Antiepileptic Drugs Flashcards
Carbamazepine (Tegretol)
Chemical Classification
Iminostilbene derivative
Carbamazepine (Tegretol)
Functional Classification
Anticonvulsant
Carbamazepine (Tegretol)
Mechanism of Action
Exact mechanism unknown; appears to decrease polysynaptic responses and block posttetanic potentiation
Carbamazepine (Tegretol)
Uses
Tonic-Clonic, complex-partial, mixed seizures; trigeminal neuralgia; bipolar disorder
Carbamazepine (Tegretol)
Contraindications
Pregnancy (D), hypersensitivity to carBAMazepine or tricyclics, AV or bundle branch block
Carbamazepine (Tegretol)
Side Effects
CNS: Drowsiness, dizziness, unsteadiness, confusion, fatigue, PARALYSIS, headache, hallucinations, WORSENING OF SEIZURES, speech disturbance, SUICIDAL THOUGHTS/BEHAVIORS
CV: HYPERTENSION, CHF, DYSRHYTHMIAS, AV BLOCK, hypotension, aggravation of cardiac artery disease
EENT: tinnitus, dry mouth, blurred vision, diplopia, nystagmus, conjunctivitis
ENDO: SIADH (geriatric patients)
GI: Nausea, Constipation, Diarrhea, anorexia, vomiting, abdominal pain, stomatitis, glossitis, increased hepatic enzymes, HEPATITIS, HEPATIC PORPHYRIA
GU: frequency, retention, albuminuria, glycosuria, impotence, increased BUN, RENAL FAILURE
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, AGRANULOCYTOSIS, LEUKOCYTOSIS, APLASTIC ANEMIA, EOSINOPHILIA, increased PT
INTEG: Rash, STEVENS-JOHNSON SYNDROME, urticaria, photosensitivity, TOXIC EPIDERMAL NECROLYSIS
RESP: pulmonary hypersensitivity (fever, dyspnea, pneumonitis)
Carbamazepine (Tegretol)
Nursing Considerations
ASSESS:
- SEIZURES: character, location, duration, intensity, frequency, presence of aura
- TRIGEMINAL NEURALGIA: facial pain including location, during, intensity, character, activity that stimulates pain
- Renal studies; urinalysis, BUN, urine creatinine q3mo
- BONE MARROW DEPRESSION: blood studies: RBC, Hct, Hgb, reticulocyte counts every wk for 4 wk then q3-6mo if on long-term therapy; if myelosuppression occurs, product should be discontinued; blood dyscrasias: fever, sore throat, bruising, rash, jaundice
- Hepatic studies: ALT, AST, bilirubin
- Product levels during initial treatment or when changing dose; should remain at 4-12mcg/ml; anorexia may indicate increased blood levels
- Mental status: mood, sensorium, affect, behavioral changes, SUICIDAL THOUGHTS/BEHAVIORS; if mental status changes, notify prescriber
- Eye problems: need for ophthalmic examinations before, during, after treatment (slit lamp, funduscopy, tonometry)
- Allergic reaction: purpura, red, raised rash; if these occur, product should be discontinued
- Toxicity: bone marrow depression, nausea, vomiting, ataxia, diploia, CV collapse, Stevens-Johnson syndrome
PERFORM/PROVIDE
-Hard candy, gum, frequent rinsing for dry mouth
Carbamazepine (Tegretol)
Overdose Treatment
Lavage, VS
Gabapentin (Neurontin)
Functionional Classification
Anticonvulsant
Gabapentin (Neurontin)
Mechanism of Action
Mechanism unknown; may increase seizure threshold; structurally similar to GABA; gabapentin binding sites in neocortex, hippocampus
Gabapentin (Neurontin)
Uses
Adjunct treatment of partial seizures, with/without generalization in patients >12yr; adjunct for partial seizures in children 3-12 yr, postherpetic neuralgia, primary restless leg syndrome in adults
Gabapentin (Neurontin)
Contraindications
Hypersensitivity
Gabapentin (Neurontin)
Side Effects
