Exam 1: Seizures

Question 1

Seizures

Answer 1

abnormal or uncontrolled neuronal discharges in the brain

Question 2

Disturbances of electrical activity in the brain that may effect

Answer 2

consciousness
motor activity
sensation

Question 3

Paroxysmal episodes

Answer 3

• sudden, involuntary muscle contractions

- alterations in consciousness, behavior, sensation and autonomic functioning

Question 4

Labeled epilepsy

Answer 4

if recurring

caused by chronic underlying condition

Question 5

Episodes may be

Answer 5

Partial (simple or complex)
Generalized (absence, myoclonic, tonic, clonic or tonic-clonic)
Unclassified

Question 6

Seizures: Identified Causes

Answer 6

• Pathological processes in brain: trauma, acute cerebral edema, infection, degeneration, neuronal injury, vascular anomalies or lesions
• Endogenous and exogenous toxic substances: uremia, lead ingestion, alcohol intoxication
• Metabolic disturbances
• Febrile states
• Developmental abnormalities
• Birth defects

Question 7

Seizures: Pathophysiology

Answer 7

Internal and external stimulus causes abnormal hypersynchronous discharges in a focal area in the cerebrum.

Neuropeptides and neurotransmitters released and blood flow is increased.

Extracellular concentrations of potassium ↑; concentrations of calcium ↓.

Question 8

Simple Partial Seizure: Clinical Manifestations

Answer 8

Motor: recurrent involuntary muscle contractions of one body part (face, hand, arm, legs) that may spread to other, same side body parts

Sensory: auditory or visual hallucinations

Psychic: sensation of déjà vu, complex hallucinations or illusions, unwarranted anger or fear, sweating

Question 9

Complex Partial (psychomotor): Clinical Manifestations

Answer 9

Onset: may have aura before onset

Motor: automatisms (patting body parts, smacking lips, aimless walking, picking at clothes)

Sensory: 1-2 minutes of loss of contact with surroundings, hallucinations

Question 10

Generalized Seizure: Clinical Manifestations

Answer 10

Absence (petit mal): transient loss of consciousness, flickering of eyelids, or intermittent jerking of hands

Myoclonic: rapid, jerky movements in extremities or over entire body, which may cause a fall

Tonic: intense muscle contraction with sudden abnormal dystonic posture, deviation of eyes, and head to one side

Clonic: Alternating contraction and relaxation of muscles to extremities for several minutes with loss of consciousness

Tonic-clonic (grand mal): aura,, loss of consciousness, cyanosis, fall; tonic then clonic contractions→ limpness, sleep, headache, confusion, loss of bladder/bowel control

Question 11

Seizures: Complications

Answer 11

Injury from fall or jerking
Airway occlusion
Aspiration
Status epilepticus → MEDICAL EMERGENCY!

Question 12

Status epilepticus

Answer 12

motor sensory or psychic seizures follow one another with no intervening periods of consciousness

Question 13

Failure to get immediate treatment for status epilepticus leads to

Answer 13

Hypoxia
Hyperthermia
Hypoglycemia
Acidosis
Death

Question 14

Convulsion

Answer 14

• Involuntary, violent spasms of large skeletal muscles of face, neck, arms and legs.
• Not synonymous with seizure.

Question 15

How do antiseizure drugs affect oral contraceptives?

Answer 15

decreases effectiveness of oral contraceptives

Question 16

Most antiseizure drugs are

Answer 16

pregnancy category D.

Question 17

Eclampsia

Answer 17

severe hypertensive disorder of pregnancy, characterized by seizures, coma, and perinatal mortality

Question 18

Antiseizure Pharmacotherapy Goals

Answer 18

suppress neuronal activity enough to prevent abnormal or repetitive firing

Question 19

Antiseizure drugs act through 3 mechanisms

Answer 19

Stimulating an influx of chloride ions
Delaying an influx of sodium
Delaying an influx of calcium

Question 20

Antiseizure Pharmacotherapy is directed at

Answer 20

• controlling movement of electrolytes across neuronal membranes or affecting neurotransmitter balance.
• some drugs act by more than one mechanism.

Question 21

Drugs that potentiate GABA action include

Answer 21

Benzodiazepines: clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan)
Barbiturates: phenobarbital (Luminal)
Newer GABA-related drugs: gabapentin (Neurontin), topiramate (Topamax)

Question 22

Drugs that suppress sodium influx include

Answer 22

Hydantoins: enytoin (Dilantin)

Phenytoin-like drugs: valproic acid (Depakene, Depakote)

Question 23

Drugs that suppress calcium influx include

Answer 23

Succinimides: ethosuximide (Zarontin)

Question 24

Drugs that potentiate GABA action act by

Answer 24

changing the action of gamma-aminobutyric acid, the primary inhibitory neurotransmitter in the brain.

