Antiepileptic Meds

Question 1

Hydantoins

Answer 1

phenytoin (Dilantin)

not used in absence seizures

Question 2

Hydantoins Mechanism of Action

Answer 2

inhibits Na and Ca influx
stabilizes cell membrane
reduces repetitive neuronal firing

Question 3

Hydantoins SE

Answer 3

MANY ARE DOSE DEPENDENT

gingival hyperplasia
tremor
hypotension
HA
drowsiness
confusion
GI distress
dizziness
insomnia
parasthesia
hyperglycemia
constipation
bradycardia
tachycardia
nystagmus/ataxia (toxicity signs)
pink or reddish brown urine (harmless)

Question 4

Hydantoins ADE

Answer 4

V-Fib
anaphylaxis
suicidal ideation
angioedema
blood dycrasias (thrombocytopenia, leukopenia)
SJS
hepatotoxicity

Question 5

Hydantoins Nursing Interventions

Answer 5

CI in pregnancy (teratogenic) use backup birth control; bleeding disorders
patients on telemetry
interacts with lots of other drugs (check MAR!)
liver labs
don’t stop abruptly; can trigger status epilepticus
monitor serum drug lvls frequently and signs of toxicity
monitor CBC
watch for rash (SJS)
good oral hygiene
take at same time with food or milk daily
avoid alcohol/CNS suppressants; don’t drive or perform hazardous activities
wear med tag
give slowly via IV

Question 6

Hydantoins Therapeutic Level

Answer 6

10-20 mcg/mL

VERY NARROW

Question 7

Valproates

Answer 7

valproic acid

increases GABA; inhibits Na and Ca influx

not used in status epilepticus

Question 8

Valproates SE

Answer 8

dizziness
drowsiness
weakness
insomnia
diplopia
GI distress
weight gain

Question 9

Valproates ADE

Answer 9

hepatotoxicity
suicidal ideation
thrombocytopenia
pancreatitis

Question 10

Valproates Nursing Interventions

Answer 10

CI in pregnancy (women should use effective contraception), liver disease, pancreatitis (report severe abdominal pain), bleeding disorders
caution with mood disorders
don’t stop abruptly (rebound seizures)
monitor liver and platelet labs; watch for signs of liver toxicity
take with food
avoid alcohol and CNS suppressants

Question 11

Valproates Therapeutic Level

Answer 11

50-100 mcg/mL

NARROW

Question 12

Antiepileptic Meds Overall Nursing Interventions

Answer 12

antiseizure drugs inhibit vitamin K and increases loss of folate in pregnant pts (folate supplements)
female pts taking oral contraceptives and antiseizure meds must use another BC method
pts shouldn’t drive/perform dangerous activities
oral care! for gingival hyperplasia
don’t stop meds abruptly (rebound effect)
almost all antiseizure meds are teratogenic

Question 13

Phenytoin Toxicity S/S

Answer 13

nystagmus
ataxia
slurred speech
confusion
decreased coordination