Anticonvulsants (36) Flashcards by Natalia Echeverry

SUMATRIPTAN: Nursing Considerations

PO: swallow tablets whole, take as soon as symptoms appear
Transdermal: apply to dry intact skin, discard after folding in half
Onset 10 minutes to 2 hours, peak 10–20 minutes
Ingestion of tyramine-containing foods (pickled products, beer, preservatives, chocolate) and caffeine may precipitate headaches
Not to be used for more than 3–4 migraines per month
Rx; Preg Cat D

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SUMATRIPTAN: Side Effects

Burning, tingling
Dizziness, numbness
Flushing
MI
Hypo/hypertension
Throat and nasal discomfort
Vision changes
Abdominal discomfort
Weakness, myalgia
Chest tightness, pressure

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SUMATRIPTAN: Purpose

Acute treatment of migraines

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VALPROATE, VALPROIC ACID: Nursing Considerations

Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions
May be given with food to decrease GI irritation
Monitor for suicidal thoughts or behavior
Rx; Preg Cat D

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VALPROATE, VALPROIC ACID: Side Effects

Sedation, drowsiness, dizziness
Mental status and behavioral changes
Prolonged bleeding time
Nausea, vomiting, constipation, diarrhea, heartburn
Hepatotoxicity
Pancreatitis
Rash
Hypo/hypertension
Visual disturbances
SIADH
Dyspnea

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VALPROATE, VALPROIC ACID: Purpose

Management of seizures, prophylaxis of bipolar disorder and migraine

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TOPIRAMATE: Nursing Considerations

Give without regard to meals
Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent seizures and status epilepticus
Do not crush or chew
Use caution with hazardous activities until stabilized
Increase fluid intake to prevent formation of kidney stones
Notify provider immediately if experiencing periorbital pain or blurred vision
Wear medical information tag
Rx; Preg Cat C

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TOPIRAMATE: Side Effects

Dizziness, drowsiness, fatigue
Impaired concentration/memory
Nervousness, speech problems
Nausea, weight loss
Vision problems
Ataxia
Photosensitivity
Behavior problems, mood problems
Anorexia

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TOPIRAMATE: Purpose

Management of seizures, prophylaxis and treatment of migraines

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PREGABALIN: Nursing Considerations

Take around the same time every day, 2–3 times daily; full therapeutic effects may require 4 weeks
Do not crush or chew
Avoid abrupt withdrawal after long-term use; discontinue gradually
Avoid use with alcohol
Use caution in potentially hazardous activities
May increase the risk of suicidal thoughts or behavior
Rx; Preg Cat C

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PREGABALIN: Side Effects

Dizziness, tiredness, weakness
Headache
Nausea, vomiting, constipation
Flatulence, bloating
Mental status and behavioral changes
Lack of coordination
Increased appetite, weight gain
Back pain
Angioedema
Blurred vision
Tremor, twitching
Hypoglycemia

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PREGABALIN: Purpose

Treatment of neuropathic pain, postherpetic neuralgia, and fibromyalgia

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PHENYTOIN: Nursing Considerations

PO: take divided doses, with or immediately after meals, to decrease adverse effects
IV administration may lead to cardiac arrest—have resuscitation equipment available; never mix in IV with any other drug or dextrose
Avoid abrupt withdrawal to prevent convulsions
Do not use antacids or antidiarrheals within 2 hours of med
Use caution with hazardous activities until stabilized
Wear medical information tag
Rx; Preg Cat D

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PHENYTOIN: Side Effects

Drowsiness, ataxia
Nystagmus
Blurred vision
Rash
Hypotension
Lethargy
GI upset
Gingival hypertrophy
Depression
Urine discoloration
Thrombocytopenia
Hyperglycemia

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PHENYTOIN: Purpose

Management of seizures

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PHENOBARBITAL: Nursing Considerations

IV: slow rate—resuscitation equipment should be available
IM: inject deep into large muscle mass to prevent tissue sloughing, can give subQ, onset 10–30 minutes
PO: onset 20–60 minutes, peak 8–12 hours, duration 6–10 hours
Use caution with hazardous activities until stabilized; drowsiness usually diminishes after initial weeks of therapy
Long-term use withdrawal symptoms: vomiting, sweating, abdomen/muscle cramps, tremors, and possibly convulsions
Vitamin D supplements are indicated for long-term use
Rx C-IV; Preg Cat D

PHENOBARBITAL: Side Effects

Drowsiness, lethargy, rash
GI upset
Initially constricts pupils
Respiratory depression
Ataxia
Nightmares
Excitement in children
Dizziness
Hypotension
Thrombocytopenia

PHENOBARBITAL: Purpose

Long-term management of seizures, management of febrile seizures, therapeutic sedation

