Chapter 23

Question 1

Generalized Seizure: Tonic Clonic

Answer 1

Full convulsive seizures, involuntary, loss of consciousness

Question 2

Generalized Seizure: Absent

Answer 2

No muscle contraction / convulsions, typically only last 3-5 seconds

Question 3

Generalized Seizure: Status Epilepticus

Answer 3

Grand mal seizure, uninterrupted seizure activity resulting in loss of oxygenation

Question 4

Partial Seizure: Simple

Answer 4

Consciousness not impaired

Question 5

Partial Seizure: Complex

Answer 5

Consciousness impaired

Question 6

Phenytoin

What is this and what is its use

Answer 6

Hydantoins

Treatment for tonic clonic seizures
Prevention of status epilepticus
Treatment post neuro surgery

Do not use during pregnancy or lactation (teratogenic drug)

Question 7

Hydantoins: Actions & Indications

Answer 7

Stabilize nerve membranes throughout CNS by influencing ionic channels in cell membrane, thereby decreasing excitability and hyperexcitability to stimulation

Question 8

Hydantoins: Pharmacokinetics
What are the therapeutic serum levels?

Answer 8

Well absorbed in the GI tract
Metabolized in the liver, excreted in urine
Therapeutic serum levels are 10-20 mcg/mL

Question 9

Hydantoins: Contraindications & Cautions

Answer 9

Allergies
Pregnancy and lactation
Caution used with elderly or debilitated patients
Impaired liver or renal function
Depression or psychoses

Question 10

Hydantoins: Adverse Effects

Answer 10

Mostly related to CNS depression: depression, confusion, drowsiness, lethargy, fatigue, constipation, dry mouth, anorexia, cardiac arrhythmias and changes in blood pressure, urinary retention, loss of libido

Severe liver toxicity and bone marrow suppression

Question 11

Hydantoins: Drug to Drug interactions

Answer 11

Alcohol

Question 12

Hydantoins: RN Considerations

Answer 12

Thorough Neruo assessment
Gingival hyperplasia (tell dentist you are taking phenytoin)
This drug can cause damage to tissue when given IV (vesicant)
Photosensitivity
No grapefruit juice

Question 13

Barbiturate used for seizures, generic name?
Therapeutic serum level

Answer 13

Phenobarbital
15-40 mcg/mL

Question 14

Benzodiazepines used for seizures, generic names?
Pharmacokinetics
RN considerations

Answer 14

Cobazam, Clonazapam, Diazepam, Lorazepam, Alprazolam
Long half life 18-50 hours
Addictive drugs, CNS assessment (LOC and Orientation)

Question 15

Medication for treating absence seizures?

Answer 15

Valproic Acid

Question 16

Medications for treating partial seizures?
Therapeutic actions?
Adverse Effects?

Answer 16

Levetiracetam: good for patients with liver compromise
Carbamazapine: effects synapses in the brain that cause seizure
Gabapentin: blocks certain nerve pain in brain that can cause seizures

Directly: altering sodium and calcium channels
Indirectly: Increasing the activity of GABA, an inhibitory neurotransmitter

Most are CNS related, liver toxicity and failure, vision changes

Question 17

RN Considerations for Patients receiving drugs to treat seizures

Answer 17

History and physical
Allergies
History of bone marrow suppression
Renal or hepatic dysfunction
Level of orientation, affect, reflexes and grip strength
EEG if appropriate

Question 18

Effectiveness of seizure medications

Answer 18

Evaluate lab values (therapeutic drug levels)
Continue to monitor adverse effects (CNS depression, vision changes, liver/renal toxicity)
Assess and re-assess for seizure activity