Antiseizure Agents Flashcards
Pharmacology Exam 1
What are the 3 types of seizures?
Tonic-Clonic Seizure
Absence Seizure
Status Epilepticus
What is the suffix for the antiseizure agent class Hydantoins?
Phenytoin
What are the 2 generic medications for the antiseizure agent class Barbiturates?
Phenobarbital
Primidone
What is the suffix for the drug class Benzodiazepines?
“azepam”
Clonazepam
Diazepam
What is the suffix for the drug class Succinimides?
“suximide”
Ethosuximide
Methosuximide
What are the two generic drug names in the drug class GABA Modulators?
Valproic Acid & Divalproex
How does Hydantoins work?
They stabilize the nerve membranes by blocking channels in the cell membranes or by altering reception sites. This decreases excitability and hyperexcitability of the membrane.
How does Barbiturates & Benzodiazepines work?
They stabilize the nerve membranes by blocking channels in the cell membranes or by altering reception sites. This decreases excitability and hyperexcitability of the membrane.
How does Succinimides work?
They suppress the abnormal electrical activity in the brain
How does GABA Modulators work?
They suppress the abnormal electrical activity in the brain and increases GABA levels in the brain.
Why is Phenytoin given?
For Seizures
Why are benzodiazepines given?
For Seizures
Why are the generic drug Ethosuximide given?
For seizures, but most commonly with absence seizures.
Why are Valproic Acid and Divalproex given?
For Seizures
What drug class does Valproic Acid and Divalproex fall under?
GABA Modulators
What does GABA stand for and what does it do?
GABA stands for gamma-aminobutyric acid, an amino acid that functions as a neurotransmitter in the central nervous system (CNS)
What patients should we be cautious with giving Phenytoin to?
Elderly or deliberate patients
Patients with impaired renal or liver functions.
Patients with depression or psychosis
What patients should we be cautious with giving ‘Phenobarbital’ and ‘Diazepam’ to?
Elderly or deliberate patients
Patients with impaired renal or liver functions.
Patients with depression or psychosis
What patients should we be cautious with giving ‘Methosuximide’ to?
Patients who have Renal or Hepatic disease
What patients should we be cautious with giving ‘Divalproex’ to?
Patients with Hepatic or Renal impairment
What are the adverse effects of Hydantoins’/Phenytoin?
CNS Depression
Cardiac Arrythmias and Hypotension
Severe Liver Toxicity
Bone Marrow Suppression
Urinary retention
Loss of Libido
What are the adverse effects of Barbiturates & Benzodiazepines?
CNS Depression:
- Confusion, Drowsiness, lethargy, fatigue
Cardiac:
Arrythmias, Changes in BP, Urinary retention
Loss of Libido
Physical dependency and withdrawal symptoms
What does the Black Box Warning on Benzodiazepines and Barbiturates say?
Mixed with opioids this medication may cause
Profound sedation
Respiratory depression
Coma
Death
What are some the adverse effects of Ethosuximide?
CNS depressant effect
Bone Marrow Suppression
Steven Johnson Syndrome
What is Steven Johnson Syndrome?
A rare, serious, and potentially fatal skin reaction that causes blistering and peeling of the skin and mucous membranes. It’s characterized by a rash that usually starts on the upper body and spreads to other areas of the body, including the face, arms, legs, and genitals. The rash is not usually itchy, but blisters appear on the skin and burst to leave painful sore
What is Bone Marrow Suppression?
Bone marrow suppression also known as myelotoxicity or myelosuppression, is the decrease in production of cells responsible for providing immunity, carrying oxygen, and/or those responsible for normal blood clotting
What are the adverse effects that may happen when a patient takes Valproic Acid?
CNS Depression
Liver Toxicity
Pancreatitis
DRESS: Drug reaction with Eosinophilia & Systemic Symptoms
What is DRESS symptoms
Drug reaction with eosinophilia and systemic symptoms (DReSS) is a rare disorder that can affect the skin, blood and any internal organs, most commonly the liver, kidney, lungs and heart. also called drug induced hypersensitivity syndrome
How may antiseizure agents affect children and what considerations should be taken?
Can affect learning & social development.
Children are more sensitive to the sedative effect.
May need to switch medication dosing when growing.
How may antiseizure agents affect adults and what considerations should be taken?
Adults should have regular routine care.
Be monitored for adverse effects.
Drugs taken during pregnancy may develop fetal abnormalities.
How may antiseizure agents affect older adults and what considerations should be taken?
Older adults are more susceptible to adverse effects.
The medications affect the CNS system so safety measures should be implemented.
Renal & Hepatic impairment can occur - monitor closely
Monitor serum levels to prevent toxicity.
