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Exam 3 - Pharmacology > Chapter 14 - Antiepileptic Drugs > Flashcards

Chapter 14 - Antiepileptic Drugs Flashcards

1
Q

What is epilepsy caused by?

A

excessive electrical activity of neurons in cerebral cortex

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2
Q

What is a seizure?

A

brief episode of abnormal electrical activity in nerve cells of brain -> may/may not lead to convulsion

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3
Q

What is a convulsion?

A

more severe seizure involuntary spasmodic contractions of any/all voluntary muscles in body, including skeletal, facial, and ocular

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4
Q

What is epilepsy?

A

chronic, recurrent pattern of seizures

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5
Q

Primary Epilepsy Another name and what cause

A

Idiopathic Epilepsy Cause cannot be determined more than 50% of cases

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6
Q

Secondary Epilepsy Another name and what cause

A

Symptomatic Epilepsy Distinct cause identified: trauma, infection, cerebrovascular disorder Infants/children: r/t developmental defects, metabolic disease/injury at birth Adults: acquired brain disorder is major cause

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7
Q

What are grand mal seizures now known as?

A

Generalized onset seizures

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8
Q

What is happening in generalized-onset seizures?

A

neuronal activity originating simultaneously in both hemispheres

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9
Q

What are the subtypes of generalized onset seizures?

A
  1. Tonic-clonic
  2. tonic
  3. clonic
  4. atonic (drop attacks)
  5. myoclonic
  6. absence and infantile spasms
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10
Q

Who is generalized onset seizures most often seen in?

A

children

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11
Q

How will a generalized onset seizure present itself to you?

A
  1. loss of consciousness
  2. no postical confusion
  3. may have rhythmic movements
  4. no convulsion
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12
Q

What are the 3 types of partial-onset seizures?

A
  1. Simple (used to be “petit mal seizures”)
  2. Complex
  3. secondary generalized tonic-clonic seizure
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13
Q

Characteristics of Simple Partial-onset seizures

A

brief loss of awareness (blank stare), no LOC

hallucinations

autonomic nervous system responses

personality changes

motor symptoms are commonly at face, arms, and leg

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14
Q

What are the classifications of seizures?

A
  1. Partial seizures
    - simple
    - complex
  2. Generalized seizures
  3. Unclassified seizures
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15
Q

Characteristics of Complex Partial-onset Seizures

A

impaired consciousness

memory impairment

behavioral effect

aura, chewing, swallowing, unreal feelings

tonic, clonic, or tonic-clonic seizures

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16
Q

Characteristics of Secondary Generalized Tonic-Clonic Seizure

A

Partial onset seizures that progress

Occurs in up to 40% of pts

Postictal confusion

17
Q

What is an Unclassified Seizure?

A

Seizures that do not fit into any other category

18
Q

What can status epilepticus lead to?

A

hypotension, hypoxia, and cardiac dysrhythmias

which can all lead to brain damage and death

19
Q

What is status epilepticus?

A

multiple seizures occurring without recovery between

20
Q

What can febrile seizures progress to?

A

Status epilepticus

21
Q

What drugs are used to treat status epilepticus?

A
  1. diazepam
  2. fosphenytoin
  3. lorazepam (off label use)
  4. phenobarbital
  5. phenytoin

Page 221, Table 14-3 has all the doses, onsets, etc.

22
Q

What are Antiepileptic Drugs (AEDs) also known as?

A

anticonvulsants

23
Q

What are the goals of therapy using AEDs?

A

control/prevent seizures while maintaining reasonable quality of life

minimize adverse effects/drug-induced toxicity

24
Q

How long does AED therapy last? When can the pt discontinue?

A

therapy is usually lifelong

Pts who are seizure-free for 1-2 years may be able to discontinue

25
Q

_______ drug therapy started before _______ drug therapy

A

single drug therapy started before multiple drug therapy

26
Q

Titrate antiepileptic drugs to the lowest effective level. True or false?

A

True

27
Q

MOA of AEDs

A

Exact MOA is unknown.

AEDs are thought to alter movement of Na, K, and Ca ions across nerve cells in the brain

  1. Increase the threshold of activity (reduce nerve’s ability to be stimulated)
  2. Limit the spread: suppress transmission of impulses from one nerve to the next
  3. Decrease the speed of nerve conduction within a neuron
28
Q

Overall effect of MOA and AEDs

A

Neurons stabilized

Neuron hyperexcitability decreased

Excessive nerve impulse spread decreased

29
Q

Indications of AEDs

A

prevention/control of seizure activity

long-term maintenance therapy for chronic, recurring seizures

acute treatment of convulsions and status epilepticus

other uses

30
Q

Adverse effects of AEDs

A

Numerous - vary per drug

often necessitate change in meds

Phenytoin: long-term may cause gingival hyperplasia, acne, hirsutism, and dilantin facies

black box warning (2008): suicidal thoughts/behavior is twice the risk

31
Q

5 AEDs

PGVTP

A
  1. Barbiturates, such as phenobarbital (Luminal)
  2. gabapentin (Neurontin)
  3. valproid acid (Depakene)
  4. topiramate (Topamax)
  5. Hydantoins, such as phenytoin (Dilantin) and fosphenytoin

People Grab Vaginas To Please

Slide 15-16, I only wrote the yellow ones

32
Q

Nursing Implications: Assessment

A

Health history, including current meds

Drug allergies

Renal and Liver function studies CBC

baseline levels

basline V/S

EEG, MRI, CT scans

baseline neurologic exam

33
Q

6 rules for taking an oral AED

RM(DN)W(OM)

A
  1. take same time everyday
  2. take with meals (decrease GI upset)
  3. do not crush, chew, or open extended-release forms
  4. take with 6-8 oz of water
  5. oral suspensions should be mixed
  6. if pt is NPO, contact physician

Real Men Do Not Water On Men

Regular Meals Do Not (crush, chew, open) Water Oral Mixed

34
Q

4 rules for IV form AEDs

A
  1. follow manufacturer’s recommendations for IV delivery, usually given slowly
  2. monitor V/S
  3. avoid extravasation of fluids
  4. use only normal saline with IV phenytoin
35
Q

What to teach pt’s regarding AEDs?

A
  1. keep a journal to monitor response to AED, seizure occurrence/descriptions, adverse effects
  2. wear med alert tag/ID
  3. AEDs should not be discontinued abruptly
  4. instruct pt of sedating effect
  5. driving may be prohibited
  6. teach pts therapy is long term/possibly lifelong (not a cure)
36
Q

Nursing Implications: What to monitor for

A
  1. therapeutic effects
    - decreased/absent seizure activity
  2. adverse effects
    - mental status, mood, LOC, sensorium changes
    - eye problems, visual disorders
    - sore throat, fever (hydantoins may cause blood dyscrasias

Exam 3 - Pharmacology (4 decks)

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