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Antiepileptic Flashcards

1
Q

whats a seizure vs convulsion?

A

Seizure
Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may not lead to a convulsion
Convulsion
Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

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2
Q

epilepsy is?

A

chronic, recurrent pattern of seizures.

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3
Q

Primary (idiopathic) epilespy

A

Cause cannot be determined.
Roughly 50% of epilepsy cases

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4
Q

Secondary (symptomatic) epilepsy

A

Distinct cause is identified.
Trauma, infection, cerebrovascular disorder

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5
Q

whats the drug for immediate treatment of status epilepticus?

A

Diazepam (Valium)

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6
Q

what are epileptic drugs known as?

A

Anticonvulsants

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7
Q

how long are people on antiepileptic drugs?

A

Usually lifelong treatment and combination of drugs may be used.

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8
Q

what should be measured?

A

Serum drug concentrations and therapeutic drug monitoring.

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9
Q

Serum concentrations of what drugs correlate better with seizure control and toxicity than do those of valproic acid, ethosuximide, and clonazepam.

A

phenytoin, phenobarbital, carbamazepine, and primidone

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10
Q

Antiepileptic drugs traditionally used to manage seizure disorders include:

A
  • Barbiturates
  • Hydantoins
  • Iminostilbenes plus valproic - acid
  • Second- and third-generation antiepileptics
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11
Q

Pharmacological effects include?

A

Reduce nerve’s ability to be stimulated
Suppress transmission of impulses from one nerve to the next
Decrease speed of nerve impulse conduction within a neuron

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12
Q

Antiepileptic Drugs:Indications

A

Prevention or control of seizure activity
Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus
Other uses

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12
Q

Long-term therapy with ______ may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies.

A

phenytoin (Dilantin®)

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13
Q

what should you do if adverse effects occurs with antiepileptic drugs?

A

Adverse effects often necessitate a change in medication.

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14
Q

Antiepileptic Drugs: Contraindications

A

Drug allergy
Pregnancy

Sometime, prescribers weigh the fetal versus mother risk of maternal epilepsy and look to newer generation of drugs

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15
Q

_________ has shown congenital spinal malformations such as spina bifida

A

Dilantin

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16
Q

Antiepileptic Drugs: Interactions - Phenytoin

A

Certain antibiotics, antifungals and SSRI’s reduce clearance and increase toxicity; increased free warfarin levels (bleeding )

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17
Q

Antiepileptic Drugs: Interactions - Carbamazepine

A

Increased metabolism of acetaminophen and its reduced efficacy

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18
Q

Antiepileptic Drugs: Interactions - Valporic acid

A

Aspirin displaces valproric acid from protein binding to increase levels and toxic risk

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19
Q

Many drugs have narrow therapeutic index so require lab drug monitoring such as:

A

phenytoin, valproic acid, phenobarbital, carbamazepine

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20
Q

what are the barbituates?

A

Phenobarbital and primidone

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21
Q

Most common adverse effects of barbiturates?

A

sedation

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22
Q

whats the the therapeutic effects of barbituates?

A

serum drug levels of 15 to 40 mcg/mL

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23
Q

contraindications of barbituates?

A

known drug allergy, porphyria, liver or kidney impairment, respiratory illness

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24
adverse effects of barbituates?
cardiovascular, central nervous system (CNS), gastrointestinal (GI), and dermatological reactions
25
What drug is a hydantoins?
Phenytoin sodium
26
What has been used as a first-line drug (prototypical drug)?
Phenytoin (Dilantin)
27
Adever effects of phenytoin sodium?
lethargy, ataxia, mental confusion, gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis (long term)
28
whats the therapeutic drug level of phenytoin sodium?
Therapeutic drug levels are usually 10 to 20 mcg/mL.
29
how to administer phenytoin sodium?
Intravenous (IV) admin. Very irritating to veins. Slow IV directly into a large vein through a large-gauge (20-gauge or larger) venous catheter. Diluted in normal saline for IV infusion. Filter must be used. Saline flush .
30
whats the second most commonly prescribed antiepileptic drug in Canada after phenytoin
carbamazepine (Tegretol®)
31
carbamazepine (Tegretol®) does?
Autoinduction of hepatic enzymes
32
oxcarbazepine (Trileptal®) what is it?
Chemical analogue of carbamazepine Precise mechanism of action has not been identified.
33
ethosuximide (Zarontin®) what is it?
Used in the treatment of uncomplicated absence seizures Not effective for secondary generalized tonic-clonic seizures
34
ethosuximide contraindications?
known allergy
35
adverse fx of ethosuximide?
GI and CNS effects
36
Drug interactions of ethosuximide?
hepatic enzyme–inducing drugs
37
gabapentin (Neurontin®) what is it?
Chemical analogue of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity Believed to work by increasing the synthesis and synaptic accumulation of GABA between neurons
38
Contraindicatioon of gabapentin?
known drug allergy
39
adverse fx of gabapentin?
CNS and GI symptoms Oral use only
40
lamotrigine (Lamictal®) what is it?
Also used for the treatment of bipolar disorder, Oral use only
41
lamotrigine contraindications?
drug allergy
42
adverse fx of lamotrigine
relatively minor CNS and GI symptoms and possible Stevens-Johnson syndrome
43
Valproic acid what is it?
Also used for absence and myoclonic seizures
44
contraindications of valporic acid
drug allergy, liver impairment
45
adverse fx of valporic acid?
weight gain, hair loss.
46
interactions of valporic acid?
aspirin to create toxic levels of valproic acid
47
levetiracetam (Keppra®) what is it?
Adjunct therapy for focal seizures with and without secondary generalization, comes in oral and injectable forms.
48
levetiracetam contraindications?
known drug allergy Mechanism of action: unknown
49
levetiracetam (Keppra®) adverse fx?
generally well tolerated, CNS effects
50
pregabalin (Lyrica®) what is it?
structurally related to GABA, used for adjunct therapy for neuropathic pain, postherpetic neuralgia
51
pregabalin (Lyrica®) indication?
Focal seizures
52
pregabalin contraindications?
known drug allergy
53
pregabalin adverse fx?
primarily CNS related
54
Nursing Implications (assessments to do)?
Health history, including current medications Drug allergies Liver function studies, complete blood count Baseline vital signs, weight Dental hygience (remember problem with Dilantin)
55
Take regularly, ______ to maintain blood levels; may need blood levels reassessed over time
SAME TIME EACH DAY
56
how much fluids should you take while taking antiepleptics?
180-240ml
57
what should you not take with carbamazepine?
grape fruit juice
58
Use only normal saline with _________. D5W causes precipitate formation
IV phenytoin (Dilantin)
59
Encourage daily oral care and frequent dental visits to monitor and possibly manage what?
gingival hyperplasia
60
can you discontinue an AED abruptly?
AEDs should not be discontinued abruptly.
61
what should you tell the patient about the therapy?
Teach patients that therapy is long term and possibly lifelong (not a cure).
62
what therapeutic effcets should you expect?
Decreased or absent seizure activity
63
Monitor for general adverse effects such as?
Mental status changes, mood changes, changes in level of consciousness or sensorium Eye problems, visual disorders Sore throat, fever (blood dyscrasias may occur with hydantoins) Many others
64

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