Question 25

The predominate effect of GABA potentiation is

Answer 25

CNS depression

Question 26

Barbiturates include

Answer 26

phenobarbital

Question 27

Phenobarbital: MOA

Answer 27

changing the action of GABA

Question 28

Phenobarbital: Primary Use

Answer 28

controlling seizures

Question 29

Adverse Effects of Phenobarbital

Answer 29

dependence, drowsiness, vitamin deficiencies, laryngospasm

Question 30

Treating Seizures with Barbituates

Answer 30

Low margin for safety. High potential for dependence. Cause profound CNS depression. Overall effective against all major seizure types except absence seizures.

Question 31

Benzodiazepines include

Answer 31

diazepam (valium)

Question 32

Diazepam: MOA

Answer 32

similar to that of barbituates but safer

Question 33

Diazepam: Primary Use

Answer 33

for short-term seizure control

Question 34

Diazepam: Adverse Effects

Answer 34

drowsiness and dizziness

Question 35

Benzodiazepines

Answer 35

Respiratory depression may result with other CNS depressants. Common side effects include dizziness, drowsiness.

Question 36

How do you treat an overdose of benzodiazepines?

Answer 36

give flumazenil (Romazicon)

Question 37

Treating Seizures with Benzodiazepines

Answer 37

Indications include absence seizures and myoclonic seizures. Tolerance may develop quickly. One of most widely prescribed classes Used also for anxiety, skeletal muscle spasms, and alcohol withdrawal symptoms

Question 38

Hydantoins and Phenytoin-Like Drugs

Answer 38

- Delay an influx of sodium ions across neuronal membranes. - Sodium movement is factor that determines whether neuron will undergo an action potential. - Sodium channels are not blocked; they are just desensitized.

Question 39

Hydantoins include

Answer 39

phenytoin (Dilantin)

Question 40

Phenytoin: MOA

Answer 40

to densitize sodium channels

Question 41

Phenytoin: Primary Use

Answer 41

treating all types of epilepsy except absence seizures

Question 42

Phenytoin: Adverse Effects

Answer 42

CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension

Question 43

Phenytoin-Like Drugs include

Answer 43

valproic acid (depakote)

Question 44

Phenytoin-Like Drugs: MOA

Answer 44

to desensitize sodium channels

Question 45

Phenytoin-Like Drugs: Primary Use

Answer 45

for absence seizures

Question 46

Phenytoin-Like Drugs: Adverse Effects

Answer 46

- limited CNS depression, visual disturbances, ataxia, vertigo, headache - Additional adverse reactions: gastrointestinal effects, hepatotoxicity, pancreatitis

Question 47

Treating Seizures with Hydantoins and Related drugs

Answer 47

- Useful in treating all types of epilepsy except absence seizures. - Provides effective seizure suppression, without the abuse potential or CNS depression associated with barbiturates. - Phenytoin-related drugs used less frequently.

Question 48

Hydantoin and Phenytoin-like Drugs: Nursing Implications

Answer 48

``` Monitor serum-drug levels Monitor for signs of toxicity Monitor for blood dyscrasias and bleeding disorders Monitor liver and kidney function Fatal hepatotoxicity can occur ```

Question 49

Succinimides

Answer 49

Suppress seizures by delaying calcium influx into neurons. | Generally only effective against absence seizures.

Question 50

Most commonly subscribed succinimides

Answer 50

ethosuximide (zarontin)

Question 51

Ethosuximide: MOA

Answer 51

suppress calcium influx

Question 52

Ethosuximide: Primary Use

Answer 52

for absence seizures

Question 53

Ethosuximide: Adverse Effets

Answer 53

rare but include drowsiness, dizziness, lethargy

Question 54

Ethosuximide: very rare but serious side effects

Answer 54

systemic lupus erythematosis, leukopenia, aplastic anemia, Stevens-Johnson syndrome

Question 55

Succinimides: Nursing Implications

Answer 55

Do not abruptly withdraw medication. Use with caution with antiseizure medications, phenothiazines, and antidepressants. Pregnancy risk—Category C.

Question 56

Once medication is selected, what happens

Answer 56

Patient placed on low initial dose. Amount gradually increased. If seizure activity remains, different medication added in small increments.

Question 57

Newer antiseizure drugs have

Answer 57

less adverse side effects than older drugs.

Question 58

Most seizure cases require

Answer 58

only a single drug.

Question 59

Patient Teaching

Answer 59

Routine labs for serum level. Routine labs for liver and kidney function. Immediately report signs of toxicity. Immediately report unusual bleeding. Immediately report liver or brain disease. Immediately report heart block, hypoglycemia, or pregnancy.

Question 60

More Patient Teaching

Answer 60

Immediately report mood changes or suicidal thoughts. Avoid driving and hazardous activities. Do not suddenly stop taking. Take with food. Report symptoms of fever or sore throat. Report weight loss and anorexia.

Question 61

Withdrawal of Antiseizure Medications

Answer 61

Should be seizure free at least three years. Withdraw gradually over several months. Resume medications if seizures return. Be aware of rebound seizures.