EXAM 4- anticonvulsant drugs

Question 1

Seizure

Answer 1

periodic attack of disturbed cerebral function.

Question 2

partial/focal seizures

Answer 2

occur in localized areas of the brain

Question 3

simple seizures

Answer 3

do not lose consciousness

Question 4

psychomotor seizures

Answer 4

often occurs in children age 3-adolescence

Question 5

absence seizures

Answer 5

also called Petit-Mal seizures

Question 6

myoclonic seizures

Answer 6

can occur suddenly and are very forceful.

Question 7

tonic-clonic seizures

Answer 7

alternates contractions (tonic phase) and relaxation (clonic phase).

Question 8

idiopathic origin

Answer 8

cause cannot be identified, 50% of cases

Question 9

acquired origin

Answer 9

cause is identified

Examples: high fever, CVA, trauma, infection

Question 10

epilepsy

Answer 10

permanent, recurrent seizure disorder.

Question 11

anticonvulsants

Answer 11

management of seizure/convulsion disorders.

Each drug has specific uses, and can only be used to treat certain seizure disorders.

Question 12

All anticonvulsants ____ abnormal neural activity in the ___, and in return ___________________.

Answer 12

depress, CNS, inhibits seizure activity

Question 13

single drug therapy started —-

Answer 13

before two-drug, or multiple-drug therapy is tried

Question 14

serum drug concentrations

Answer 14

MUST BE MEASURED

Question 15

Hydantoins

Answer 15

Dilantin (phenytoin)

Question 16

Succinimides

Answer 16

Zarontin (ethosuximide)

Question 17

Oxazolidinediones

Answer 17

Tridione (trimethadione)

Question 18

Misc. drugs for seizures

Answer 18

Carbamazepine (Tegretol)
Valporic Acid (Depakote)
Keppra
Topamax

Question 19

Benzodiazepines

Answer 19

• Ativan (lorazepam)
• Valium (diazepam)
• Klonopin (clonazepam)

Question 20

Anticonvulsants decrease the ________________. When the nerve cells are calmer, seizure activity decreases in______ and ______. Sometimes seizures are ___________________________.

Answer 20

• excitability of nerve cells in the brain,
• intensity and frequency
• eliminated all together, and other times only partial control is obtained.

Question 21

In some cases individuals respond well to one drug therapy, but in other cases ______________________________.

Answer 21

a combination of anticonvulsants are needed.

Question 22

may be used for other diseases such as

Answer 22

bipolar, neuropathic pain, and anxiety

Question 23

Adjustments to the medication may need to be made when the patient is ____________.

Answer 23

under lots of stress, severe illness, or when other drugs are being taken in combination with the anticonvulsants.

Question 24

status epilepticus

Answer 24

• 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.

Question 25

medication of choice for status epileptics

Answer 25

• 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.

Question 26

most common prescribed anticonvulsant

Answer 26

Hydantoins-Phenytoin (Dilantin)

Question 27

adverse reactions of Hydantoins-Phenytoin (Dilantin)

Answer 27

• 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

Question 28

contraindications of hydantoins

Answer 28

• known hypersensitivity
• pt with heart problems, pregnancy, and lactation
• use cautiously in pt with liver, kidney, or neurological disorders

Question 29

do NOT mix Hydantoins with

Answer 29

other CNS depressants

Question 30

Phenytoin (Dilantin) interacts with many different drugs.

Answer 30

It is important to talk with your health care provider about other medications the patient is on to see if an interaction will occur.

Question 31

adverse reactions of barbiturates

Answer 31

Most common is sedation, which ranges from mild sleepiness to somnolence.

• N/V
• constipation,
• bradycardia,
• skin rash,
• headache
• fever.

Question 32

Adverse reactions of benzodiazepines

Answer 32

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)

Question 33

contraindications of barbiturates

Answer 33

• known hypersensitivity

- pt with liver, kidney, and neurological diseases, and active pulmonary disease

Question 34

DO NOT mix Barbiturates with other CNS depressants. together are –

Answer 34

a lethal combination, can cause increase sedation, respiratory depression, and death. -Both barbiturates and alcohol have the same effect on the body.

Question 35

contraindications of benzodiazepines

Answer 35

• 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

Question 36

DO NOT mix Benzodiazepines and other CNS depressants due to —

Answer 36

each having the same effect on the body.

Question 37

nursing process

Answer 37

-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

Question 38

regular serum plasma levels of the anticonvulsant are taken to-

Answer 38

monitor pt for toxicity

Question 39

When a patient has a seizure it is important to —-

Answer 39

document the time of the occurrence, the length of the seizure, and the psychic or motor activity occurring before, during, and after the seizure.

Question 40

Do not miss a dose of the anticonvulsant.

Answer 40

An abrupt withdraw can cause the presence of status epilepticus.

Question 41

anticonvulsants should be given-

Answer 41

with food or right after pt eats to prevent stomach upset

Question 42

Carbamazepine (Tegretol) may cause ——-

Answer 42

aplastic anemia and agranulocytosis. Watch for any unusual bruising or bleeding, fever, sore throat, rash, or mouth ulcers.

Question 43

Blood dyscrasias can occur with this type of anticonvulsant.

Answer 43

Hydantoins.

–Lab tests should be done routinely to monitor and watch for any problems with the medication.

Question 44

____ produce a hypersensitivity rash.

Answer 44

barbiturates.

–if this occurs call health care provider immediately

Question 45

pt and family teaching

Answer 45

• 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.

Question 46

what has been reported with the use of Phenytoin?

Answer 46

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.

Question 47

signs of toxicity for Phenytoin

Answer 47

• slurred speech,
• ataxia,
• lethargy,
• dizziness,
• N//V