CNS: Drowsiness, Confusion, dizziness, fatigue, anxiety, somnolence, ataxia, amnesia, abnormal thinking, unsteady gait, Depression; children 3-12 yr old, emotional lability, aggression, thought disorder, hyperkinesia, hostility, SEIZURES, SUICIDAL IDEATION
CV: vasodilation, peripheral edema, hypotension
EENT: dry mouth, blurred vision, Diplopia, nystagmus
GI: constipation, increased appetite, dental abnormalities, nausea, vomiting
GU: impotence, bleeding, UTI
HEMA: LEUKOPENIA, decreased WBC
INTEG: pruritus, abrasion, STEVENS-JOHNSON SYNDROME
MS: myalgia
RESP: Rhinitis, pharyngitis, cough
Gabapentin (Neurontin)
Nursing Considerations
ASSESS:
- SEIZURES: aura, location, duration, activity at onset
- PAIN: location, duration, characteristics if using for chronic pain, migraine
- mental status: mood, sensorium, affect, behavioral changes, SUICIDAL THOUGHTS/BEHAVIORS; if mental status changes, notify prescriber
- eye problems, need for ophthalmic exam before, during, after treatment (slit lamp, funduscopy, tonometry)
- WBC, gabapentin level (therapeutic 5.9-21mcg/ml, toxic >85mcg/ml
PERFORM/PROVIDE
- SEIZURE PRECAUTIONS: padded side rails; move objects that may harm patient
- Increased fluids, bulk in diet for constipation
Phenobarbital
functional classification
Anticonvulsant
Phenobarbital
Chemical Classification
Barbiturate
Phenobarbital
Mechanism of Action
Decreases impulse transmission; increases seizure threshold at cerebral cortex level
Phenobarbital
Uses
All forms of epilepsy, status epilepticus, febrile seizures in children, sedation, insomnia
Phenobarbital
Contraindication
Pregnancy (D), breastfeeding, geriatric patients, hypersensitivity to barbiturates, porphyria, hepatic/respiratory disease, nephritis, hyperthyroidism, diabetes mellitus
Phenobarbital
Side Effects
CNS: paradoxic excitement (geriatric patients), drowsiness, lethargy, hangover headache, flushing, hallucinations, COMA
GI: nausea, vomiting, diarrhea, constipation
HEMA: AGRANULOCYTOSIS, MEGALOBLASTIC ANEMIA, THROMBOCYTOPENIA, THROMBOPHLEBITIS
INTEG: rash, urticaria, STEVEN-JOHNSON SYNDROME, ANGIOEDEMA, local pain, swelling, necrosis, scaling eczema
Phenobarbital
Nursing Considerations
ASSESS:
- mental status: mood, sensorium, affect, memory (long, short)
- BLOOD DYCRASIS: fever, sore throat, bruising, rash, jaundice
- SEIZURES: type, duration, precipitating factors
- blood studies
- therapeutic blood level periodically: 15-40mcg/ml
- respiratory status: rate, rhythm, depth, respiratory depression; have emergency equipment nearby
- DEPENDENCE: physical or psychological, monitor amount given to patient; if patient suicidal, may save medications for attempt
- PAIN: use pain scale if product used for pain; product may increase pain level
PERFORM/PROVIDE:
-Supervision of ambulation because dizziness, drowsiness may occur
Primidone
Functional Classification
Anticonvulsant
Primidone
Chemical Classification
Barbiturate derivative
Primidone
Mechanism of Action
Raises seizure threshold by conversion of product to PHENobarbital, decreases neuron firing
Primidone
Uses
Generalized tonic-clonic (Grand mal), complex seizures
Primidone
Contraindications
Pregnancy (D), breastfeeding, hypersensitivity, porphyria, hepatic encephalopathy
Primidone
Side Effects
CNS: Stimulation, Drowsiness, irritability, psychosis, ataxia, vertigo, fatigue, emotional disturbances, mood changes, paranoia, SUICIDAL IDEATION
EENT: diplopia, nystagmus, edema of eyelids
GI: Nausea, Vomiting, Anorexia, HEPATITIS
GU: impotence
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, NEUTROPENIA, EOSINOPHILIA, MEGALOBLASTIC ANEMIA, decreased serum folate level, lymphadenopathy
