Anticonvulsants

Question 1

Clonazepam

Answer 1

purpose: management of seizures & panic disorders

SE: Drowsiness, dizziness, behavioral changes, poor coordination, palpitations, tachycardia, blurred vision, increased salvation, nausea, constipation, dysuria, libido changes, thrombocytopenia, resp depression, rash, muscle weakness

Nurs con: -do not discontinue abruptly, seizures may increase

• avoid alcohol, CNS depressants
• May take with food or milk to decrease GI symp
• report signs of toxicity: bone marrow suppression, nausea, vomiting, ataxia, diplopia, cardiovascular collapse
• may increase risk of suicidal thoughts
• RX C-1V

Question 2

Divalproex sodium

Answer 2

• purpose: management of seizures, prophylaxis of migraine headache
• SE: sedation, drowsiness, dizziness, mental status & behavioural changes, prolonged bleeding ime, N, V, D, constipation, hepatotoxicity, teratogenicity, pancreatitis, thrombocytopenia, headache, diplopia, alopecia, multiorgan hypersensitivity, rash
• Nurs Con: -Take with or immediately after meals to lessen GI upset; swallow hole
• avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions
• monitor blood levels, platelets, bleeding time & 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
• Rx

Question 3

Gabapentin

Answer 3

purpose: mngmt of seizures, postherpetic neuralgia and primary restless leg syndrome

SE: drowsiness, ataxia, diplopia, rhinitis, constipation, memory problems, back or joint pain, Edema, Diarrhea

Nurs con: -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 regards to meals, can open capsules
• do not crush or chew capsules
• use caution with hazardous activities
• Rx

Question 4

Lamotrigine

Answer 4

purpose: mngmnt of seizures and bipolar disorder

SE: Ataxia, dizziness, headache, N, V, anorexia, rhinitis, diplopia, blurred vision, abdominal pain, dysmenorrhea, loss of coordination, mood changes, irritability, insomnia, depression

Nurs con: -in pediatric patients, stop at first signs of rash all patients should notify providers 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
• Rx

Question 5

Magnesium Sulfate

Answer 5

purpose: prophylaxis of seizures that occur with preeclampsia: treatment of eclampsia, acute nephritis in children and hypomagnesemia

SE: muscle weakness, flushing, confusion, dizziness, hypotension, oliguria, bradycardia, decreased reflexes, bradypnea, hypophosphatemia, hyperkalemia, hyocalcemia

Nurs con:

• given IM or IV
• Antidote: calcium gluconate

Question 6

phenobarbital

Answer 6

purpose: long-term mngmnt of seizures, mngmt of febrile seizures, therapeutic sedation

SE: drowsiness, lethargy, rash, GI upset, initially constricts pupils, resp depression, Ataxia, Nightmares, Excitement in children, dizziness, hypotension, thrombocytopenia

Nurs Con: IV: slow rate- resuscitation equipment should be available

• IM: inject deep into large muscle mass to preven tissue sloughing, can give subQ, onset 10-30min
• PO: onset 20-60 min, 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 & possibly convulsions
• Vit D supplements are indicated for long term use
• Rx- C1V

Question 7

Phenytoin

Answer 7

Purpose: mngmnt of seizures

SE: Drowsiness, ataxia, nystagmus, rash, hypotension, lethargy, GI upset, gingival hypertrophy, depression, urine discoloration, thrombocytopenia, hyperglycemia

Nurs con: PO: take divided doses, with or immediately after meals to decrease adverse effects

• IV administration may lead to cardiac arrest- have resuscitation equip 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
• RX

Question 8

Pregabalin

Answer 8

purpose: tx of neuropathic pain, postherpetic nueralgia and fibromyalgia

SE: dizziness, tiredness, weakness, headache, N, V, constipation, flatulence, bloating, mental status & behavioral changes, lack of coordination, increased appetite/weight gain, back pain, angioedema, blurred vision, tremor, twitching, hypoglycemia

Nurs con: take around same time everyday 2-3 times daily: full therapeutic effects may require 4 weeks

• do not crush/chew
• avoid abrupt withdrawal after long-term use, discontinue gradually
• avoid use w alcohol
• use caution in potentially hazardous activities
• may increase risk of suicidal thoughts or behaviors

Question 9

Topiramate

Answer 9

purpose: mngmt of seizures, prophylaxis & tx of migraines

SE: dizziness, drowsiness, fatigue, impaired concentration/memory, nervousness, speech problems, nausea, weight loss, vision problems, ataxia, photosenstivity, behavioral problems, mood problems, anorexia

Nurs con: -give without regard to meals
-avoid abrupt withdrawal after long-term use; discontinue gradually to prevent siezures & 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
Rx

Question 10

Valproate, Valproic acid

Answer 10

purpose: mngmnt of seizures, prophylaxis of bipolar disorder & migraine

SE: sedation, drowsiness, dizziness, mental status & behavioral changes, N, V, constipation, diarrhea, heartburn, prolonged bleeding time, hepatotoxicity, pancreatitis, rash, hypo.hypertension, visual disturbances, SIADH, dyspnea

Nurs con: -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 behaviors

Question 11

Sumatriptan (antimigraines)

Answer 11

purpose; acute tx of migraines

SE: burning, tingling, dizziness, numbness, flushing, MI, hypo/hypertension, throat & nasal discomfort, vision changes, abdominal discomfort, weakness, myalgia, chest tightness, pressure

Nurs con: - 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 10-20mins
• ingestion of tyramine-containing foods (pickled products, beer preservatives, chocolate) and caffeine may precipitate headache
• not to be used for more than 3-4 migraines per month