Should have a medic alert.
True or False
Epilepsy is the most prevalent neurological disorder
True
What history should be collected during the nursing assessment?
Factors for contraindications and cautions.
What physicals examinations should be done during the nursing assessment?
Skin - Due to adverse effects
Vital
CNS - due to adverse effect
Muscle Strength - due to CNS effect
Abdominal - due to adverse
Urine Output - do to risk of urinary retention
What nursing diagnosis can be made before a patient is administered Antiseizure agents?
Impaired Comfort - due to GI & CNS effect.
Impaired Skin Integrity - due to adverse effects
Altered Skin Integrity - Adverse effect.
Injury Risk - Due to CNS effect
Infection Risk - due to bone marrow suppression
Knowledge Deficit
What nursing implementation can be made for a patient prescribed Antiseizure agents?
Administer with food - If GI adverse effect
Monitor CBC (complete blood count) due to bone marrow suppression
Prepare to discontinue the medication should any of the following occur:
Skin Rash
Bone Marrow Suppression
Unusual Depression
Personality changes
Discontinue slowly
What is Epilepsy?
Most prevalent neurological disorder.
Collection of different syndromes.
Seizure
Loss of control
Frightening to patients
What causes seizures?
Abnormal neurons sensitive to stimulations or over responsiveness.
What is the best way to diagnose seizures?
Through EEG (Electroencephalogram) which measures electrical activity in the brain.
What drug class does Valproic Acid belong to?
GABA Modulators
What drug class does Divalproex belong to?
GABA Modulators
What drug class does Primidone belong to?
Barbiturates
What drug class does Ethosuximide belong to?
Succinimides
What drug class does Phenytoin belong to?
Hydantoins
What drug class does Diazepam belong to?
Benzodiazepines
What characterizes a Tonic-Clonic seizure?
A seizure that has both tonic (stiffening) and clonic (jerking) muscle contractions on both side of the body in intervals. appear as spasms. Usually lasts less than 5 minutes. Loss of consciousness happens and the recovery period is characterized with exhaustion and confusion.
What characterizes an absence seizure?
Seizure that is characterized by sudden but temporary loss of consciousness for about 5-15 seconds usually accompanied by blinking or staring. Usually in children 3y/o, usually outgrown by puberty.
What is a Status Epilepticus seizure?
Seizure rapidly occur without cognitive recovery in between. They usually last over 5 minutes and is the most dangerous form of seizure and considered a medical emergency because they may lead to brain damage due to anoxia.
What should be the serum levels of Hydantoins?
Therapeutic serum phenytoin levels: 10-20 mcg/mL
What is the half life of Barbiturates’?
up to 100 hrs
What is the half life of Benzodiazepines?
18-50 hrs
What is the Drug-Drug adverse interaction to Succinimides?
Primidone. It lowers primidone levels when they are both taken.
What is an adverse Drug-Drug interaction to Phenytoin?
Alcohol
What is an adverse Drug-Drug interaction to Diazepam?
Opioids & Alcohol
what is the adverse Drug-Drug interaction to GABA modulators?
Other antiseizure drugs
* Risk of toxicity
* Risk of breakthrough seizure
Would a person be considered epileptic after one seizure episode?
No.
Epilepsy is chronic or recurrent seizures.
What is a primary seizure?
When there is no underlying cause or reason for the seizure.
What is a secondary seizure?
There is a cause for the seizure. This could be due to a head injury, drug overdose, fever or environmental factors
Which drug is most often used to treat Status Epilepticus seizures?
Phenytoin, Clonazepam and Phenobarbital
Why does children up to 6 years old possibly need a higher dosage of antiseizure agents?
Because they metabolize the drug faster - so dosage may need to be adjusted.
When can an child receive adult dosing?
After age 10 y/o
Can a woman breastfeed while taking antiseizure agents?
No bacuse the infant can experience CNS effect incl heavy sedation.
Why would a patient be prescribed Phenytoin over Barbiturates?
Less sedative effect
What substance may decrease the seizure threshold?
Alcohol
How come barbiturates and Benzodiazepines have long half lives?
Due to their low lipid solubility so they have a long duration.
What other antiseizure drugs has a Black Box Warning for serious skin reaction?
Carbamazepine, Lamotrigine, and Topiramate.
Which drug class is Stevens-Johnson syndrome an adverse effect of?
Succinimides
Which 2 drug classes are bone marrow depression an adverse effect of?
Hydantoins & Succinimides
Which drug classes have CNS depression as an adverse effect?
All of them
Name 3 generic drugs that have loss of libido as an adverse effect?
Phenytoin, Primidone and clonazepam
