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a_nclex > Antiepileptic Drugs > Flashcards

Antiepileptic Drugs Flashcards

1
Q

Carbamazepine (Tegretol)

Chemical Classification

A

Iminostilbene derivative

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2
Q

Carbamazepine (Tegretol)

Mechanism of Action

A

Exact mechanism unknown; appears to decrease polysynaptic responses and block posttetanic potentiation

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3
Q

Carbamazepine (Tegretol)

Uses

A

Tonic-Clonic, complex-partial, mixed seizures; trigeminal neuralgia; bipolar disorder

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4
Q

Carbamazepine (Tegretol)

Contraindications

A

Pregnancy (D), hypersensitivity to carBAMazepine or tricyclics, AV or bundle branch block

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5
Q

Carbamazepine (Tegretol)

Side Effects

A

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)

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6
Q

Carbamazepine (Tegretol)

Nursing Considerations

A

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

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7
Q

Carbamazepine (Tegretol)

Overdose Treatment

A

Lavage, VS

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8
Q

Gabapentin (Neurontin)

Functionional Classification

A

Anticonvulsant

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9
Q

Gabapentin (Neurontin)

Mechanism of Action

A

Mechanism unknown; may increase seizure threshold; structurally similar to GABA; gabapentin binding sites in neocortex, hippocampus

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10
Q

Gabapentin (Neurontin)

Uses

A

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

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11
Q

Gabapentin (Neurontin)

Contraindications

A

Hypersensitivity

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12
Q

Gabapentin (Neurontin)

Side Effects

A

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

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13
Q

Gabapentin (Neurontin)

Nursing Considerations

A

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
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14
Q

Phenobarbital

functional classification

A

Anticonvulsant

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15
Q

Phenobarbital

Chemical Classification

A

Barbiturate

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16
Q

Phenobarbital

Mechanism of Action

A

Decreases impulse transmission; increases seizure threshold at cerebral cortex level

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17
Q

Phenobarbital

Uses

A

All forms of epilepsy, status epilepticus, febrile seizures in children, sedation, insomnia

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18
Q

Phenobarbital

Contraindication

A

Pregnancy (D), breastfeeding, geriatric patients, hypersensitivity to barbiturates, porphyria, hepatic/respiratory disease, nephritis, hyperthyroidism, diabetes mellitus

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19
Q

Phenobarbital

Side Effects

A

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

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20
Q

Phenobarbital

Nursing Considerations

A

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

21
Q

Primidone

Functional Classification

A

Anticonvulsant

22
Q

Primidone

Chemical Classification

A

Barbiturate derivative

23
Q

Primidone

Mechanism of Action

A

Raises seizure threshold by conversion of product to PHENobarbital, decreases neuron firing

24
Q

Primidone

Uses

A

Generalized tonic-clonic (Grand mal), complex seizures

25
Q

Primidone

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity, porphyria, hepatic encephalopathy

26
Q

Primidone

Side Effects

A

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

27
Q

Primidone

Nursing Considerations

A

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
28
Q

Phenytoin (Dilantin)

Functional Classification

A

Anticonvulsant; antidysrhythmic (IB)

29
Q

Phenytoin (Dilantin)

Chemical Classification

A

Hydantoin

30
Q

Phenytoin (Dilantin)

Mechanism of Action

A

Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction

31
Q

Phenytoin (Dilantin)

Uses

A

Generalized tonic-clonic seizures; status epilepticus; nonepileptic seizures associated with Reye’s syndrome or after head trauma; Bell’s palsy, complex partial seizures

32
Q

Phenytoin (Dilantin)

Contraindications

A

Pregnancy (D), hypersensitivity, psychiatric condition, bradycardia, SA and AV block, Stokes-Adams syndrome, hepatic failure, acute intermittent porphyria

33
Q

Phenytoin (Dilantin)

Side Effects

A

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)

34
Q

Phenytoin (Dilantin)

Nursing Considerations

A

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
35
Q

Fosphenytoin

functional classification

A

anticonvulsant

36
Q

Fosphenytoin

chemical classification

A

Hydantoin, phosphate phenytoin ester

37
Q

Fosphenytoin

Mechanism of Action

A

Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction, prodrug of phenytoin

38
Q

Fosphenytoin

Uses

A

Generalized tonic-clonic seizures, status epilepticus, partial seizures

39
Q

Fosphenytoin

Contraindications

A

Pregnancy (D), hypersensitivity, psychiatric conditions, bradycardia, SA and AV block, Stokes-Adams syndrome, absence seizures

40
Q

Fosphenytoin

Side Effects

A

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

41
Q

Fosphenytoin

Nursing Considerations

A

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
42
Q 
Valproic Acid  (Depakote) 
(Functional Classification)
A

anticonvulsant, vascular headache suppressant

43
Q 
Valproic Acid (Depakote)
(Chemical Classification)
A

Carboxylic acid derivative

44
Q 
Valproic Acid (Depakote)
(Mechanism of Action)
A

Increases levels of gamma-aminobutyric acid (GABA) in the brain, which decreases seizure activity

45
Q 
Valproic Acid (Depakote)
(Uses)
A

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

46
Q 
Valproic Acid (Depakote)
(Contraindications)
A

Hypersensitivity, urea cycle disorders

47
Q 
Valproic Acid (Depakote)
(Side Effects)
A

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

48
Q 
Valproic Acid (Depakote)
(Nursing Considerations)
A

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
49
Q

Carbamazepine (Tegretol)

Functional Classification

A

Anticonvulsant

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