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343 Pharm Exam 5 > Chapter 19 : Antiseizure Drugs > Flashcards

Chapter 19 : Antiseizure Drugs Flashcards

1
Q

What does seizure mean?

A

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

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2
Q

What does epilepsy mean?

A

Chronic, recurrent pattern of seizures

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3
Q

What are 3 common generalized seizure types?

A

Tonic clonic ( grand mal )
Absense ( petit mal )
Psychomotor

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4
Q

What is tonic-clonic ( gland mal )?

A

Most common
Generalized altering muscle spams and jerkiness

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5
Q

What is absence (petit mal)?

A

Brief loss of consciousness (10secs or less)
Usually occurs in children
( day dreaming stare )

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6
Q

What is psychomotor?

A

Repetitive behavior
- chewing or swallowing motions
- behavior changes
Motor seizures

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7
Q

What are the 2 functions of antiseizure drugs?

A

Stabilizes nerve cell membranes
Suppress abnormal electric impulses in cerebral cortex

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8
Q

What are the 3 specific types of action any anti seizure drug?

A

Suppress sodium influx
Suppress calcium influx
Enhance action of GABA

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9
Q

Antiseizure drugs usually is better with what?

A

Another seizure medication
Like adding on

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10
Q

What is the goal of therapy?

A

To control or prevent seizures while maintaining a reasonable quality of life

To minimize adverse effects and drug induced toxicity

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11
Q

Antiseizure drugs usually are a what time drug?

A

Life long

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12
Q

Usually we start off what with these drugs?

A

Low dose is started

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13
Q

Notes
If low dose is not effective
Increase dosages
If not we use multiple drug therapy

Serum drug concentrations must be measured
- therapeutic drugs monitoring

A
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14
Q

Patients who are seizure free for 1-2 years ___be able to what for antieplieptic therapy?

A

May be able to discontinue
( to see what happens )

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15
Q

Patients who have a seizure, usually what happens to their driving status?

A

They get suspended for 6 months
Then their doctors are able see if their able to drive

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16
Q

Indications for antiseizure drugs
Prevention or control of seizure activity
Long term maintenance therapy for chronic, recurring seizures

Acute treatment of convulsions and status epilepticus

A
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17
Q

Sometimes antiseizure drugs can be used to treat what other 2 conditions?

A

Migraine management
Pain control

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18
Q

What are the 4 antiseizure drugs we will be talking about?

A

Hydrantoins ( phenytoin )
Phenobarbital ( barbiturate )
Benzodiazepines
Valproate

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19
Q

What is the action of an hydantoins ( phenytoin )?

A

Inhibits sodium influx and stabilize cell membranes

Reduces repetitive neuronal firing

Limits seizures

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20
Q

What is super important to note about hydantoins (phenytoin)?

A

It’s highly protein bound
Narrow therapeutic window

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21
Q

What is the syndrome with hydantoins (phenytoin)?

A

Purple glove syndrome

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22
Q

How do we get purple glove syndrome?

How do we give it?

What do we do prior to this medication administration?

A

Potent vasoconstrictor

Give in central line or PICC line, never in hands or IM

Dilute

( this vasoconstriction can cause tissue damage and loss of limb )

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23
Q

What are the 6 hydantoins side effects?

A

Gingival hyperplasia
Osteoporosis
Fatal hepatotoxicity
Nephrotoxicity
CV side effects
Teratogenic

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24
Q

What is gingival hyperplasia?

