EXAM 4- anticonvulsant drugs Flashcards
Seizure
periodic attack of disturbed cerebral function.
partial/focal seizures
occur in localized areas of the brain
simple seizures
do not lose consciousness
psychomotor seizures
often occurs in children age 3-adolescence
absence seizures
also called Petit-Mal seizures
myoclonic seizures
can occur suddenly and are very forceful.
tonic-clonic seizures
alternates contractions (tonic phase) and relaxation (clonic phase).
idiopathic origin
cause cannot be identified, 50% of cases
acquired origin
cause is identified
Examples: high fever, CVA, trauma, infection
epilepsy
permanent, recurrent seizure disorder.
anticonvulsants
management of seizure/convulsion disorders.
Each drug has specific uses, and can only be used to treat certain seizure disorders.
All anticonvulsants ____ abnormal neural activity in the ___, and in return ___________________.
depress, CNS, inhibits seizure activity
single drug therapy started —-
before two-drug, or multiple-drug therapy is tried
serum drug concentrations
MUST BE MEASURED
Hydantoins
Dilantin (phenytoin)
Succinimides
Zarontin (ethosuximide)
Oxazolidinediones
Tridione (trimethadione)
Misc. drugs for seizures
Carbamazepine (Tegretol)
Valporic Acid (Depakote)
Keppra
Topamax
Benzodiazepines
- Ativan (lorazepam)
- Valium (diazepam)
- Klonopin (clonazepam)
Anticonvulsants decrease the ________________. When the nerve cells are calmer, seizure activity decreases in______ and ______. Sometimes seizures are ___________________________.
- excitability of nerve cells in the brain,
- intensity and frequency
- eliminated all together, and other times only partial control is obtained.
In some cases individuals respond well to one drug therapy, but in other cases ______________________________.
a combination of anticonvulsants are needed.
may be used for other diseases such as
bipolar, neuropathic pain, and anxiety
Adjustments to the medication may need to be made when the patient is ____________.
under lots of stress, severe illness, or when other drugs are being taken in combination with the anticonvulsants.
status epilepticus
- An emergency situation where seizures activity is continual with no interruptions.
- Can be life-threatening due to lack of oxygenation to brain, patient is unconscious during seizure activity.
medication of choice for status epileptics
- Valium or Ativan -initial drugs of choice, but are short acting.
- -> Patient will also need to have a longer-lasting anticonvulsant added, such as Phenytoin (Dilantin) or Phenobarbital.
most common prescribed anticonvulsant
Hydantoins-Phenytoin (Dilantin)
adverse reactions of Hydantoins-Phenytoin (Dilantin)
- Nystagmus-involuntary movement of the eyeball
- Ataxia-loss of control of voluntary movements, mainly gait
- Slurred speech
- Skin Rash
- N/V
- Gingival hyperplasia-overgrowth of gum tissue. Important to inform the dentist that you are on Phenytoin (Dilantin).
- Hepatotoxicity
contraindications of hydantoins
- known hypersensitivity
- pt with heart problems, pregnancy, and lactation
- use cautiously in pt with liver, kidney, or neurological disorders
do NOT mix Hydantoins with
other CNS depressants
Phenytoin (Dilantin) interacts with many different drugs.
It is important to talk with your health care provider about other medications the patient is on to see if an interaction will occur.
adverse reactions of barbiturates
Most common is sedation, which ranges from mild sleepiness to somnolence.
- N/V
- constipation,
- bradycardia,
- skin rash,
- headache
- fever.
Adverse reactions of benzodiazepines
Most common side effect is sedation in varying degrees.
-anorexia,
-constipation,
-diarrhea.
(some may go away as therapy continues, others are dose dependent and may need dosage adjustments)
contraindications of barbiturates
- known hypersensitivity
- pt with liver, kidney, and neurological diseases, and active pulmonary disease
DO NOT mix Barbiturates with other CNS depressants. together are –
a lethal combination, can cause increase sedation, respiratory depression, and death. -Both barbiturates and alcohol have the same effect on the body.
contraindications of benzodiazepines
- known hypersensitivity
- pregnancy, pt with psychosis, glaucoma, liver and kidney disease, neurological disorders
- use VERY cautiously in the elderly and debilitated to due to sedation effects
DO NOT mix Benzodiazepines and other CNS depressants due to —
each having the same effect on the body.
nursing process
-the type of seizure disorder.
-Any family history of seizure disorders is important to note and the patients recent drug therapy .
-Vital signs are important to establish a baseline reading.
-Many lab and diagnostic tests may be ordered such as:
Electroencephalogram, CT scan, Complete Blood Count (CBC), and hepatic and renal function
regular serum plasma levels of the anticonvulsant are taken to-
monitor pt for toxicity
When a patient has a seizure it is important to —-
document the time of the occurrence, the length of the seizure, and the psychic or motor activity occurring before, during, and after the seizure.
Do not miss a dose of the anticonvulsant.
An abrupt withdraw can cause the presence of status epilepticus.
anticonvulsants should be given-
with food or right after pt eats to prevent stomach upset
Carbamazepine (Tegretol) may cause ——-
aplastic anemia and agranulocytosis. Watch for any unusual bruising or bleeding, fever, sore throat, rash, or mouth ulcers.
Blood dyscrasias can occur with this type of anticonvulsant.
Hydantoins.
–Lab tests should be done routinely to monitor and watch for any problems with the medication.
____ produce a hypersensitivity rash.
barbiturates.
–if this occurs call health care provider immediately
pt and family teaching
- Instruct the patient and family not to discontinue the use of anticonvulsant medications, or skip any doses of the medication.
- Patient and family need to be aware that anticonvulsant blood levels must be monitored at regular intervals.
- Family needs to be aware of care to be provided before, during and after a seizure occurs.
- Patients may need to restrict activity until their seizures are better under control with medication therapy.
what has been reported with the use of Phenytoin?
Hydantoins Cont-Hypersensitivity and Stevens-Johnson syndrome.
–This type of anticonvulsant can affect the blood glucose levels causing hyperglycemia. Long term administration-gingival hyperplasia and gingivitis can occur.
signs of toxicity for Phenytoin
- slurred speech,
- ataxia,
- lethargy,
- dizziness,
- N//V
