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Antiepileptic Drugs Flashcards

1
Q

Seizure

A

Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may not lead to a convulsion

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2
Q

Convulsion

A

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

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3
Q

Epilepsy

A

Chronic, recurrent pattern of seizures

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4
Q

Epilepsy

Primary (idiopathic) vs Secondary (symptomatic)

A

Primary (idiopathic)
Cause cannot be determined.
Roughly 50% of epilepsy cases

Secondary (symptomatic)
Distinct cause is identified.
Trauma, infection, cerebrovascular disorder

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5
Q

Classification of Epilepsy

A

Generalized onset seizures
-Both hemispheres
-Tonic-clonic seizures (may also be just tonic or clonic)
-Atonic seizures (also known as drop attacks)

Focal onset seizures
-Localized or focal region
-Simple
-Complex
-Secondary generalized tonic-clonic

Unclassified seizures

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6
Q

Status Epilepticus

A

Multiple seizures occur that last 5 minutes or longer of continuous or electrographic seizure activity or recurrent seizure activity without recovery between seizures

Result: hypotension, hypoxia, brain damage, and possibly death

True medical emergency

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7
Q

Drug of choice for immediate treatment: for Status Epilepticus

A

diazepam (valium)

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8
Q

Antiepileptic Drugs facts

A

Also known as anticonvulsants
-Difference between epilepsy and convulsions

Antiepileptic drug (AED) therapy is usually lifelong

Combination of drugs may be used

Single-drug therapy is started before multiple-drug therapy is tried.

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9
Q

Antiepileptic Drugs function

titrate to? why?

A

To control or prevent seizures while maintaining a reasonable quality of life

Titrate to lowest possible dose that controls seizures

To minimize adverse effects and drug-induced toxicity

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10
Q

Antiepileptic Drugs

Serum drug concentrations that must be measured
?

A

Therapeutic drug monitoring

Serum concentrations of phenytoin, phenobarbital, carbamazepine, and primidone correlate better with seizure control and toxicity than do those of valproic acid, ethosuximide, and clonazepam.

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11
Q

4 class of 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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12
Q

Antiepileptic Drugs Mechanism of Actionand Drug Effects

A

Exact mechanism of action is not known.

Pharmacological effects:

-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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13
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

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14
Q

Antiepileptic Drugs: Adverse Effects

A

Numerous adverse effects; vary per drug

Adverse effects often necessitate a change in medication.

Long-term therapy with phenytoin (Dilantin®) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies.

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15
Q

Long-term therapy with phenytoin (Dilantin®) may cause

A

gingival hyperplasia, acne, hirsutism, and Dilantin facies.

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16
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

Dilantin has shown congenital spinal malformations such as spina bifida

17
Q

Dilantin has shown

A

congenital spinal malformations such as spina bifida

18
Q

Antiepileptic Drugs: Interactions

Phenytoin

A

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

19
Q

Antiepileptic Drugs: Interactions

Carbamazepine

A

Increased metabolism of acetaminophen and its reduced efficacy

20
Q

Antiepileptic Drugs: Interactions

Valproic Acid

A

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

21
Q

Antiepileptic Drugs medications

A

carbamazepine (Mazepine, Tegretol)
ethosuximide (Zarontin®)
fosphenytoin (Cerebyx®)
gabapentin (Neurontin®)
lamotrigine (Lamictal®)
levetiracetam (Keppra®)
oxcarbazepine (Trileptal®)
phenobarbital
phenytoin (Dilantin)
pregabalin (Lyrica®)
primidone
topiramate (Topamax®)
valproic acid (Depakene®)

22
Q

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

A

phenytoin, valproic acid, phenobarbital, carbamazepine

23
Q

Barbiturates: phenobarbital and primidone

Primidone is metabolized in the ____ to phenobarbital.

Common AE

Therapeutic effects: serum drug levels of __ to __ mcg/mL

A

Primidone is metabolized in the liver to phenobarbital.

Most common adverse effect is sedation.

