Chapter 15- Seizures Flashcards
What is status epilepticus?
- medical emergency
- continuous seizure activity which can lead to coma or death
What are the causes of epilepsy/seizures?
- 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
Once an anti seizure medication is selected….what comes next?
- pt. is placed on low initial dose
- amount is gradually increased
- if seizures remain, different med is added in small increments
What is the goal of anti seizure pharmacotherapy?
-SUPPRESS neuronal activity enough to prevent abnormal or repetitive firing
What 3 mechanisms do antiseizure drugs act through?
- Stimulating influx of chloride ions
- Delaying influx of sodium
- Delaying influx of calcium
-controlling movement of electrolytes across neuronal membranes or affecting neurotransmitter balance
What is the withdrawal of antiseizure meds?
- seizure free of at least 3 years
- withdraw gradually over several months
- resume meds if seizures return
- be aware of rebound seizures
Benzodiazepines indications
- absence seizures and myoclonic seizures
- tolerance develops quickly
- also used for anxiety, skeletal muscle spasms, alcohol withdrawal symptoms
Benzodiazepine abuse
- Schedule IV drug
- pregnancy category D
- respiratory depression may result with other CNS depressants
What is benzodiazepines contraindicated in?
Narrow-angle glaucoma
Common side effects of benzodiazepines
Dizziness and drowsiness
What drug do you give in case of overdose of benzodiazepines?
flumazenil (Romazicon)
benzodiazepine mechanism of action, prototype drug, primary use, adverse effects
- similar to barbiturates
- Valium
- short-term seizure control
- drowsiness and dizziness
Barbiturates mechanism of action
Changing action of GABA
Barbiturates primary use
-controlling seizures
Barbiturates prototype drug
Phenobarbital (luminal)
Barbiturates adverse effects
- Dependence
- drowsiness
- vitamin deficiencies
- laryngospasm
Patient teaching while taking barbiturates
- use reliable contraception
- immediately report pregnancy
- report excessive signs of bleeding
- report drowsiness and bone pain
Barbiturates are effective against all major seizure types EXCEPT…
absence seizures
Hydantoins are useful in treating all types of epilepsy EXCEPT…
Absence seizures
Hydantoins provide…
Effective seizure suppression without the abuse potential or CNS depression associated with barbiturates
What should the nurse monitor when patient is taking hydantoin?
- serum drug levels
- signs of toxicity
- blood dyscrasis or bleeding disorders
- liver and kidney function
- fatal hepatotoxicity can occur
- watch for GINGIVAL HYPERPLASIA
Contraindications for hydantoin
- rash
- seizures due to hypoglycemia
- sinus bradycardia
- heart block
Patient teaching with hydantoin
- 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
What is the prototype drug for hydantoins?
Phenytoin (Dilantin)
Mechanism of action for hydantoins
-desensitize sodium channels
Adverse effects of hydantoins
- CNS depression
- gingival hyperplasia
- skin rash
- cardiac dysrhythmias
- hypotension
Phenytoin-like drugs prototype drug
Valproic acid (depakene)
Primary use of phenytoin-like drugs
ABSENCE seizures
Adverse effects of phenytoin-like drugs
- limited CNS depression
- visual disturbances
- ataxia
- vertigo
- headache
- GI effects
- hepatotoxicity
- pancreatitis
Patient teaching for phenytoin-like drugs
- avoid alcohol, OTC drugs, and herbal meds
- avoid nicotine
- avoid driving and hazardous activities
- rebound seizures if discontinued abruptly
- take with food
Succinimides suppress seizures by…
Delaying calcium influx into neurons
Succinimides are only effective against…
Absence seizures
Succinimides prototype drug
Ethosuximide (zarontin)
Adverse effects of succinimides
Rare... -drowsiness -dizziness -lethargy Rare but serious... -systemic lupus erythematosis -leukopenia -aplastic anemia -Stevens-Johnson syndrome
Patient teaching for succinimides
- 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