MAGNESIUM SULFATE: Nursing Considerations

Given IM or IV
Antidote: calcium gluconate
Rx

MAGNESIUM SULFATE: Side Effects

Muscle weakness
Flushing
Confusion, dizziness
Hypotension
Oliguria
Bradycardia
Decreased reflexes
Bradypnea
Hypophosphatemia
Hyperkalemia
Hypocalcemia

MAGNESIUM SULFATE: Purpose

Prophylaxis of seizures that occur with preeclampsia; treatment of eclampsia, acute nephritis in children, and hypomagnesemia

LAMOTRIGINE: Nursing Considerations

In pediatric patients, stop at first sign of rash; all patients should notify provider of rashes
Take divided doses with meals or just after to decrease adverse effects
Use caution with hazardous activities until stabilized
Avoid abrupt withdrawal; stop gradually to prevent increase in frequency of seizures
Wear medical information tag
Rx; Preg Cat C

LAMOTRIGINE: Side Effects

Ataxia, dizziness
Headache
Nausea, vomiting, anorexia
Rhinitis
Diplopia, blurred vision
Abdominal pain, dysmenorrhea
Loss of coordination
Mood changes
Irritability
Insomnia
Depression

LAMOTRIGINE: Purpose

Management of seizures and bipolar disorder

**GABAPENTIN:** Nursing Considerations

* Do not take within 2 hours of antacid use * Avoid abrupt withdrawal after long-term use; discontinue gradually over a week to prevent convulsions * Give without regard to meals; can open capsules and put in juice or applesauce * Do not crush or chew capsules * Use caution with hazardous activities * Wear medical information tag * Rx; Preg Cat C

**GABAPENTIN:** Side Effects

* Drowsiness * Ataxia * Diplopia * Rhinitis * Constipation * Memory problems * Back or joint pain * Edema * Diarrhea

**GABAPENTIN:** Purpose

Management of seizures, postherpetic neuralgia, and primary restless leg syndrome

**DIVALPROEX SODIUM:** Nursing Considerations

* Take with or immediately after meals to lessen GI upset; swallow whole * Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions * Monitor blood levels, platelets, bleeding time, and liver function tests * Delayed-release products: peak blood level 3–5 hours, duration 12–24 hours * Extended-release products: onset 2–4 days, peak blood level 7–14 hours, duration 24 hours * Wear medical information tag * Rx; Preg Cat D

**DIVALPROEX SODIUM:** Side Effects

**DIVALPROEX SODIUM:** Purpose

Management of seizures, prophylaxis of migraine headache

**CLONAZEPAM:** Nursing Considerations

* Do not discontinue abruptly, seizures may increase * Avoid alcohol, CNS depressants * May take with food or milk to decrease GI symptoms * Report signs of toxicity: bone marrow suppression, nausea, vomiting, ataxia, diplopia, cardiovascular collapse * May increase risk of suicidal thoughts * Wear medication identification tag * Rx C-IV

**CLONAZEPAM:** Side Effects

* Drowsiness, dizziness * Behavioral changes * Poor coordination * Palpitations, tachycardia * Blurred vision * Increased salivation * Nausea, constipation * Dysuria * Libido changes * Thrombocytopenia * Respiratory depression * Rash * Muscle weakness

**CLONAZEPAM:** Purpose

Management of seizures and panic disorder

**CARBAMAZEPINE:** Nursing Considerations

* Avoid driving and other activities requiring alertness the first 3 days * Monitor blood levels, CBC regularly, esp. during first 2 months; periodic eye exams * Take with food or milk to decrease GI upset * Do not mix with grapefruit juice * Urine may turn pink to brown * Avoid abrupt withdrawal; discontinue gradually * Avoid use with alcohol, CNS depressants * Inform provider before taking any new medication or herbal medication * Rx; Preg Cat D

**CARBAMAZEPINE:** Side Effects

* Myelosuppression * Dizziness, drowsiness * Ataxia * Diplopia, rash * Photosensitivity * Depression * Nausea * Vomiting * Dyspepsia * Aplastic anemia * Stevens-Johnson syndrome * Suicidal thoughts

**CARBAMAZEPINE:** Purpose

Management of seizures, trigeminal neuralgia, and neuropathic pain

1. SUMATRIPTAN 2. VALPROATE, VALPROIC ACID 3. TOPIRAMATE 4. PREGABALIN 5. PHENYTOIN 6. PHENOBARBITAL 7. MAGNESIUM SULFATE 8. LAMOTRIGINE 9. GABAPENTIN 10. DIVALPROEX SODIUM 11. CLONAZEPAM 12. CARBAMAZEPINE