Antiepileptic Drugs Flashcards
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
a. Levetiracetam
b. Phenobarbital
c. Valproic acid
d. Gabapentin
ANS: B
Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options; therefore, it allows for once-a-day dosing.
The nurse has given medication instructions to a patient receiving phenytoin. Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
a. ―I will need to take extra care of my teeth and gums while on this medication.‖
b. ―I can go out for a beer while on this medication.‖
c. ―I can skip doses if the side effects bother me.‖
d. ―I will be able to stop taking this drug once the seizures stop
ANS: A
Thorough dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
a. ―Driving is allowed after 2 weeks of therapy.‖
b. ―If seizures recur, take a double dose of the medication.‖
c. ―Antacids can be taken with the AED to reduce gastrointestinal adverse effects.‖
d. ―Take the drug at the same time every day.
ANS: D
Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. The other options are not correct statements.
A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
a. Give the same dose intravenously.
b. Give the morning dose with a small sip of water.
c. Contact the prescriber for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
ANS: C
If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber‘s order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
The nurse is monitoring a patient who has been taking carbamazepine for 2 months. Which effects would indicate that autoinduction has started to occur?
a. The drug levels for carbamazepine are higher than expected.
b. The drug levels for carbamazepine are lower than expected.
c. The patient is experiencing fewer seizures.
d. The patient is experiencing toxic effects from the drug
ANS: B
With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
The nurse is giving an intravenous dose of phenytoin. Which action is correct when administering this drug?
a. Give the dose as a fast intravenous (IV) bolus.
b. Mix the drug with normal saline, and give it as a slow IV push.
c. Mix the drug with dextrose (D5W), and give it as a slow IV push.
d. Mix the drug with any available solution as long as the administration rate is correct.
ANS: B
Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure
The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?
a. Increased risk of suicidal thoughts and behaviors
b. Signs of bone marrow depression
c. Indications of drug addiction and dependency
d. Increased risk of cardiovascular events, such as strokes
ANS: A
The U.S. Food and Drug Administration (FDA) has required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect.
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
a. Diazepam
b. Midazolam
c. Valproic acid
d. Carbamazepin
ANS: A
Diazepam and lorazepam are considered by many to be the drugs of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options
Phenytoin has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
a. The safe and the toxic plasma levels of the drug are very close to each other.
b. The phenytoin has a low chance of being effective.
c. There is no difference between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
ANS: A
Having a ―narrow therapeutic index‖ means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 18 mcg/mL. What concern will the nurse have, if any?
a. The patient is at risk for seizures because the drug level is not at a therapeutic level.
b. The patient‘s seizures should be under control because this is a therapeutic drug level.
c. The patient‘s seizures should be under control if she is also taking a second antiepileptic drug.
d. The drug level is at a toxic level, and the dosage needs to be reduced.
ANS: B
Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect.
A patient is taking gabapentin, and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?
a. The medication is used for the treatment of neuropathic pain.
b. The medication is helpful for the treatment of multiple sclerosis.
c. The medication is used to reduce the symptoms of Parkinson‘s disease.
d. The medical record is missing the correct information about the patient‘s history of seizures.
ANS: A
Gabapentin is commonly used to treat neuropathic pain. The other options are incorrect.
The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.)
a. AED therapy can be stopped when seizures are stopped.
b. AED therapy is usually lifelong.
c. Consistent dosing is the key to controlling seizures.
d. A dose may be skipped if the patient is experiencing adverse effects.
e. Abruptly stopping AEDs may cause rebound seizure activity.
ANS: B, C, E
Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.
