurred speech, nystagmus, vomiting

Question 6

Carbamazepine (Sodium Channel Blocker) Nurs Considerations

Answer 6

• Teratogenic: relating to, or causing, developmental malformations in fetus
• Monitor WBCs and platelet count bc this can cause agranulocytosis ⇒ pt at risk for infection
• Monitor sodium bc this increases risk of HYPOnatremia
• Avoid grapefruit juice
• Report Sxs of pancreatitis: upper abdominal pain, anorexia, NV

Question 7

Valproic Acid (Sodium Channel Blocker) Nurs Considerations

Answer 7

• Can cause lots of weight gain !!! ⇒ contributes to metabolic syndrome ⇒ caution pts
• Avoid all EtOH consumption bc this is alrdy a CNS depressant
• Hepatotoxic ⇒ monitor LFTs
• Monitor WBCs and platelet count
• Teratogenic: high birth defects

Question 8

Phenobarbital (Barbiturates) Nurs Considerations

Answer 8

• Watch for resp depression and sedation or coma w/ high dosages
• Can develop addiction for this ⇒ try to use only for short period as a “rescue drug”

Question 9

Lamotrigine (Sodium Channel Blocker) Nurs Considerations

Answer 9

• Increases risk of suicidal thoughts ⇒ report accordingly and educate pt on seeking help immediately
• Watch for worsening depression or mood changes
• Teratogenic
• Don’t abruptly stop