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NURS 320 > Exam 1: Seizures > Flashcards

Exam 1: Seizures Flashcards

1
Q

Seizures

A

abnormal or uncontrolled neuronal discharges in the brain

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2
Q

Disturbances of electrical activity in the brain that may effect

A

consciousness
motor activity
sensation

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3
Q

Paroxysmal episodes

A
  • sudden, involuntary muscle contractions

- alterations in consciousness, behavior, sensation and autonomic functioning

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4
Q

Labeled epilepsy

A

if recurring

caused by chronic underlying condition

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5
Q

Episodes may be

A

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

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6
Q

Seizures: Identified Causes

A
  • 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
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7
Q

Seizures: Pathophysiology

A

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 ↓.

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8
Q

Simple Partial Seizure: Clinical Manifestations

A

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

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9
Q

Complex Partial (psychomotor): Clinical Manifestations

A

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

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10
Q

Generalized Seizure: Clinical Manifestations

A

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

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11
Q

Seizures: Complications

A

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

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12
Q

Status epilepticus

A

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

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13
Q

Failure to get immediate treatment for status epilepticus leads to

A 
Hypoxia
Hyperthermia
Hypoglycemia
Acidosis
Death
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14
Q

Convulsion

A
  • Involuntary, violent spasms of large skeletal muscles of face, neck, arms and legs.
  • Not synonymous with seizure.
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15
Q

How do antiseizure drugs affect oral contraceptives?

A

decreases effectiveness of oral contraceptives

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16
Q

Most antiseizure drugs are

A

pregnancy category D.

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17
Q

Eclampsia

A

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

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18
Q

Antiseizure Pharmacotherapy Goals

A

suppress neuronal activity enough to prevent abnormal or repetitive firing

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19
Q

Antiseizure drugs act through 3 mechanisms

A

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

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20
Q

Antiseizure Pharmacotherapy is directed at

A
  • controlling movement of electrolytes across neuronal membranes or affecting neurotransmitter balance.
  • some drugs act by more than one mechanism.
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21
Q

Drugs that potentiate GABA action include

A

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

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22
Q

Drugs that suppress sodium influx include

A

Hydantoins: enytoin (Dilantin)

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

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23
Q

Drugs that suppress calcium influx include

A

Succinimides: ethosuximide (Zarontin)

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24
Q

Drugs that potentiate GABA action act by

A

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

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25
Q

The predominate effect of GABA potentiation is

A

CNS depression

26
Q

Barbiturates include

A

phenobarbital

27
Q

Phenobarbital: MOA

A

changing the action of GABA

28
Q

Phenobarbital: Primary Use

A

controlling seizures

29
Q

Adverse Effects of Phenobarbital

A

dependence, drowsiness, vitamin deficiencies, laryngospasm

30
Q

Treating Seizures with Barbituates

A

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

31
Q

Benzodiazepines include

A

diazepam (valium)

32
Q

Diazepam: MOA

A

similar to that of barbituates but safer

33
Q

Diazepam: Primary Use

A

for short-term seizure control

34
Q

Diazepam: Adverse Effects

A

drowsiness and dizziness

35
Q

Benzodiazepines

A

Respiratory depression may result with other CNS depressants.

Common side effects include dizziness, drowsiness.

36
Q

How do you treat an overdose of benzodiazepines?

A

give flumazenil (Romazicon)

37
Q

Treating Seizures with Benzodiazepines

A

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

38
Q

Hydantoins and Phenytoin-Like Drugs

A
  • 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.
39
Q

Hydantoins include

A

phenytoin (Dilantin)

40
Q

Phenytoin: MOA

A

to densitize sodium channels

41
Q

Phenytoin: Primary Use

A

treating all types of epilepsy except absence seizures

42
Q

Phenytoin: Adverse Effects

A

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

43
Q

Phenytoin-Like Drugs include

A

valproic acid (depakote)

44
Q

Phenytoin-Like Drugs: MOA

A

to desensitize sodium channels

45
Q

Phenytoin-Like Drugs: Primary Use

A

for absence seizures

46
Q

Phenytoin-Like Drugs: Adverse Effects

A
  • limited CNS depression, visual disturbances, ataxia, vertigo, headache
  • Additional adverse reactions: gastrointestinal effects, hepatotoxicity, pancreatitis
47
Q

Treating Seizures with Hydantoins and Related drugs

A
  • 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.
48
Q

Hydantoin and Phenytoin-like Drugs: Nursing Implications

A 
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
49
Q

Succinimides

A

Suppress seizures by delaying calcium influx into neurons.

Generally only effective against absence seizures.

50
Q

Most commonly subscribed succinimides

A

ethosuximide (zarontin)

51
Q

Ethosuximide: MOA

A

suppress calcium influx

52
Q

Ethosuximide: Primary Use

A

for absence seizures

53
Q

Ethosuximide: Adverse Effets

A

rare but include drowsiness, dizziness, lethargy

54
Q

Ethosuximide: very rare but serious side effects

A

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

55
Q

Succinimides: Nursing Implications

A

Do not abruptly withdraw medication.

Use with caution with antiseizure medications, phenothiazines, and antidepressants.

Pregnancy risk—Category C.

56
Q

Once medication is selected, what happens

A

Patient placed on low initial dose.

Amount gradually increased.

If seizure activity remains, different medication added in small increments.

57
Q

Newer antiseizure drugs have

A

less adverse side effects than older drugs.

58
Q

Most seizure cases require

A

only a single drug.

59
Q

Patient Teaching

A

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.

60
Q

More Patient Teaching

A

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.

61
Q

Withdrawal of Antiseizure Medications

A

Should be seizure free at least three years.

Withdraw gradually over several months.

Resume medications if seizures return.

Be aware of rebound seizures.

NURS 320 (28 decks)

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