Chapter 14 Flashcards
Seizure
Brief episode of abnormal electrical activity in nerve cells of the brain
Convulsion
Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles
Epilepsy
Chronic, recurrent pattern of seizures
Primary (idiopathic)
Cause cannot be determined
Roughly 50% of epilepsy cases
Secondary (symptomatic)
Distinct cause is identified
Trauma, infection, cerebrovascular disorder
Status Epileptics
Multiple seizures occur with no recovery between them
- Result: hypotension, hypoxia, brain damage, and death
- True medical emergency
- (could only happen in a medical setting via IV push) Usual treatment: Diazepam or lorazepam IV push; followed by fosphenytoin or phenytoin infusion
Antiepileptic Drugs (AEDs)
Also known as anticonvulsants
-goal is to control or prevent seizures while maintaining a reasonable quality of life
-
Electroencephlagram
used to determine if patients are really having seizures or what part of the brain the seizure is originating from
How long is AED therapy?
Usually lifelong
- combination of drugs may be used (single drug therapy is tried first)
- complications: sedation and drowsiness
- give at night to minimize adverse effects
Why do we check serum drug concentrations?
To make sure they are in a therapeutic range.
Normal blood level for phenytoin (table 14-6)
10-20 mcg/mL
Also known as anticonvulsants
Barbiturates Hydantoins Iminostilbenes plus valproic acid Second- and third-generation antiepileptics Se Table 14-1, pg. 221
Antiepileptic Drugs: Indications
Prevention or control of seizure activity
Long-term maintenance therapy for chronic, recurring seizures
Acute treatment of convulsions and status epilepticus
Other uses (such as bipolar disorder)
Side effects of AEDs
-black box warnings on some (ex: suicidal thoughts and behavior)
Long term therapy with phenytoin (dilantin) may cause _______
- gingival hyperplasia (gums grow over teeth)
- acne
- hirsutism (extra hair)
- Dilatntin facies (strange expression on face)
________ has been used as a first-line drug for many years and is the prototypical drug.
Phenytoin (Dilantin), a type of hydantoins; grandmother/grandfather of the other drugs we have developed
Forphenytoin/Cerebyx can be given
only IV; never orally
How do we start IV for antiseizure drugs?
- very irritating to veins, so need a good IV site
- SLOW IV directly into a large vein through a large-gauge venous catheter-dilute with NS in syringe
- DILUTED IN NORMAL SALINE ONLY FOR IV infusion (0.9%NaCl)
- FILTER must be used
- Saline flush before and after injection or infusion
- only pump no drip
Whats D5W?
dextros 5 percent in water, used to infuse certain drugs, but not for AEDs
Drug interactions for phenytoin
Decreased effects of anticoagulants, oral contraceptives, antihistamines, dopamine, theophylline
What do you need to teach a female patient taking oral contraceptives who needs to take phenytoin?
Your birthcontrol is less effective need to use another method
What is thrombocynpenia
low platelet levels
Why would a patient taking phenytoin need to go to the dentist more often?
gingival hyperplasia (gums grow over teeth)
When should patients take phenytoins?
The same time everyday, preferbly at night
How could phenytoin effect urine?
Make it change color; this is normal
Why is sore throat, bruising, nosebleed a concern for a patient on phenytoin?
low platelet levels
Second most commonly prescribed antiepileptic drug in the US after phenytoin
Carbamazepine (Tegretol) , only given orally
What is the autoinduction of hepatic enzymes
over time, the drug’s efficiency decreases
Adverse effects of Carbamazepine (Tegretol)
CNS and GI symptoms
How to combat GI symtpms with Carbamazepine (Tegretol)
take with food
Which drug do we use for absence seizures? Who has these often?
ethosuximide (Zarontin); children
Nursing implications for AED oral drugs
- Take regularly, same time each day
- Take with meals to reduce GI upset
- Do not crush, chew, or open extended-release forms
- If patient is NPO for a procedure, contact prescriber regarding AED dosage
Nursing implications for IV AED drugs
- Follow manufacturer’s recommendations for IV delivery—usually given slowly.
- Monitor vital signs during administration.
- Avoid extravasation of fluids.
- Use only normal saline with IV phenytoin (Dilantin).
WATCH IV SITE TO MAKE SURE IT IS NOT SWELLING/RED
Nursing implications for all patients on AEDs
- Teach patients to keep a journal to monitor:
- Response to AED
- Seizure occurrence and descriptions
- Adverse effects
- Instruct patients to wear a medical alert tag or ID.
- AEDs should not be discontinued abruptly.
- Follow driving recommendations.
-patients can sometimes have an aura, know they are about to have a seizure
