Anticonvulsant Medication Info Flashcards
1
Q
Many anticonvulsants require _____ monitoring
A
blood
2
Q
Anticonvulsants are used for what? (2)
A
Long term management of chronic epilepsy
Management of seizures not cause by epilepsy
3
Q
Off label uses for Anticonvulsants? (4)
A
Anxiety
Bipolar disorder
Chronic pain
Migraines
4
Q
what anticonvulsant med can cause GI side effects?
A
Gabapentin (Neurontin)
5
Q
Anticonvulsants are categorized by what?
A
their mechanism of action
(ex: sodium channel blocker, calcium channel blocker, GABA enhancer, glutamate blocker)
6
Q
what type of Anticonvulsant prevents the rapid firing of neurons?
A
sodium channel blockers
7
Q
what type of Anticonvulsant slows down the flow of calcium into cells, limiting the development of action potentials?
A
calcium channel blockers
8
Q
what type of Anticonvulsant enhances inhibitory effects, making neurons less likely to fire?
A
GABA enhancers
9
Q
what type of Anticonvulsants prevent excitatory signaling by binding to and blocking glutamate?
A
glutamate blockers
10
Q
what anticonvulsant meds can be used for anxiety? (2)
A
1) Gabapentin (Neurontin)
2) Lorazepam (Ativan)
11
Q
Why should someone taking an Anticonvulsants never stop abruptly?
A
it can trigger a recurrence of seizures
12
Q
For which anticonvulsant med is there NO drug monitoring needed? Why?
A
Gabapentin (Neurontin) because it has a very wide dose range
13
Q
What are broad spectrum anticonvulsants used for?
A
effective for tx of focal and generalized seizures
14
Q
what are narrow spectrum anticonvulsants used for?
A
used primarily for focal-onset seizures (including focal which evolve to b/ convulsive seizures)
15
Q
what anticonvulsant med may enhance CI influx which makes cell more negative and harder for cell to generate action potential?
A
GABA enhancers
16
Q
what anticonvulsant prevent return of the channel to active state, stabilizes them, and keeps in inactive state?
A
sodium channel blockers
17
Q
what type of anticonvulsant med inhibits slow depolarization which is needed for spike-wave bursts?
A
calcium channel blockers
18
Q
Some GABA enhancers decrease what?
A
some decrease metabolism of GABA so more is available
19
Q
What type of anticonvulsant med is Phenytoin (Dilantin)?
A
sodium channel blocker
20
Q
for which anticonvulsant med should their be caution in those with a hx of addiction?
A
Gabapentin (Neurontin)
21
Q
How is Phenytoin (Dilantin) given?
A
PO, IM or IV
22
Q
what anticonvulsant med can be given for panic attacks?
A
Lorazepam (Ativan)
23
Q
What is the therapeutic range for Phenytoin (Dilantin)?
A
10-20 mcg/mL
24
Q
What anticonvulsant med is indicated for focal seizures?
A
Topiramate (Topamax)
25
What must be done if Phenytoin (Dilantin) is administered IV? (2)
- give normal saline bc phenytoin can be very irritating to veins
- infuse over 30-60 mins
26
What anticonvulsants cause drowsiness? (2)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
27
what meds are phenobarbitals?
solfoton & luminal
28
what anticonvulsants cause ataxia? (3)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Lamotrigine (Lamictal)
29
What is Phenobarbital (Solfoton, Luminal) classified as?
a barbiturate
30
what anticonvulsant meds can cause fatigue? (2)
1) Gabapentin (Neurontin)
2) Topiramate (Topamax)
31
when will doses of Gabapentin (Neurontin) be very high?
for pain control
32
What anticonvulsants are indicated for partial seizures? (8)
1) Valproic Acid/ Valproate (Depakote)
2) Carbamazepine (Tegretol)
3) Oxycarbazepine (Trileptal)
4) Gabapentin (Neurontin)
5) Lamotrigine (Lamictal)
6) Levetiracetam (Keppra)
7) Phenytoin (Dilantin)
8) Topiramate (Topamax)
33
what anticonvulsants are indicated for status epilepticus? (4)
1) Phenytoin (Dilantin)
2) Lorazepam (Ativan)
3) Diazepam
3) Phenobarbital (Solfoton, Luminal)
34
what anticonvulsant med requires slow withdrawal?
