Chapter 14

Question 1

Seizure

Answer 1

Brief episode of abnormal electrical activity in nerve cells of the brain

Question 2

Convulsion

Answer 2

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

Question 3

Epilepsy

Answer 3

Chronic, recurrent pattern of seizures

Question 4

Primary (idiopathic)

Answer 4

Cause cannot be determined

Roughly 50% of epilepsy cases

Question 5

Secondary (symptomatic)

Answer 5

Distinct cause is identified

Trauma, infection, cerebrovascular disorder

Question 6

Status Epileptics

Answer 6

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

Question 7

Antiepileptic Drugs (AEDs)

Answer 7

Also known as anticonvulsants
-goal is to control or prevent seizures while maintaining a reasonable quality of life
-

Question 8

Electroencephlagram

Answer 8

used to determine if patients are really having seizures or what part of the brain the seizure is originating from

Question 9

How long is AED therapy?

Answer 9

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

Question 10

Why do we check serum drug concentrations?

Answer 10

To make sure they are in a therapeutic range.

Question 11

Normal blood level for phenytoin (table 14-6)

Answer 11

10-20 mcg/mL

Question 12

Also known as anticonvulsants

Answer 12

Barbiturates
Hydantoins
Iminostilbenes plus valproic acid
Second- and third-generation antiepileptics 
Se Table 14-1, pg. 221

Question 13

Antiepileptic Drugs: Indications

Answer 13

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)

Question 14

Side effects of AEDs

Answer 14

-black box warnings on some (ex: suicidal thoughts and behavior)

Question 15

Long term therapy with phenytoin (dilantin) may cause _______

Answer 15

1. gingival hyperplasia (gums grow over teeth)
2. acne
3. hirsutism (extra hair)
4. Dilatntin facies (strange expression on face)

Question 16

________ has been used as a first-line drug for many years and is the prototypical drug.

Answer 16

Phenytoin (Dilantin), a type of hydantoins; grandmother/grandfather of the other drugs we have developed

Question 17

Forphenytoin/Cerebyx can be given

Answer 17

only IV; never orally

Question 18

How do we start IV for antiseizure drugs?

Answer 18

• 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

Question 19

Whats D5W?

Answer 19

dextros 5 percent in water, used to infuse certain drugs, but not for AEDs

Question 20

Drug interactions for phenytoin

Answer 20

Decreased effects of anticoagulants, oral contraceptives, antihistamines, dopamine, theophylline

Question 21

What do you need to teach a female patient taking oral contraceptives who needs to take phenytoin?

Answer 21

Your birthcontrol is less effective need to use another method

Question 22

What is thrombocynpenia

Answer 22

low platelet levels

Question 23

Why would a patient taking phenytoin need to go to the dentist more often?

Answer 23

gingival hyperplasia (gums grow over teeth)

Question 24

When should patients take phenytoins?

Answer 24

The same time everyday, preferbly at night

Question 25

How could phenytoin effect urine?

Answer 25

Make it change color; this is normal

Question 26

Why is sore throat, bruising, nosebleed a concern for a patient on phenytoin?

Answer 26

low platelet levels

Question 27

Second most commonly prescribed antiepileptic drug in the US after phenytoin

Answer 27

Carbamazepine (Tegretol) , only given orally

Question 28

What is the autoinduction of hepatic enzymes

Answer 28

over time, the drug’s efficiency decreases

Question 29

Adverse effects of Carbamazepine (Tegretol)

Answer 29

CNS and GI symptoms

Question 30

How to combat GI symtpms with Carbamazepine (Tegretol)

Answer 30

take with food

Question 31

Which drug do we use for absence seizures? Who has these often?

Answer 31

ethosuximide (Zarontin); children

Question 32

Nursing implications for AED oral drugs

Answer 32

• 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

Question 33

Nursing implications for IV AED drugs

Answer 33

• 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

Question 34

Nursing implications for all patients on AEDs

Answer 34

• 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