Antiseizure Agents Flashcards
What seems to cause seizures?
Abnormal neurons sensitive to stimulation or prone to over-responsiveness
What are primary seizures?
Seizures with no underlying cause
What are secondary seizures?
Seizures because of a primary cause (ie. head injury, overdose, fever)
What is a tonic-clonic seizure?
dramatic contractions/relaxations of muscles (spasms)
What is an absence seizure?
abrupt, brief loss of consciousness
Looks like daydreaming, absent stare
What is Status Epilepticus?
Most dangerous of seizures
Repeated seizures lasting longer than 5 minutes
Considerations for use of Antiepileptic Agents
In Children
- Can affect learning and development
- More sensitive to sedating effects
- May need to switch doses/meds as they get older
- They often need LARGER doses since they metabolize the drug faster
- Parents need support and education
Considerations for use of Antiepileptic Agents
In Adults
- Regular, routine care
- Monitor for adv. effects
- Medic Alert Bracelet
- DO NOT breastfeed while taking => causes heavy sedation in infants
- Fetal abnormalities => use barrier contraception, weigh risk vs benefit in pregnancy
Considerations for use of Antiepileptic Agents
In Older Adults
- More susceptible to adv. effects
- LOWER dose needed to do to impaired metabolism
- CNS effects => need for safety precautions
- Renal or hepatic impairment => inc. risk of toxicity
- Monitor serum levels closely
- Medic alert Bracelet
Anti-Seizure
Hydantoins
Drug Name
Phenytoin
Anti-Seizure
Hydantoins
Mechanism of Action
Stabilizes the nerve membranes by blocking channels in the cell membrane or altering recepter sites
* Decreases excitability and hyperexcitability to stimulation
(less sedating than barbituates)
Hydantoins
Indication
Seizures
Anti-Seizure
Hydantoins
Contraindications
Absolute:
* Allergy
Cautions:
* Elderly or debilitated patients
* Impaired renal or hepatic funtion
* Depression or pyschoses
Anti-Seizure
Hydantoins
Adverse Effects
- CNS depression (confusion, lethargy)
- Cardiac Arrhythmias
- Hypotension
- Severe liver toxicity
- Bone Marrow suppression
- Urinary Retention
- Loss of libido
Anti-Seizure
Barbituates and Benzodiazepines
Adverse Effects
- SIGNIFICANT CNS depression (confusion, lethargy, fatigue)
- Cardiac Arrhythmias, changes in BP
- Urinary Retention
- Loss of libido
- Physical dependence and withdrawal
- Black Box Warning: Opiods & Benzodiazepines together can results in: Profound sedation, respiratory depression, coma, death
Anti-Seizure
Hydantoins
Drug Interactions
Alcohol (CNS depressant)
(also lowers seizure threshold)
Anti-Seizure
Barbituates & Benzodiazepines
Drug Interactions
Alcohol (CNS depressant)
(also lowers seizure threshold)
Same as hydantoins
Anti-Seizure
Barbituates
Drug Names
- Phenobarbital
- Primidone
Anti-Seizure
Benzodiazepines
Drug Names
“-azepam”
* Clonazepam
* Diazepam
Half Life of Barbituates and Benzodiazepines
Barbituates: Up to 100 hours
Benzodiazepines: 18-50 hours
Not for long term use, low lipid solubility
Anti-Seizure
Barbituates & Benzodiazepines
Mechanism of Action
Same as hydantoin
Stabilizes the nerve membranes by blocking channels in the cell membrane or altering receptor sites
* Decreases excitability and hyperexcitability to stimulation
Barbituates & Benzodiazepines
Indication
Seizures
Anti-Seizure
Barbituates & Benzodiazepines
Contraindications
Absolute:
* Allergy
Cautions:
* Elderly or debilitated patients
* Impaired renal or hepatic funtion
* Depression or pyschoses
Same as hydantoins
Anti-Seizure
Succinimides
Drug Names
“-suximide”
* Ethosuximide
* Methsuximide
Anti-Seizure
Succinimides
MOA
Suppress the abnormal electrical activity in the brain
Succinimides
Indications
- Seizures
- Most commonly used for absence seizures
Anti-Seizure
Succinimides
Contraindications
Absolute:
* Allergy
Cautions:
* Renal or hepatic disease
Anti-Seizure
Succinimides
Adverse Effects
- CNS depressant effects
- Bone Marrow suppression
- Stevens-Johnson Syndrome
Anti-Seizure
Succinimides
Drug Interactions
Primidone
Barbituate…. decreases primidone levels
Anti-Seizure
GABA Modulators
Drug Names
- Valproic Acid
- Divalproex
Anti-Seizure
GABA Modulators
MOA
- Reduces abnormal electrical activity in brain
- Increases GABA levels in the brain
GABA Modulators
Indication
Seizures
Anti-Seizure
GABA Modulators
Contraindication
Absolute:
* Allergy
Cautions:
* Hepatic or renal impairment
Anti-Seizure
GABA Modulators
Adverse Effects
- CNS Depression
- Liver Toxicity
- Pancreatitis
- DRESS: Drug reaction with eosinophilia and systemic symptoms (severe hypersensitivity => in the mucus membranes => organs)
Anti-Seizure
GABA Modulators
Drug Interactions
Other anti-seizure drugs
(risk of toxicity and risk of breakthrough seizures)
What are the OTHER drugs to treat seizures?
- Carbamazepine (Bloack Box warning for severe skin reactions, ADE: agranulocytosis, aplastic anemia, blood dyscrasias)
- Lamotrigine (Black Box warning for serious skin reactions)
- Levetiracetam
- Topiramate (serious skin reactions)
Antiseizure Agents Nursing Assessment
History:
* Contraindications and Cautions
Physical:
* Skin
* Vital Signs
* CNS
* Muscle strength
* Abdominal
* Urine output
Labs:
* ECG, renal & hepatic function tests, CBC
Antiseizure Agents
Nursing Conclusions
- Impaired comfort (GI,CNS)
- Altered Thought Process (CNS effects)
- Impaired skin integrity (skin reactions)
- Injury Risk (CNS)
- Infection Risk (bone marrow)
- Knowledge Deficit
Antiseizure Agents
Interventions/Patient Teaching
- Administer with food
- Monitor CBC before and during
- Protect from infection
- Prepare to discontinue drug (skin rash, bone marrow suppression, unusual depression, personality changes)
- Discontinue drug slowly
- Counseling to women of childbearing age
- Provide safety measures
- Patient Teaching (Medic alert bracelets, no alcohol/cns depressants)
