Anti-seizure Meds Ch 23 Flashcards by Shaniya Capre

Describe epilepsy

-Sudden discharge of excessive electrical energy from nerve cells
-May stimulate motor neurons causing contractions/muscle spasms
-Treatment depends on type of seizure and manifestations

Manifestation of seizures depends on:
-Location of cells initiating electrical impulse
-Pathways that are stimulated

How well did you know this?

Not at all

Perfectly

What is are primary seizures?

-No underlying cause, there isn’t a reasoning its happening

How well did you know this?

Not at all

Perfectly

What is secondary seizures?

-Could be cause by outside factor like head trauma, overdose, but a reasoning that is causing the excessive impulses

How well did you know this?

Not at all

Perfectly

What is a generalized seizure?

-Begins in one area, spreads and involves LOC
-Involves both hemisphere and loss of consciousness
-Multiple classisfications like:
-Tonic clonic
-Absence
-Tonic
-Atonic
-Myoclonic
-Status epilepticus
-Febrile

How well did you know this?

Not at all

Perfectly

What are partial seizures?

-Usually focal origin, does not spread
-Presentations depends on the area of the foci
-Involve one area of the brain,
-Pt can be presenting symptoms depending on where in the brain the seizures are happening

How well did you know this?

Not at all

Perfectly

What is a tonic clonic seizure?

*Generalized seizure
-Motor type seizure with stiffening(tonic) and clonic (jerking)
-Person may have a vague sensation that warns them that the tonic contractions are about to begin

How well did you know this?

Not at all

Perfectly

What are absence seizures?

*Generalized seizure
-Absent seizures, loss of consciousness from 3- 5 seconds
-could be just blinking and blank staring, no motion or contractions

How well did you know this?

Not at all

Perfectly

What are atonic seizures?

Could be generalized or focal
Seizures that causes sudden loss of muscle tone
-Limp in extremities and facial muscles

How well did you know this?

Not at all

Perfectly

What is the myoclonic seizure?

Can be either motor or non motor
-Muscle contractions that can be isolated to the face, trunk, extremity
-More rare and secondary seizures

How well did you know this?

Not at all

Perfectly

What is status epilepticus?

-Seizures happening rapidly with out cognitive recovery in between
-Most sever form of generalized seizures and a medical emergency

How well did you know this?

Not at all

Perfectly

What is a Febrile seizure?

-Mostly occur to children 3 months -6 years old
-High fevers that results in families

How well did you know this?

Not at all

Perfectly

What do drugs that are for generalized seizures do?

-Stabilize nerve membrane by blocking channels in the cell membrane
-Effect mainly the CNS
-Effect the entire brain

How well did you know this?

Not at all

Perfectly

What are drugs used for generalized seizures?

Hydantoins- phenytoin (Dilantin)
Barbituates- phenobarbital (Luminal)
Benzos- diazepam (Valium)
Succinimides- ethosuximide (Zarontin)

How well did you know this?

Not at all

Perfectly

What are Hydantoins used for ?

Generalized seizures

How well did you know this?

Not at all

Perfectly

What is Phenytoin(Dilantin)?

Hydantoins
which is used for generalized seizures

How well did you know this?

Not at all

Perfectly

What is the therapeutic action of Phenytoin(Delantin)?

Hydantoins
-Stabilize nerve membranes throughout the CNS directly by influencing Ionic channels in the cell membrane, stopping sodium movement
-Less sedating than other anti epileptics
-Decreasing excitability and hyperexictlybilty to stimulation

How well did you know this?

Not at all

Perfectly

What are the indications of phenytoin (Dilantin)?

Hydantoins
-Generalized seizures
-Help treat tonic clonic seizures
-Treatment of seizures after surgery
-Prevention of status epilepticus

How well did you know this?

Not at all

Perfectly

What are pharmokinetics of phenytoin (Dilantin)?

Hydantoins
Well absorbed in the GI tract, metabolized in liver, and excreted in urine
-Therapeutic serum levels is 10-20 mcg/mL

How well did you know this?

Not at all

Perfectly

What are adverse effects of phenytoin (Dilantin)?

Hydantoins
-CNS depression (esp when starting med)
Depression, confusion, drowsiness ,legarthy, fatigue, constipation ,dry mouth, anorexia, urinary retention
-Ataxia-seen with overdose/dose regulation
-severe Liver toxicity
-Bone marrow suppression
-Skin reactions
-Gingival hyperplasia(enlargement of gums)
-Dermatological reactions (hirsutism, stevens-Johnson syndrome)

How well did you know this?

Not at all

Perfectly

What are contras for phenytoin (Dilantin)?

Hydantoins
Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities

How well did you know this?

Not at all

Perfectly

What are cautions for phenytoin (Dilantin)?

Hydantoins
Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

How well did you know this?

Not at all

Perfectly

What are drug to drug interaction for phenytoin (Dilantin)?

Hydantoins
ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

How well did you know this?

Not at all

Perfectly

What is administration of phenytoin (Dilantin)?

Hydantoins
Do not stop abruptly! Can induce a seizure! Could put pt into status epilepticus
IV  sloooow, NS only, pain with IVP
Shake bottle well!! if in liquid
-Could be oral or IV

What is phenobarbital (Luminal)?