A

Overgrowth of the gum tissue

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25
So since hydantoins causes gingival hyperplasia, what do we usually have to tell them?
Extreme dental care Brushing and flossing extreme
26
Why does hydantoins cause osteoporosis?
Decreases the absorption of vitamin D
27
Since hydanotoins causes hepatotoxicity and nephrotoxity, what type of tests will we do?
Bun creatinine LFTS
28
Hydanotojns has some form of suicidal ideation, so we what?
Warn patients & screens for that
29
What are the 3 CV hydantoins side effects?
Hypotension Bradycardia Ventricular fibrillation
30
So to avoid CV side effects, what are we going to do?
Administer it very very slowly Because it causes cardiovascular collapse
31
2 Big messages for hydantoins regarding females is what?
That they need to have 2 forms of birth control because it decreases its effectiveness No pregnancy because it’s teratogenic
32
What are the 2 decrease effect medications that phenytoin causes?
Anticoagulants Oral contraceptives
33
Notes Increase effect with cimetidine INH - tb drug Decrease effects with folic acid Calcium Antacids Sucralfate Cisplatin
34
What are the foods that are decreased with phenytoin? (3)
Folic acid Calcium Vitamin D
35
Phenobarbital ( barbiturate )
36
Phenobarbital ( barbiturate ) is typically used for who?
A pregnant person who has a seizure disorder
37
How long does it take for Phenobarbital ( barbiturate ) to work?
2-3 weeks to reach therapeutic levels So educate patients that it may take a while to work
38
What is the biggest clinical manifestation of Phenobarbital ( barbiturate )?
Respiratory depression
39
Phenobarbital ( barbiturate ) has a high physical dependence rate so what do we tell them?
Slowly wean off the medication
40
If you go cold turkey of Phenobarbital ( barbiturate ) what happens?
Fetal withdrawal symptoms = death
41
We want to educate patients to avoid what while on Phenobarbital ( barbiturate )?
Alcohol
42
Notes Phenobarbital ( barbiturate ) Elderly : may have greater sedation, altered excretion
43
Benzodiazepines
44
What are the 3 Benzodiazepines medications?
Clonazepam Clorazepate Diazepam
45
Benzodiazepines usually used more for who?
Status epilepticus ( a seizure that won’t stop )
46
How does Benzodiazepines work?
Relax the muscules and interrupt that neuro muscular stimulation
47
Benzodiazepines how do we give it? Route?
IM or IV
48
Benzodiazepines can cause what massive clinical manifestation? And how would we prevent it?
Cardiovascular collapse - don’t give it with bradycardia & hypotension Causes life threatening tachycardia - very careful
49
Notes Clonazepam Treats absense & myoclonic seizures Tolerance may occur in 6 months Clorazepate Treated partial seizure Diazepam Treats status epliepticus IV for status Short term effect - antiseizure medication must be given during or immediately after the administration of diazepam
50
Valproate
51
What is valproate medication?
Valproic acid
52
What are the side effects of valproate?
Dizziness Drowsiness’s Weakness Insomnia Diplopia GI Distres Suicidal ideation Thrombocytopenia
53
Antiseizure drugs & pregnancy
54
Most antiseizure drugs are teratogenic, what the one medication that is the expection ?
Phenobarbital ( barbiturate )
55
Antiseizure drugs tend to inhibit what vitamin? And how does it affect pregnancy?
K Infant hemorrhage soon after birth
56
Typically how would we avoid this infant hemorrhage with anti seizure drugs?
Since vitamin K tends to be inhibited - so we usually give it a few days before birth or at delivery injection
57
If a patient is trying to get pregnant And since anti seizure drugs decrease the loss of ____ We usually recommend to take extra ____ supplements
Folic acid ( folate )
58
Nursing implications notes IV forms - follow manufactures instructions, give slowly, observe for skin damage Teach patients to journal their response to medication Wear medic alter bracelet Do not discontinue suddenly Follow driving recommendation Teach patients that therapy is long term and possibly life long Teach females of childbearing age to use reliable contraception Teach good dental hygiene and regular dental visits with hydantoins Take medications as directed
59
Practice question 1 Before administrating a daily dose of phenytoin, what is the most important for the nurse to do? 1. Maintains the patient on bed rest 2. Check phenytoin levels 3. Monitor intake and output 4. Monitor renal function tests
2. Check phenytoin levels
60
Practice question 2 A patient was discharged 3 days ago on phenytoin therapy for seizure disorder. The patient comes to the emergency department experiencing seizures. What will be of most value to determine the etiology of the returned seizures? 1. A ct scan 2. EEG 3. Serum phenytoin levels 4. Serum electrolytes
3. Serum phenytoin levels
61
Practice question 3 When assessing a patient taking phenytoin therapy for seizure disorder, which indicates an adverse reaction to this therapy? A. Thrombocytopenia B. Leukocytosis C. Gingival atrophy D. Hypoglycemia
A. Thrombocytopenia

343 Pharm Exam 5 (7 decks)

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