INTEG: Rash, edema, alopecia, lupuslike syndrome
Primidone
Nursing Considerations
ASSESS:
- SEIZURES: location, duration, type; folic acid deficiency; fatigue, weakness, neuropathy, depression
- Product level: therapeutic level 5-15mcg/ml; CBC, LFTs should be obtained q6mo
- Respiratory depression, wheezing
- Blood dyscrasias: fever, sore throat, bruising, rash, jaundice
Phenytoin (Dilantin)
Functional Classification
Anticonvulsant; antidysrhythmic (IB)
Phenytoin (Dilantin)
Chemical Classification
Hydantoin
Phenytoin (Dilantin)
Mechanism of Action
Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction
Phenytoin (Dilantin)
Uses
Generalized tonic-clonic seizures; status epilepticus; nonepileptic seizures associated with Reye’s syndrome or after head trauma; Bell’s palsy, complex partial seizures
Phenytoin (Dilantin)
Contraindications
Pregnancy (D), hypersensitivity, psychiatric condition, bradycardia, SA and AV block, Stokes-Adams syndrome, hepatic failure, acute intermittent porphyria
Phenytoin (Dilantin)
Side Effects
CNS: drowsiness, dizziness, insomnia, paresthesias, depression, SUICIDAL TENDENCIES, aggregation, headache, confusion, slurred speech, peripheral neuropathy
CV: hypotension, VENTRICULAR FIBRILLATION
EENT: nystagmus, diplopia, blurred vision
ENDO: diabetes insipidus
GI: nausea, vomiting, constipation, anorexia, weight loss, HEPATITIS, jaundice, gingival hyperplasia
GU: NEPHRITIS, urine discoloration
HEMA: AGRANULOCYTOSIS, LEUKOPENIA, APLASTIC ANEMIA, THROMBOCYTOPENIA, MEGALOBLASTIC ANEMIA
INTEG: rash, LUPUS ERYTHEMATOSUS, STEVENS-JOHNSON SYNDROME, hirsutism, TOXIC EPIDERMAL NECROLYSIS
SYST: hypocalcemia, PURPLE GLOVE SYNDROME (IV)
Phenytoin (Dilantin)
Nursing Considerations
ASSESS:
- PHENYTOIN HYPERSENSITIVITY SYNDROME 3-12wk after start of treatment: rash, temp, lymphadenopathy; may cause hepatotoxicity, renal failure, rhabdomyolysis
- SERIOUS SKIN DISORDERS: for beginning rash that may lead to Stevens-Johnson syndrome or toxic epidermal necrolysis; phenytoin should not be used again; may occur more often among Asian patients with HLA-B 1502
- PURPLE GLOVE SYNDROME with IV use
- phenytoin level: toxic level 30-50mcg/ml, therapeutic level: 7.5-20mcg/ml; wait >/=1 wk to draw levels
- SEIZURES: duration, type, intensity, precipitating factors; obtain EEG periodically
- blood studies: CBC, platelets q2wk until stabilized, then monthly x12, then q3mo; discontinue product if neutrophils <1600mm3, renal function: albumin conc; folic acid levels
- Mental status: mood, sensorium, affect, memory (long, short), suicidal thoughts/ behaviors
- RESPIRATORY DEPRESSION: rate, depth, character
- BLOOD DYSCRASIAS: fever, sore throat, bruising, rash, jaundice
Fosphenytoin
functional classification
anticonvulsant
Fosphenytoin
chemical classification
Hydantoin, phosphate phenytoin ester
Fosphenytoin
Mechanism of Action
Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction, prodrug of phenytoin
Fosphenytoin
Uses
Generalized tonic-clonic seizures, status epilepticus, partial seizures
Fosphenytoin
Contraindications
Pregnancy (D), hypersensitivity, psychiatric conditions, bradycardia, SA and AV block, Stokes-Adams syndrome, absence seizures
Fosphenytoin
Side Effects
CNS: drowsiness, dizziness, insomnia, paresthesias, depression, SUICIDAL TENDENCIES, aggression, headache, confusion, paresthesia
CV: hypo/hypertension, VENTRICULAR FIBRILLATION, CHF, SHOCK
EENT: nystagmus, diplopia, blurred vision
