Epilepsy & Migraine

Question 1

Tonic

Answer 1

muscles in the body become stiff

Question 2

Atonic

Answer 2

Muscles in the body relax

Question 3

Myoclonic

Answer 3

Short jerking in parts of the body

Question 4

Clonic

Answer 4

Periods of shaking or jerking parts on the body

Question 5

Generalized seizures

2 types

Answer 5

*Affects both sides of the brain.
* Absence seizures (petit mal seizures)
* Tonic clonic seizures (grand mal seizures)

Question 6

Absence seizures

petit mal seizures

Answer 6

can cause rapid blinking or a few seconds of staring into space

Question 7

Tonic-clonic seizures

grand mal seizures

Answer 7

can make a person:
* cry out
* lose consciousness
* fall to the ground
* have muscle jerks or spasm

Question 8

Focal Seizures

Answer 8

• located in one area of the brain (partial seizures)
• Simple focal seizures
• Complex focal seizures
• Secondary generealized seizures

Question 9

Simple Focal Seizures

Answer 9

affects a small part of the brain
These seizures can cause twitching or a change in sensation, such as a strange taste or smell

Question 10

Complex Focal Seizures

Answer 10

can make a person w/ epilepsy confused or dazed. The person will be unable to respond questions or directions for up to a few minutes

Question 11

Secondary Generalized seizures

Answer 11

begin in one part of the brain, but then spread to both sides of the brain => 1st has a focal seizure followed by generalized seizure.

Question 12

What conditions affect the brain

Answer 12

mostly unknown, some causes include:
* stroke
* brain tumor
* traumatic brain injury or head injury
* CNS infection

Question 13

Common Meds

(8 categories) (14 meds)

Answer 13

• Block voltage-gated Na+ channel – valproic acid, carbamazepine, oxcarbazepine, lamotrigine, phenytoin, topiramate, zonisamide
• Block Ca2+ channels – High voltage Ca channels : topiramate, lamotrigine
  Pregabalin, gabapentin
  T-Type Ca channel – zonisamide, valproic acid
• AMPA Receptor blocker – Pregabalin, Gabapentin
• SV2 Protein on Glutamate – Levetiracetam
• NMDA Receptor blocker – Felbamate
• GABA-A Agonists– Benzodiazepine, barbiturates
• GABA transporter inhibitor – Tiagabine
• GABA aminotransferase inhibitor - Vigabatrin

Question 14

Sodium Channel Blockers

SCB Meds (6)

Answer 14

• Phenytoin (dilantin)
• Fosphenytoin (cerebyx)
• Carbamazepine (tegretol)
• Valproic Acid (depacon)
• Sodium Valproate (depakote)
• Lamotrigine (lamictal)

Question 15

SCB Overall Education

Answer 15

• Type, frequency, and duration of seizures; have a log and doc/indicate
• Screenings
  Depression, suicidal thoughts
  Pregnancy
• Laboratory test results
  CBC* leukopenia
  Liver and renal function tests
• Dx tests
  ECG (phenytoin, carbamazepine, or lamotrigine)

Question 16

SCB MOA & Indications

Answer 16

• blocks the action potential in the neuron
• Partial seizures, generalized seizures

Question 17

SCB CI

Answer 17

• Pregnancy/breastfeeding
• Severe Hepatic Disease

Question 18

Phenytoin, fosphenythoin
SE & ADR

Answer 18

• Headaches, dizziness, visual disturbances, hypersensitivity reactions (SJS, TEN, DRESS), hepatotoxicity, impaired metabolism of vitamin D, decreased absorption of folic acid and vitamin B12, suicidal thoughts
• Boxed warning:rapid IV administration can result in hypotension and cardiac arrhythmias

Question 19

Phenytoin nursing edu

Answer 19

Recognize signs of gingival hyperplasia; e.g., sore, swollen gums
Maintain dental hygiene,
Monitor ECG

Question 20

Carbamazepine: (SE/ADR)

Answer 20

Pancreatitis, hepatotoxicity, renal dysfunction, hypertension, AV block
Boxed warning:Steven Johnson Syndrome, Toxic epidermal necrolysis, Drug Rash with Eosinophilia and Systemic Symptoms, bone marrow depression

Question 21

Carbamazepine CI:

Answer 21

Avoid grapefruit/ grapefruit juice

Question 22

Lamotrigine SE & ADR

Answer 22

Headache, dizziness, dysmenorrhea; seizures, suicidal thoughts, disseminated intravascular coagulation, leukopenia, thrombocytopenia
Boxed warning:SJS, Toxic epidermal necrolysis

Question 23

Valproate SE & ADR

Answer 23

Gastrointestinal problems, thrombocytopenia, leukopenia , suicidal thoughts, CNS depression,
Boxed warning:pancreatitis, hepatotoxicity, fetal toxicity, DRESS

Question 24

Valproate Education

Answer 24

Report symptoms of pancreatitis; uppper abd pain, N/V, anorexia

Question 25

Migrane Meds (7 &10)

Answer 25

Sumatriptan (imitrex, onzetra xsail, tosymra, zembrace, symtouch),
Naratriptan (amerge), Rizatriptan (maxalt), Zolmitriptan (zomig),
Almotriptan, Froratriptan (frova), electriptan (relpax)

Question 26

Migrane meds MOA:

Answer 26

causes vasoconstriction by binding to 1B/D serotonin on cerebral blood vessels

Question 27

Migraine meds SE:

Answer 27

mild pain, tingling, numbness, coldness or burning sensation at site of injection, fatigue, dizziness, weakness

Question 28

Migraine meds EDUCATION:

Answer 28

take med as soon as symptoms start
AVOID triggers, lights as necessary
stay hydrated, well rested & NOT hungry

Question 29

Calcium Channel Blockers (CCB) meds (1)

Answer 29

Levetiracetam (Keppra)

go to med, good effect on pts

Question 30

CCB MOA:

keppra

Answer 30

blocks action potential in excited neurons

Question 31

CCB INDICATIONS:

keppra

Answer 31

generalized or partial seizures

Question 32

CCB CONTRAINDICATIONS:

levetiracetam

Answer 32

pregnancy/breastfeeding

Question 33

CCB SE/ADRs:

levetiracetam

Answer 33

suicidal thoughts, hepatitis / SJS, Toxic epidermal necrolysis

Question 34

CCB Nursing Considerations:

Answer 34

• pt should be adcised to take meds as directed & that doses should be evenly spaced throughout the day.
• **phenytoin - monitor serum levels **
• may take several wks to obtain desired med effect
• abrupt withdrawal of med may cause STATUS EPILEPTICUS - seizure lasting >20 mins
• Pts. should AVOID alcohol & other CNS depressants
• Nothing should be in pts. mouth & DONT restrain => put them on their side wait 5 mins & if more then call 911!
• after pts have a stroke, seizure is very likely to happen have precautions