Antiepileptic Drugs Flashcards
Which antiepileptic drug allows once-a-day dosing?
a. topiramate (Topamax®)
b. phenobarbital sodium
c. valproic acid (Depakene®)
d. gabapentin (Neurontin®)
ANS: B
Phenobarbital has the longest half-life of all standard antiepileptic drugs, which allows once-a-day dosing
During the nurse’s assessment, the patient describes her seizures as initial muscular contractions throughout her body, then alternating between contractions and relaxation. What kind of seizure is she describing?
a. Convulsion
b. Partial seizure
c. Simple seizure
d. Generalized tonic–clonic seizure
ANS: D
Generalized tonic–clonic seizures are seizures that involve initial muscular contraction throughout the body (tonic phase) and that then progress to alternating contraction and relaxation (clonic phase).
While teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, what information should the nurse emphasize?
a. Driving will be allowed after 2 weeks of therapy.
b. If seizures recur, the patient should take a double dose of the medication.
c. Antacids can be taken with the AED to reduce gastrointestinal adverse effects.
d. Regular consistent dosing is important for successful treatment.
ANS: D
Consistent medication regularly taken 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 with AEDs. Nonadherence is the most notable factor leading to treatment failure.
A patient has a 9-year history of a seizure disorder that has been managed well with phenytoin therapy. He is to receive nothing by mouth because he has surgery in the morning. What should 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 physician for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
ANS: C
The physician should be contacted for an order of the appropriate dosage form of the medication. The route should not be changed without a physician’s order. The morning dose should not be given with a small sip of water. Withholding the medication may lead to seizure activity during the surgical procedure.
A patient has been taking carbamazepine (Tegretol®) for several months and is worried because the physician has increased the dose twice since the beginning of therapy. Which is the nurse’s best explanation to the patient?
a. The initial dose was not sufficient to prevent seizures.
b. Autoinduction results in lower-than-expected drug concentrations.
c. Because the seizures are difficult to manage, increased doses are needed to control them.
d. Forgetting to take the medication as prescribed led to a need for increased dosage.
ANS: B
With carbamazepine, autoinduction occurs and leads to lower-than-expected drug concentrations. Therefore, the dose may need to be adjusted over time.
When administering phenytoin (Dilantin®) intravenously, what must the nurse remember?
a. Normal saline is the only solution to be used with phenytoin.
b. Intravenous (IV) doses must be given rapidly to raise blood levels quickly.
c. The patient should be monitored closely for tachycardia and increased blood
pressure.
d. Phenytoin can be combined with other solutions without fear of precipitate
formation.
ANS: A
IV phenytoin should be given with normal saline solution only. The IV dose must be given slowly. The patient must be monitored for bradycardia and decreased blood pressure. To prevent precipitation formation due to incompatibilities, phenytoin cannot be combined with other solutions.
Which teaching tips is appropriate for the nurse to give a patient taking topiramate (Topamax®)?
a. Do not chew, crush, or break the tablet.
b. Take the medication on an empty stomach.
c. Crush the medication if needed to facilitate swallowing.
d. If adverse effects are too severe, a dose may be skipped.
ANS: A
Topiramate and valproic acid tablets and delayed- or extended-release dosage forms are not to be altered in any way and must be taken as prescribed. Topiramate should be taken whole, not crushed or broken. Taking this medication with meals may help reduce the nausea that may occur. The medication should be taken at the same time each day, and doses should not be skipped. If adverse effects become a problem, the patient should contact the prescriber.
What is the drug of choice for the immediate treatment of status epilepticus?
a. diazepam (Valium®)
b. midazolam
c. valproic acid (Depakene)
d. carbamazepine (Tegretol)
ANS: A
Diazepam rectally administered is an initial emergent drug for status epilepticus.
Phenytoin (Dilantin) has a narrow therapeutic index. Which statement defines this characteristic?
a. The safe and toxic plasma levels are very close.
b. Phenytoin has a narrow chance of being effective.
c. No difference exists between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
ANS: A
A narrow therapeutic index means that a narrow difference exists between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels.
A patient has been taking gabapentin (Neurontin®) for several years as part of the treatment for partial seizures. His wife has called because he ran out of medication this morning, and she wonders whether he can go without it for a week until she can go to the drugstore. Which statement is true in this situation?
a. Because the patient is taking another antiepileptic drug, he can go a week without
the gabapentin.
b. Stopping this medication abruptly may cause withdrawal seizures.
c. The patient should temporarily increase the dosage of his other medications.
d. The patient can probably stop all medication because he has been treated for
several years now.
ANS: B
Abrupt discontinuation of the gabapentin can lead to withdrawal seizures.