GI: nausea, vomiting, diarrhea, constipation, anorexia, weight loss, hepatitis, jaundice, gingival hyperplasia
HEMA: AGRANULOCYTOSIS, LEUKOPENIA, APLASTIC ANEMIA, THROMBOCYTOPENIA, MEGALOBLASTIC ANEMIA
INTEG: rash lupus erythematosus, STEVENS-JOHNSON SYNDROME, hirsutism, hypersensitivity, pruritus
SYST: hyperglycemia, hypokalemia, SJS/TEN Asian patients positive for HLA-B 1502
Fosphenytoin
Nursing Considerations
ASSESS:
- Drug level: target level 10-20mcg/ml, toxic level 30-50mcg/ml, wait >2 hr after dose before testing, 4hr after IM dose
- Blood studies: CBC, platelets q2wk until stabilized, then mostly monthly x12mo, then q3mo; discontinue product if neutrophils <1600/mm3, serum calcium, albumin, phosphorus
- Mental status: mood, sensorium, affect, memory (long, short), SUICIDAL THOUGHTS/BEHAVIORS
- Seizure activity including type, location, duration, character; provide seizure precaution
- Renal studies: urinalysis, BUN, urine creatinine
- Hepatic studies: ALT, AST, bilirubin, creatinine
- Allergic reaction: red, raised; product should be discontinued
- TOXICITY/BONE MARROW DEPRESSION: nausea, vomiting, ataxia, diplopia, cardiovascular collapse, slurred speech, confusion
- Respiratory depression: rate, depth, character of respirations
- BLOOD DYSCRASIAS: fever, sore throat, bruising, rash, jaundice
- Continuous monitoring of ECG, BP, respiratory function
- Rash; discontinue as soon as rash develops, serious adverse reactions such as STEVENS-JOHNSON SYNDROME can occur
Valproic Acid (Depakote) (Functional Classification)
anticonvulsant, vascular headache suppressant
Valproic Acid (Depakote) (Chemical Classification)
Carboxylic acid derivative
Valproic Acid (Depakote) (Mechanism of Action)
Increases levels of gamma-aminobutyric acid (GABA) in the brain, which decreases seizure activity
Valproic Acid (Depakote) (Uses)
Simple (petit mal), complex (petit mal), absence, mixed, seizures; manic episodes associated with bipolar disorder, prophylaxis of migraine, adjunct for schizophrenia, tardive dyskinesia, aggression in children with ADHD, organic brain syndrome, mania, migraines; tonic-clonic (grand mal), myoclonic seizures
Valproic Acid (Depakote) (Contraindications)
Hypersensitivity, urea cycle disorders
Valproic Acid (Depakote) (Side Effects)
CNS: Sedation, Drowsiness, dizziness, headache, incoordination, depression, hallucinations, behavioral changes, tremors, aggression, weakness, COMA, SUICIDAL IDEATION
EENT: visual disturbances, taste perversion
GI: Nausea, Vomiting, Constipation, Diarrhea, Dyspepsia, anorexia, cramps, HEPATIC FAILURE, PANCREATITIS, TOXIC HEPATITIS, stomatitis, weight gain
GU: enuresis, irregular menses
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, LYMPHOCYTOSIS, increased PT, bruising, epistaxis
INTEG: Rash, alopecia, photosensitivity, dry skin
Valproic Acid (Depakote) (Nursing Considerations)
Assess:
- Seizure disorder: location, aura, activity, duration; seizure precautions should be in place
- Mental status: bipolar disorder: mood, activity, sleeping/eating, behavior; suicidal thoughts/behaviors
- Migraines: frequency, intensity, alleviating factors
- Blood studies: Hct, Hgb, RBC, serum folate, PT/PTT, serum ammonia, platelets, vit D if patient receiving long-term therapy
- Hepatic studies: AST, ALT, bilirubin; hepatic failure has occurred
- Blood levels: therapeutic level 50-100mcg/ml, during seizures
- Respiratory dysfunction: respiratory depression, character, rate, rhythm; hold product if respirations are <12/min or if pupils are dilated
- Pancreatitis; may be fatal
