Chapter 15- Seizures

Question 1

What is status epilepticus?

Answer 1

• medical emergency

- continuous seizure activity which can lead to coma or death

Question 1

What are the causes of epilepsy/seizures?

Answer 1

• infectious diseases (inflammation of the brain)
• trauma (direct blows to the head; chemical trauma)
• metabolic disorders (hypoglycemia, hyponatremia, water intoxication)
• vascular diseases (changes in O2)
• pediatric disorders (rapid increase in temp)
• neoplastic disease (tumors)
• medications
• high doses of local anesthetics
• eclampsia (hypertensive disorder of pregnancy)
• drug abuse
• withdrawal syndromes

Question 1

Once an anti seizure medication is selected….what comes next?

Answer 1

• pt. is placed on low initial dose
• amount is gradually increased
• if seizures remain, different med is added in small increments

Question 1

What is the goal of anti seizure pharmacotherapy?

Answer 1

-SUPPRESS neuronal activity enough to prevent abnormal or repetitive firing

Question 1

What 3 mechanisms do antiseizure drugs act through?

Answer 1

1. Stimulating influx of chloride ions
2. Delaying influx of sodium
3. Delaying influx of calcium

-controlling movement of electrolytes across neuronal membranes or affecting neurotransmitter balance

Question 1

What is the withdrawal of antiseizure meds?

Answer 1

• seizure free of at least 3 years
• withdraw gradually over several months
• resume meds if seizures return
• be aware of rebound seizures

Question 1

Benzodiazepines indications

Answer 1

• absence seizures and myoclonic seizures
• tolerance develops quickly
• also used for anxiety, skeletal muscle spasms, alcohol withdrawal symptoms

Question 1

Benzodiazepine abuse

Answer 1

• Schedule IV drug
• pregnancy category D
• respiratory depression may result with other CNS depressants

Question 1

What is benzodiazepines contraindicated in?

Answer 1

Narrow-angle glaucoma

Question 1

Common side effects of benzodiazepines

Answer 1

Dizziness and drowsiness

Question 1

What drug do you give in case of overdose of benzodiazepines?

Answer 1

flumazenil (Romazicon)

Question 1

benzodiazepine mechanism of action, prototype drug, primary use, adverse effects

Answer 1

• similar to barbiturates
• Valium
• short-term seizure control
• drowsiness and dizziness

Question 1

Barbiturates mechanism of action

Answer 1

Changing action of GABA

Question 1

Barbiturates primary use

Answer 1

-controlling seizures

Question 1

Barbiturates prototype drug

Answer 1

Phenobarbital (luminal)

Question 1

Barbiturates adverse effects

Answer 1

• Dependence
• drowsiness
• vitamin deficiencies
• laryngospasm

Question 1

Patient teaching while taking barbiturates

Answer 1

• use reliable contraception
• immediately report pregnancy
• report excessive signs of bleeding
• report drowsiness and bone pain

Question 1

Barbiturates are effective against all major seizure types EXCEPT…

Answer 1

absence seizures

Question 1

Hydantoins are useful in treating all types of epilepsy EXCEPT…

Answer 1

Absence seizures

Question 1

Hydantoins provide…

Answer 1

Effective seizure suppression without the abuse potential or CNS depression associated with barbiturates

Question 1

What should the nurse monitor when patient is taking hydantoin?

Answer 1

• serum drug levels
• signs of toxicity
• blood dyscrasis or bleeding disorders
• liver and kidney function
• fatal hepatotoxicity can occur
• watch for GINGIVAL HYPERPLASIA

Question 1

Contraindications for hydantoin

Answer 1

• rash
• seizures due to hypoglycemia
• sinus bradycardia
• heart block

Question 1

Patient teaching with hydantoin

Answer 1

• routine labs for serum level
• routine labs for liver and kidney function
• report signs of toxicity
• report unusual bleeding
• report liver or brain disease
• report heart block, hypoglycemia, pregnancy
• maintain good oral hygiene

Question 1

What is the prototype drug for hydantoins?

Answer 1

Phenytoin (Dilantin)

Question 1

Mechanism of action for hydantoins

Answer 1

-desensitize sodium channels

Question 1

Adverse effects of hydantoins

Answer 1

• CNS depression
• gingival hyperplasia
• skin rash
• cardiac dysrhythmias
• hypotension

Question 1

Phenytoin-like drugs prototype drug

Answer 1

Valproic acid (depakene)

Question 1

Primary use of phenytoin-like drugs

Answer 1

ABSENCE seizures

Question 1

Adverse effects of phenytoin-like drugs

Answer 1

• limited CNS depression
• visual disturbances
• ataxia
• vertigo
• headache
• GI effects
• hepatotoxicity
• pancreatitis

Question 1

Patient teaching for phenytoin-like drugs

Answer 1

• avoid alcohol, OTC drugs, and herbal meds
• avoid nicotine
• avoid driving and hazardous activities
• rebound seizures if discontinued abruptly
• take with food

Question 1

Succinimides suppress seizures by…

Answer 1

Delaying calcium influx into neurons

Question 2

Succinimides are only effective against…

Answer 2

Absence seizures

Question 3

Succinimides prototype drug

Answer 3

Ethosuximide (zarontin)

Question 4

Adverse effects of succinimides

Answer 4

Rare...
-drowsiness
-dizziness
-lethargy
Rare but serious...
-systemic lupus erythematosis
-leukopenia
-aplastic anemia
-Stevens-Johnson syndrome

Question 5

Patient teaching for succinimides

Answer 5

• report mood changes or suicidal thoughts
• avoid driving and hazardous activities
• do not suddenly stop taking med
• take with food
• report symptoms of fever or sore throat
• report weight loss and anorexia