Gabapentin (Neurontin)
35
what anticonvulsant has a very long half life? what does this mean?
Phenobarbital (Solfoton, Luminal)
it stays in the body longer
36
what is the drug of choice for partial seizures?
Carbamazepine (Tegretol)
37
what anticonvulsant meds cause irritability? (2)
1) Phenytoin (Dilantin)
2) Levetiracetam (Keppra)
38
what anticonvulsant med is indicated for new onset epilepsy?
Gabapentin (Neurontin)
39
What is the drug of choice for status epilepticus?
Lorazepam (Ativan)
40
What anticonvulsant meds cause sedation? (5)
1) Phenobarbital (Solfoton, Luminal)
2) Carbamazepine (Tegretol)
3) Valproic Acid/ Valproate (Depakote)
4) Topiramate (Topamax)
5) Lorazepam (Ativan)
41
what anticonvulsant causes visual problems?
Phenytoin (Dilantin)
42
what anticonvulsant meds can cause dizziness? (3)
1) Valproic Acid/ Valproate (Depakote)
2) Lamotrigine (Lamictal)
3) Ethosuximide (Zarontin)
43
what is the drug of choice for generalized tonic-clonic seizures?
Carbamazepine (Tegretol)
44
what anticonvulsants can cause diplopia? (3)
1) Phenobarbital (Solfoton, Luminal)
2) Carbamazepine (Tegretol)
3) Lamotrigine (Lamictal)
45
what anticonvulsant med is used for generalized seizures in children older than 2?
Lamotrigine (Lamictal)
46
which anticonvulsant med is used as "add on therapy" ?
Zonisamide (Zonegran)
47
what anticonvulsant causes peripheral neuropathy?
Phenytoin (Dilantin)
48
what anticonvulsants are indicated for generalized tonic-clonic seizures? (8)
1) Carbamazepine (Tegretol)
2) Phenytoin (Dilantin)
3) Valproic Acid/ Valproate (Depakote)
4) Topiramate (Topamax)
5) Phenobarbital (Solfoton, Luminal)
6) Levetiracetam (Keppra)
7) Oxycarbazepine (Trileptal)
8) Zonisamide (Zonegran)
49
what anticonvulsant can cause pancreatitis?
Valproic Acid/ Valproate (Depakote)
50
What anticonvulsant med can be used for chronic neuropathic pain?
Gabapentin (Neurontin)
51
which anticonvulsant causes cognitive skill impairment? which causes cognitive dysfunction?
Phenobarbital (Solfoton, Luminal)
Topiramate (Topamax)
52
what anticonvulsant has a similar mechanism of action to phenytoin?
Carbamazepine (Tegretol)
53
what anticonvulsant works to stabilize the neurons from becoming too excited?
Phenytoin (Dilantin)
54
when is Gabapentin (Neurontin) often given? why?
it is often given at night because it can cause fatigue
55
for which anticonvulsant must sudden withdrawal be avoided?
Valproic Acid/ Valproate (Depakote)
56
what anticonvulsant inactivates fast sodium channels leading to enhanced GABA effects and decreased glutamate release?
Phenobarbital (Solfoton, Luminal)
57
what anticonvulsant is indicated for myoclonic seizures?
Valproic Acid/ Valproate (Depakote)
58
what anticonvulsants can cause nausea and vomiting? (5)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Valproic Acid/ Valproate (Depakote)
4) Lamotrigine (Lamictal)
5) Ethosuximide (Zarontin)
59
what anticonvulsant meds can cause respiratory depression? (2)
1) Phenobarbital (Solfoton, Luminal)
2) Lorazepam (Ativan)
60
what anticonvulsant med can be used for headaches?
Gabapentin (Neurontin)
61
what type of anticonvulsant is Carbamazepine (Tegretol)?
sodium channel blocker
62
What anticonvulsant med can be used for migraine headaches?
