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Prototype Drugs > Antiepileptic Drugs Chapter 14 > Flashcards

Antiepileptic Drugs Chapter 14 Flashcards

1
Q

carbamazepine** (Tegretol-XR, Tegretol)

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Iminostilbenes
INDICATIONS: Partial, secondary generalized, generalized tonic-clonic seizures

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2
Q

carbamazepine** (Tegretol-XR, Tegretol)

DOSAGES/ THERAPEUTIC PLASMA LEVELS

A

PO: 12 400-1200 mg/day

THERAPEUTIC PLASMA LEVEL 4-12 mcg/mL

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3
Q

carbamazepine** (Tegretol-XR, Tegretol)

ADVERSE EFFECTS

A

ADVERSE EFFECTS:nausea, headache, dizziness, unusual eye movements, visual change, behavioral changes, rash, abdominal pain, abnormal gait

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4
Q

carbamazepine** (Tegretol-XR, Tegretol)

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

NI: associated with autoinduction of hepatic enzymes (within 2 months of initial treatment)
CT: may worsen byoclonic or absence seizures; bone marrow depression

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5
Q

carbamazepine** (Tegretol-XR, Tegretol)

DRUG INTERACTIONS

A

Altered CYP450 enzyme metabolism: increased carbamazepine levels and toxicity risk (azole antifungals, diltiazem, isoniazid, macrolides, protease inhibitor antiretrovirals, SSRIs, valproic acid, verapamil)
Altered CYP450 enzyme metabolism: reduced carbamazepine levels and efficacy (barbiturates, hydantoins, rifampin, succinimides, theophyline)
Altered CYP450 enzyme metabolism: increased hepatic metabolism of acetaminophen and toxicity risk, reduced efficacy (acetaminophen
Altered CYP450 enzyme metabolism: reduced efficacy; pt response must be monitored (antipsychotics, antidepressants, benzodiazepines, cyclosporine, oral contraceptives)
Altered CYP450 metabolism: Increased MAOI toxicity risk (MAOIs)

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6
Q

gabapentin** (Neurontin)

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Miscellaneous
INDICATIONS: Partial, secondary generalized seizures, neuropathic pain, adjunct partial seizures/ prophylaxis of partial seizures

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7
Q

gabapentin** (Neurontin)

DOSAGES

A

Pediatric: PO: 10-15 mg/kg/day divided tid, then adjust

Adult PO: older than 18 yr, 900-1800 mg/day

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8
Q

gabapentin** (Neurontin)

ADVERSE EFFECTS

A

CNS and GI symptoms, dizziness, drowsiness, nausea, visual and speech changes, edema

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9
Q

gabapentin** (Neurontin)

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

CT: known drug allergy

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10
Q

gabapentin** (Neurontin)

DRUG INTERACTIONS

A

Additive CNS depression: Increased CNS depression (alcohol)

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11
Q

phenobarbital**

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Barbiturate
INDICATIONS: Pediatric; Partial, secondary generalized, geralized tonic-clonic seizures, prophylaxis for febrile seizures, psychomotor seizures
INDICATIONS: Adult; partial, secondary generalized, generalized tonic-clonic seizures

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12
Q

phenobarbital**

DOSAGES/ THERAPEUTIC PLASMA LEVELS

A

ORAL, INJECTABLE
Pediatric: PO: 3-6 mg/kg/day
Adult: PO: 1-3 mg/kg/day
THERAPEUTIC PLASMA LEVELS: 10-40 mcg/mL

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13
Q

phenobarbital**

ADVERSE EFFECTS

A

Dizziness, drowsiness, lethargy, paradoxical restlessness

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14
Q

phenobarbital**

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

CT: sedation, known drug allergy, porphyria liver/ kidney impairment, respiratory illness, adverse effects include cardiovascular, CNS, GI , dermatologic reactions

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15
Q

phenytoin** (Dilantin)

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Hydantoin
INDICATIONS: Pediatric; partial secondary generalized, generalized tonic-clonic seizures;
INDICATIONS: Adult; generalized tonic-clonic seizures

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16
Q

phenytoin** (Dilantin)

DOSAGES/ THERAPEUTIC PLASMA LEVELS

A

Pediatric: PO: 5-10 mg/kg/day
Adult: PO: 300-600 mg/day
THERAPEUTIC PLASMA LEVELS: 10-20 mcg/mL

17
Q

phenytoin** (Dilantin)