Barbiturates

What is the therapeutic actions of phenobarbital (Luminal)?

Barbiturates -Inhibits impulses conduction in cerebellum, cerebral cortex, lower brainstem -Decreases CNS excitation, motor response -Reduce the tonic/clonic, muscular and emotional response to stimulation -Not approved by FDA but given in US for emergency situations SCHEDULE 4-risk for addiction and withdrawl

What is the indications of phenobarbital (Luminal)?

-Barbiturates -Generalized seizures

What are adverse effects of phenobarbital (Luminal)?

Barbiturates CNS depression Sedation, hypnosis, anesthesia, respiratory depression, and deep coma **Addiction/ withdrawal

What are contras/cautions of phenobarbital (Luminal)?

Barbiturates -Renal/hepatic dysfunction - Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities -Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

What are drug to drug interactions with phenobarbital (Luminal)?

Barbiturates ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

What is diazepam (Valium)?

Benzodiazepines

What is the therpeutic actions of diazepam (Valium)?

Benzodiazepines -Potentiate the effects of GABA-stabilizing nerve endings, decreasing nerve excitability -Cause muscle relaxations and relieve anxiety -reduce tonic-clonic, muscular, and emotional responses to stimuli

What are indications of diazepam (Valium)?

Benzodiazepines Generalized seizures calm the brain increasing gaba

What is the adverse effects of diazepam (Valium)?

Benzodiazepines -CNS depression: Depression, confusion,drowsiness, lethargy, fatigue, constipation,dry mouth, anorexia, cardiac arrhythmias and changes in blood pressur, urinary retention, loss libido -Physical dependence and withdrawal Watch for paradoxical effects increased talkativeness, emotional release, excitement, and excessive movement SCHEDULE 4-risk for addiction and withdrawl

What is the Contras/cautions of diazepam (Valium)?

Benzodiazepines -Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities -Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

What is the drug-drug interactions of diazepam (Valium)?

ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

What is a drug for Absence seizures?

valproic acid (Depakote)

What is the therapeutic actions of valproic acid (Depakote)?

-May increase GABA activity, reduces electrical activity - For absence seizures

What are indications of valproic acid (Depakote)?

Absence seizures Mania Migraine prevention focal seizures Drugs for Absence Seizures

What are adverse effects of valproic acid (Depakote)?

-CNS depression -Liver toxicity -Follow liver functions (LFTs), esp. first 6 months -Thrombocytpenia -pancreatitis -hyperammonemia Drugs for Absence Seizures

What are contras/cautions of valproic acid (Depakote)?

-Severe liver/renal disease -Pregnancy/lactation (weigh risk) Drugs for Absence Seizures

What are drug-drug of valproic acid (Depakote)?

May potentiate diazepam, barbiturates, anticoag meds Drugs for Absence Seizures

What is a drugs used for partial seizures

gabapentin (Neurontin) levetiracetam (Keppra) lamotrigine (Lamictal **carbamazepine (Tegretol)

What is carbamazepine(Tegretol)?

Drugs Used for Partial Seizures

What is therapeutic actions of carbamazepine(Tegretol)?

Stabilizes nerve endings by altering sodium and calcium channels Increasing activity of GABA

What is Pharmacokinetics of carbamazepine(Tegretol)?

Oral Long half-life (25-65 hrs)

What are adverse effects of carbamazepine(Tegretol)?

-CNS depression -GI effects (N/V, anorexia) -BBW: Increased risk for suicidality -Taper off  risk for sz if sudden withdrawal -Edema -Bone marrow supression

What are contras of carbamazepine(Tegretol)?

Existing bone marrow suppression-not given to pt w bone. Marrow supression Pregnancy/ lactation

How do seizure medications affect children?

May impact on social/learning May be more sensitive to sedation May metabolize meds faster; increase dose by age/kg for control Educate parents, involve children

How do seizure medications affect older adults?

More sensitive to toxic effects, dose reduction

What are ethnic considerations with seizure medications?

Arab/Asian Americans-metabolize differently. Metabolize drugs faster,so increased dose **Cultural considerations- Box 23.3 page 394** Ask about this

Nursing Considerations: Anti-Seizure medications What should you assess?

Allergies Co-morbidities Pregnancy/ lactation status Description of sz. Ask how frequently nd duration VS, Neuro assessment Physical assessment Labs

Nursing Considerations: Anti-Seizure medications What are nursing diagnosis?

Risk for injury r/t CNS effects of medication Disturbed thought process r/t CNS effects Risk for infection r/t bone marrow suppression

Nursing Considerations: Anti-Seizure medication What are implementations?

Discontinue medication for toxic effects Educate pt on administration: Administer with food (if GI upset) Take regularly, same time each day Do not abruptly stop! Do not crush, chew, open extended-release forms Monitor for adverse effects Educate pt on adverse effects and when to notify PCP Monitor CBC, LFTs, therapeutic drug levels Provide safety measures to protect against injury/ falls Suggest wearing medic-alert bracelet Pregnancy counseling Dental/ mouth care (phenytoin)

Nursing Considerations: Anti-Seizure medication What should you evaluate?

Patient compliance Seizure control