Topiramate (Topamax)
63
What is the biggest side effect when taking Gabapentin (Neurontin)?
mental cloudiness
64
what anticonvulsant can cause increased ammonia levels?
Valproic Acid/ Valproate (Depakote)
65
what anticonvulsants stop the spread of seizure activity in the motor cortex? (2)
Phenytoin (Dilantin)
Carbamazepine (Tegretol)
66
what anticonvulsants can cause headaches? (4)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Lamotrigine (Lamictal)
4) Ethosuximide (Zarontin)
67
what anticonvulsant needs to be kept in a dry location (NOT a bathroom)?
Carbamazepine (Tegretol)
68
what anticonvulsants can cause hypotension? (3)
1) Phenytoin (Dilantin)
2) Phenobarbital (Solfoton, Luminal)
3) Levetiracetam (Keppra)
69
what anticonvulsant is highly (90%) protein bound? what does this mean?
Phenytoin (Dilantin)
it has a higher risk for drug interactions
70
what anticonvulsant med can cause depression?
Levetiracetam (Keppra)
71
what anticonvulsant is indicated for trigeminal neuralgia?
Carbamazepine (Tegretol)
72
what anticonvulsant can cause arrhythmias?
Phenytoin (Dilantin)
73
what anticonvulsant med can cause tremors?
Gabapentin (Neurontin)
74
what anticonvulsant inactivates fast sodium channels and is a GABA enhancer?
Valproic Acid/ Valproate (Depakote)
75
what anticonvulsant med can be used for hiccups?
Gabapentin (Neurontin)
76
what anticonvulsant can cause hyperactivity and inattention in children?
Phenobarbital (Solfoton, Luminal)
77
what anticonvulsants are indicated for bipolar disorder? (2)
1) Carbamazepine (Tegretol)
2) Valproic Acid/ Valproate (Depakote)
78
what anticonvulsants can cause suicidal thoughts? (6)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Oxycarbazepine (Trileptal)
4) Valproic Acid/ Valproate (Depakote)
5) Gabapentin (Neurontin)
6) Levetiracetam (Keppra)
79
what anticonvulsants are contraindicated in absence seizures bc they may worsen them? (2)
1) Carbamazepine (Tegretol)
2) Oxycarbazepine (Trileptal)
80
what anticonvulsant med can be used for alcohol withdrawal?
Gabapentin (Neurontin)
81
what anticonvulsant can lead to physical dependence?
Phenobarbital (Solfoton, Luminal)
82
What anticonvulsant is used as adjunctive therapy or monotherapy for partial seizures in children and adults?
Oxycarbazepine (Trileptal)
83
what anticonvulsants are contraindicated in myoclonic seizures bc they may worsen them? (3)
Carbamazepine (Tegretol)
Oxycarbazepine (Trileptal)
Gabapentin (Neurontin)
84
what anticonvulsants can cause skin rash? (4)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol) (common)
3) Lamotrigine (Lamictal)
4) Ethosuximide (Zarontin)
85
what anticonvulsant meds can cause hyponatremia? (2)
1) Carbamazepine (Tegretol)
2) Levetiracetam (Keppra)
86
What anticonvulsant is a sulfa med?
Zonisamide (Zonegran)
87
what anticonvulsant can cause liver toxicity requiring monitoring of LFTs?
Valproic Acid/ Valproate (Depakote)
88
what anticonvulsants can cause steven johnson syndrome? (5)
1) Phenytoin (Dilantin)
2) Carbamazepine (Tegretol)
3) Lamotrigine (Lamictal)
4) Levetiracetam (Keppra)
5) Zonisamide (Zonegran)
89
what anticonvulsant med has no known drug interactions?
Levetiracetam (Keppra)
90
what anticonvulsant med can cause edema?