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

NI: Highly protein bound, exaggerated effects in pts with low serum albumin (malnourished or renal failure)
CT: known drug allergy and heart conditions that involve bradycardia or blockage of electrocardiac function

18
Q

phenytoin** (Dilantin)

ADVERSE EFFECTS

A

Nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis

19
Q

phenytoin** (Dilantin)

DRUG INTERACTIONS

A

Altered CYP450 enzyme metabolism: reduced hydantoin clearance and increased effects (amiodarone, benzodiazepines, azole antifungals, isoniazid, proton pump inhibitors, sulfonamide antibiotics, SSRIs,)
Altered CYP450 enzyme metabolism: increased hydantoin clearance and reduced effects (carbamazepine)
Displacement of warfarin from plasma protein binding sites: increased free warfarin levels and bleeding risk (warfarin)

20
Q

valproic acid** (Depacon, IV Depakote, Depakene oral)

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Miscellaneous
INDICATIONS: generalized tonic-clonic, absence, myoclonic seizures

21
Q

valproic acid** (Depacon, IV Depakote, Depakene oral)

DOSAGES/ THERAPEUTIC PLASMA LEVELS

A

Adult and pediatric
PO: 15-60 mg/kg/day divided bid-tid
IV: 10-15 mg/kg/day as a 60-min infusion
THEAPEUTIC PLASMA LEVELS: 50-100 mcg/mL

22
Q

valproic acid** (Depacon, IV Depakote, Depakene oral)

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

NI: Highly bound to plasma proteins: competes with other highly protein-bound medications
CT: known drug allergy, liver impairment, and urea cycle disorders

23
Q

valproic acid** (Depacon, IV Depakote, Depakene oral)

ADVERSE EFFECTS

A

Dizziness, drowsiness, GI upset, weight gain, hepatoxicity, pancreatitis

24
Q

valproic acid** (Depacon, IV Depakote, Depakene oral)

DRUG INTERACTIONS

A

Displacement of valproic acid from plasma protein binding sites: increased free valproic acid levels and toxicity risk (aspirin)
Altered CYP450 enzyme metabolism: reduced valproic acid efficacy, increased lamotrigine levels, increased or decreased carbamazepine levels (carbamazepine, oxcarbazepine, lamotrigine)
Altered hepatic metabolism: increased lorazepam toxicity risk (lorazepam)
Altered CYP450 enzyme metabolism: reduced valproic acid efficacy (rifampin)
Altered CYP450 enzyme metabolism: increased tricyclic antidepressant toxicity risk (tricyclic antidepressants)

25
Q

primidone** (Mysoline)

CLASS/ INDICATIONS

A

ANTIEPILEPTIC DRUGS: Chapter 14
CLASS: Barbiturate
INDICATIONS: Pediatric; partial, secondary generalized, generalized tonic-clonic seizures
INDICATIONS: >8; partial, secondary generalized, generalized tonic-clonic seizures

26
Q

primidone** (Mysoline)

DOSAGES/ THERAPEUTIC PLASMA LEVELS

A

Pediatric: PO; 8, 250 mg 4-6 times/day; max 2g/day

THERAPEUTIC PLASMA LEVELS: 5-12 mcg/mL

27
Q

primidone** (Mysoline)

ADVERSE EFFECTS

A

Dizziness, drowsiness, lethargy, paradoxical restlessness

28
Q

primidone** (Mysoline)

DRUG INTERACTIONS

A

Dizziness, drowsiness, lethargy, paradoxical restlessness

29
Q

fosphenytoin (Cerebyx)**

CLASS/ INDICATIONS

A

Antiepileptic Drugs: Chapter 14
CLASS: Hydantoin
INDICATIONS: partial, secondary generalized, generalized tonic-clonic seizures

30
Q

fosphenytoin (Cerebyx)**

DOSAGES

A

Pediatric: IV 10-20 PE/kg loading dose; may begin maintenance dosing 8-12 hr later using pediatric phenytoin dosing guidelines
Adult: IV 10-20 PE/kg loading dose; maintenance dose 4-6 mg/kg/day

31
Q

fosphenytoin (Cerebyx)**

ADVERSE EFFECTS

A

Nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis

32
Q

fosphenytoin (Cerebyx)**

NURSING IMPLICATIONS/ CONTRAINDICATIONS

A

NI: If dysrhythmias or hypotension occur discontinue infusion/ implement fall prevention after infusion

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