Antiseizure Flashcards
What is our Hydantoin
Phenytoin
Phenytoin (Hydantoins)
Action
affects ion channels to reduce excitability to stimulation
Phenytoin (Hydantoins)
Indication
seizures
and those with seizures who need less sedating meds
Phenytoin (Hydantoins)
Pharmacokinetics of therapeutic range
therapeutic serum level: 10-20mcg/mL
Phenytoin (Hydantoins)
Contra/Cautions
allergy
caution in elderly/debilitated
impaired renal/liver function
depression or psychoses (can be worsened)
Phenytoin (Hydantoins)
Adverse Effects
CNS depression, confusion, lethargy HTN severe liver toxicity bone marrow suppression urinary retention loss of libido
Phenytoin (Hydantoins)
Drug-Drug
Alcohol - increase CNS effects and decreases seizure threshold
What are the Barbiturates
Phenobarbital Primidone (PO only)
What are the Benzodiazepines
“-azepam”
Clonazepam
Diazepam
Barbiturate
Half-life
100 hours
Benzodiazepine
Half-life
18-50 hours
Barbiturates & Benzodiazepines
Action
stabilize nerves by decreasing excitability in the ion channels
Barbiturates & Benzodiazepines
Indications
epilepsy
status-epilepticus: phenobarbital
Barbiturates & Benzodiazepines
Contra/Cautions
allergy
caution in elderly/debilitated
impaired renal/liver function
depression or psychoses (can be worsened)
Barbiturates & Benzodiazepines
Drug-Drug
Alcohol - increase CNS depression
Barbiturates & Benzodiazepines
Adverse Effects
CNS: CNS depression/confusion/drowsiness
CV: arrhythmia, HTN
Other: urinary retention, loss of libido, physical dependence/withdrawal
What are our Succinimides
“-suximide”
Ethosuximide
Methsuximide
Succinimide
Indication
Absence seizures
Succinimides
Action
suppress abnormal activity in brain specifically associated with absence seizures
Succinimides
Contra/Cautions
known allergy
pregnancy/lact
renal/hepatic disease
Succinimides
Adverse effects
CNS depressant effects
bone marrow suppression (pancytopenia)
steven-johnson syndrome
Succinimides
Drug-Drug
Primidone- decreases primidone levels
What are the other drugs for absence seizures
“-amide”
acetazolamide
zonisamide
valproic acid
Acetazolamide & Zonisamide
Action
alters electrolyte movement to stabilize the nerve membrane
Valporic Acide
Action
reduces abnormal activity in the brain and increases GABA activity at inhibitory receptors
Acetazolamide/Zonisamide/Valporic Acid
Contra/cautions
known allergy
hepatic/renal impairment
Acetazolamide/Zonisamide/Valporic Acid
Adverse effects
liver toxicity
CNS depression/suppression
Acetazolamide/Zonisamide/Valporic Acid
Drug-Drug
Phenytoin: break through seizures can occur
Drugs for partial seizures
“-azepine”
carbamazepine
oxcarbazepine
Gabapentin
Lamotrigine
Levetiraxetam
Topiramate
Partial Seizure Drugs
Action
Directly: alters sodium/calcium channels
Indirectly: increases activity of GABA (a inhibitory neurotransmitter)
Partial Seizure Drugs
Contra/caution
known allergy
severe hepatic/renal dysfunction
bone marrow suppression
Partial Seizure Drugs
Adverse effects
most are CNS related
liver toxicity and failure
potential for increased suicidality
Partial Seizure Drugs
drug-drug
CNS depressants and alcohol
carbamazepine: consult a drug guid
hormonal contraceptives: decrease contraceptive effect and increases metabolism of anticonvulsant
Antiseizure Agents
Nursing process - assessment
description of seizure (onset, duration, generalized: aura/recovery?)
vitals, CNS, muscle strength, EEG, renal/hepatic labs
Antiseizure Agents
Nursing diagnoses
acute pain r/t CNS effects
disturbed thought process r/t CNS effects
impaired skin integrity r/t CNS effects
risk for injury r/t CNS effects
risk for infection r/t bone marrow suppression
deficient knowledge
Antiseizure Agents
Implementation
give with food
monitor CBC before and during
discontinue drug slowly
counseling for women of child bearing age
safety measures
prepare to d/c if: marrow suppression, unusual depression, personality changes