Gabapentin (Neurontin)
91
what anticonvulsants can cause decreased blood counts? what type of decreased blood count(s)? (5)
1) Carbamazepine (Tegretol): neutropenia and thrombocytopenia
2) Valproic Acid/ Valproate (Depakote): thrombocytopenia
3) Gabapentin (Neurontin): leukopenia
4) Lamotrigine (Lamictal): neutropenia but rare
5) Levetiracetam (Keppra): type not specified in ppt
92
what anticonvulsant can be given with phenytoin?
Valproic Acid/ Valproate (Depakote)
93
what anticonvulsant is indicated for prophylaxis for surgery?
Phenytoin (Dilantin)
94
for which anticonvulsant med should the dose be reduced in patients with renal impairment?
Gabapentin (Neurontin)
95
what anticonvulsants needs to be taken with food? (3)
1) Carbamazepine (Tegretol)
2) Valproic Acid/ Valproate (Depakote)
3) Ethosuximide (Zarontin)
96
What anticonvulsant can decrease sweating? What should be watched?
Zonisamide (Zonegran)
watch temperature
97
What anticonvulsant meds are benzodiazepines? (3)
1) Lorazepam (Ativan)
2) Diazepam
3) Clonazepam
98
what anticonvulsants are indicated for generalized absence seizures? (3)
1) Valproic Acid/ Valproate (Depakote)
2) Ethosuximide (Zarontin) **only indication**
3) Lamotrigine (Lamictal)
99
what anticonvulsant can cause gingival hyperplasia (gum overgrowth)?
Phenytoin (Dilantin)
100
what is the drug level for Carbamazepine (Tegretol)?
4-12 mcg/mL
101
What anticonvulsants have narrow therapeutic ranges requiring drug montiroing? (3)
1) Valproic Acid/Valproate (Depakote)
2) Phenytoin (Dilantin)
3) Lamotrigine (Lamictal) **window not as narrow as others**
102
What labs need to be done when taking Carbamazepine (Tegretol)? (6)
1) drug levels
2) sodium
3) CBC (esp WBCs)
4) LFTs
5) BUN (esp in renal impairment)
6) Creatinine (esp in renal impairment)
103
what anticonvulsant is indicated to control sx of acute mania in bipolar disorder?
Valproic Acid/ Valproate (Depakote)
104
What anticonvulsant med causes diarrhea?
Ethosuximide (Zarontin)
105
what anticonvulsant is thought to act on the calcium channels to decrease glutamate and increase GABA in the brain?
Gabapentin (Neurontin)
106
for what anticonvulsant MUST tube feeds be stopped 2 hours before administration and after?
Phenytoin (Dilantin)
107
What anticonvulsants decrease the efficacy of oral contraceptives? (3)
1) Carbamazepine (Tegretol)
2) Oxycarbazepine (Trileptal)
3) Lamotrigine (Lamictal)
108
what type of anticonvulsant is Oxycarbazepine (Trileptal)?
sodium channel blocker
109
what labs need to be monitored when taking Valproic Acid/ Valproate (Depakote)? (3)
1) LFTs
2) CBC
3) Ammonia levels
110
what is the difference between Carbamazepine (Tegretol) and Oxycarbazepine (Trileptal)?
oxycarbazepine has the same efficacy but it is better tolerated
111
those with sulfa allergies should avoid which anticonvulsant?
Zonisamide (Zonegran)
112
what anticonvulsant is indicated for neonatal seizures?
Valproic Acid/ Valproate (Depakote)
113
what anticonvulsant med can cause emotional lability?
Gabapentin (Neurontin)
114
How can Valproic Acid/ Valproate (Depakote) be given?
orally or intravenously
115
If someone is having a seizure in the hospital, what is the drug of choice to stop it?
Lorazepam (Ativan)
116
What med should NOT be given with Lamotrigine (Lamictal)? Why?
What should be avoided & why?
Valproic acid bc it can cause toxic levels
Avoid other anti-epileptic drugs because they will decrease levels of lamotrigine
117
What should levels of Valproic Acid/ Valproate (Depakote) be?
50-100 mcg/mL
118
what anticonvulsant med can be used for hot flashes & night sweats?