Therapeutic effects: serum drug levels of 15 to 40 mcg/mL

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

Adverse effects: cardiovascular, central nervous system (CNS), gastrointestinal (GI), and dermatological reactions

24
Q

Hydantoins: phenytoin sodium

AEs

Therapeutic drug levels are usually __to __ mcg/mL.

A

Phenytoin (Dilantin®) has been used as a first-line drug for many years - prototypical drug.

Long-term therapy adverse effects: lethargy, ataxia, mental confusion, gingival hyperplasia, acne, hirsutism,

Dilantin facies, and osteoporosis (long term)

Therapeutic drug levels are usually 10 to 20 mcg/mL.

25
Hydantoins: phenytoin sodium Intravenous (IV) administration
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
26
carbamazepine (Tegretol®) Autoinduction of?
Second most commonly prescribed antiepileptic drug in Canada after phenytoin Autoinduction of hepatic enzymes
27
ethosuximide (Zarontin®)
Used in the treatment of uncomplicated absence seizures Not effective for secondary generalized tonic-clonic seizures Contraindication: known allergy Adverse effects: GI and CNS effects Drug interactions: hepatic enzyme–inducing drugs
28
Miscellaneous Drugs
gabapentin (Neurontin®) perampanel (Fycompa®) pregabalin (Lyrica®) lamotrigine (Lamictal®) levetiracetam (Keppra®) topiramate (Topamax®) valproic acid (Epival®)
29
gabapentin (Neurontin®) action
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 Contraindication: known drug allergy Adverse effects: CNS and GI symptoms Oral use only
30
lamotrigine (Lamictal®)
Also used for the treatment of bipolar disorder Contraindications: drug allergy Common adverse effects: relatively minor CNS and GI symptoms and possible Stevens-Johnson syndrome Oral use only
31
Valproic acid contraindication? AEs Interacts with?
Also used for absence and myoclonic seizures Contraindications: drug allergy, liver impairment Common adverse effects: weight gain, hair loss Interacts with aspirin to create toxic levels of valproic acid
32
levetiracetam (Keppra®)
Adjunct therapy for focal seizures with and without secondary generalization Contraindication: known drug allergy Mechanism of action: unknown Adverse effects: generally well tolerated, CNS effects No drug interactions Oral and injectable forms
33
pregabalin (Lyrica®)
Structurally related to GABA Indication: focal seizures Most common uses: adjunct therapy for neuropathic pain, postherpetic neuralgia Contraindication: known drug allergy Adverse drug reactions: primarily CNS related Oral use only
34
Nursing Implications
Assessment -Health history, including current medications -Drug allergies -Liver function studies, complete blood count -Baseline vital signs, weight -Dental hygience (remember problem with Dilantin)
35
Antiepileptic Drugs: Nursing Implications Oral drugs
Take regularly, same time each day to maintain blood levels; may need blood levels reassessed over time Take with meals to reduce gastrointestinal upset and at least 180-240 mL of fluid but avoiding juice, milk and carbonated beverages (no grapefruit juice with carbamazepine) Do not crush, chew, or open extended-release forms If patient is not to take anything by mouth for a procedure, contact physician regarding AED dosage Encourage daily oral care and frequent dental visits to monitor and possibly manage gingival hyperplasia
36
No grapefruit juice with
carbamazepine
37
IV forms
Follow manufacturer’s recommendations for IV delivery (usually given slowly). Monitor vital signs during administration. Avoid extravasation of fluids. Use only normal saline with IV phenytoin (Dilantin). D5W causes precipitate formation
38
Teach patients to keep a journal to monitor:
Response to AED Seizure occurrence and descriptions Adverse effects Instruct patients to wear a medical alert tag or ID. AEDs should not be discontinued abruptly. Instruct patients to follow driving recommendations. Teach patients that therapy is long term and possibly lifelong (not a cure).
39
Nursing Implications
Monitor for therapeutic effects. -Decreased or absent seizure activity Monitor for adverse effects. -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

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