Gabapentin (Neurontin)
119
What must be done if Valproic Acid/ Valproate (Depakote) is given IV? (2)
- must be diluted with at least 50 mL of NSS or D5W
- give over an hour (no more than 20 mg/min)
120
what anticonvulsant meds can cause weight gain? (2)
1) Gabapentin (Neurontin)
2) Lamotrigine (Lamictal)
121
What might decrease drug levels in pts taking Topiramate (Topamax)?
use of other anticonvulsants
122
What lab should be monitored for pts taking Gabapentin (Neurontin) and why?
CBC bc it can decrease WBCs
123
What anticonvulsant med is different from other anti-epileptic drugs? What is its mechanism of action?
Lamotrigine (Lamictal)
It works on Sodium Channels which decrease the release of specific neuro- transmitters (glutamate) calming brain activity
124
What is important to teach pts taking Lamotrigine (Lamictal)?
if they are taking an oral contraceptive, it is important to use another form of contraception
125
What are the black box warnings for Lamotrigine (Lamictal)?
Rashes & Steven Johnson Syndrome
126
How should Lamotrigine (Lamictal) be started and why?
start at very low doses and titrate up slowly to avoid rash
127
what labs should be monitored for a pt taking Lamotrigine (Lamictal)? (2)
1) drug levels
2) CBC
128
how can Levetiracetam (Keppra) be given?
intravenously or orally
129
What should be avoided when taking Levetiracetam (Keppra)?
stopping abruptly
130
What anticonvulsant med can cause weight loss?
Topiramate (Topamax)
131
what should be monitored in pts taking Levetiracetam (Keppra)? (4)
1) CBC
2) Blood pressure
3) Rash
4) Sodium
132
What anticonvulsant med can be used as a mood stabilizer?
Topiramate (Topamax)
133
What drugs does Ethosuximide (Zarontin) interact with?
phenytoin & valproic acid
134
What must be monitored for pts taking Ethosuximide (Zarontin)? (3)
1) CBC
2) LFTs
3) Renal function
135
What pt teaching should the nurse provide about medicine administration to a pt who is newly prescribed Zonisamide (Zonegran)?
Must swallow capsule whole! Do not crush or cut it
136
What does Lorazepam (Ativan) increase?
GABA
137
How is Lorazepam (Ativan) given and why?
given by intravenous push (IVP) because we want to stop seizure activity
138
What is important to note about prolonged use of Lorazepam (Ativan)?
prolonged use can be addictive / it is a drug of abuse. it is a controlled substance
139
what is the antidote for benzodiazepines?
flumazenil
140
Which anticonvulsants are most toxic during pregnancy? (5)
1) Phenytoin
2) Valproate
3) Phenobarbital
4) Diazepam
5) Lorazepam
141
what must nurses know about the anticonvulsant their patient is taking?
Know why the patient is on the med! What type of seizures do they experience??
142
Anticonvulsant Nursing Management: What should the nurse assess? (7)
1) Assess for medication efficacy
2) Assess for suicidal thoughts especially when meds are first started and mood changes
3) Assess liver function
4) Assess renal function
5) Assess bone marrow, especially platelets and WBCs
6) Assess for rashes
7) Assess for fall risk
143
Anticonvulsant Nursing Management: why do we want to assess for rashes?
we want to prevent steven johnson from developing
144
Anticonvulsant Nursing Management: why do we want to assess for fall risk?
b/c a lot of them can cause sedation and drowsiness
145
Anticonvulsant Nursing Management: what should the nurse do/educate their patient on? (5)
1) NEVER ABRUPTLY STOP!
2) Use
3) Side effects
4) Encourage if using for seizure to wear medic alert bracelet
5) Help patient adapt to diagnosis and being on chronic meds
146
discontinuation of therapy may be done if the patient meets what criteria? (3)
1) Seizure onset was between 2 and 35 years of age
2) Normal EEG
3) Seizure free for 2 to 5 years
147
discontinuation of seizure therapy should be done over what time period? what does this mean?
over 3 to 6 months or more
this means weening off the med (titrating off)
148
After a pt discontinues therapy completely, why do we do close monitoring for the first year?
this would be the time period that a person would have a recurrence of seizures
