FINALLLL

Question 1

Hydantoins

Answer 1

Phenytoin or also known as Dilantin

Work to stabilize the neurons from being too excited

Stops spread of seizure activity in the motor cortex

Works on stabilizing the movement of NA+ across the cell membrane

Question 2

What is Hydantoins used for?

Answer 2

Used for clonic-tonic seizures, status epileptics (get random seizures and can’t get them to stop), prophylaxis for surgery (make sure they don’t have seizures during the surgery or post up)

Question 3

Routes of Hydantoins

Answer 3

PO, IM, IV

Question 4

Drug Interactions of Hydantoins

Answer 4

90% protein bounds so it has a lot of drug interactions and drug toxicity

and has a very narrow therapeutic window

PPI, sulfa meds, oral anticoagulants, valproic acid, can decrease efficacy of oral contraceptives

Question 5

Nursing considerations of Hydantoins

Answer 5

Poor absorption with tube feeds so stop feeds for 2 hours before and after

Can not be given IV with D5W. Infuse over 30-60 minutes

Question 6

Side effects of Hydantoins

Answer 6

Drowsiness, ataxia, irritability, headache

Changes in conduction system

Arrhythmias especially is toxic

can cause suicidal thoughts

Steven johns syndrome

Can cause hyperplasia (increase cells of the gums that causes bleeding and deterioration of the mouth)

Question 7

Iminostilbenes

Answer 7

Carbamazepine

treats partial, complex partial seizures, and generalized seizures

Treats trigeminal neuralgia which is a very painful nerve disease where there is pain along the trigeminal nerve (forehead, cheekbone, jaw line)

Can have suicidal thoughts because its so bad

Question 8

What is iminostilbenes used for?

Answer 8

drug of choice for trigeminal symptoms and bipolar

can have suicidal thoughts because its so bad (trigeminal neuralgia)

Question 9

Side effects of imostilbenes

Answer 9

WILL MAKE ABSENCE AND MYOCLONIC SEIZURES WORSE

will cause thrombocytopenia and leukopenia

Steven Johnson and increased suicidal thoughts

Question 10

Drug interactions of iminostilbenes

Answer 10

Make OC less effective

Buproprion, lamotrigine, TCA, Valproic Acid, when lithium is used can cause toxic neurological effects

Question 11

Labs for iminostilbenes

Answer 11

watch the CBC (affects platelets) and WBC (every 3 months and maybe every 6 weeks if changes occur)

Question 12

Nursing consideration for iminostilbenes

Answer 12

When given in feeding tube must be flushed before and after 100 ml and dilute with NSS or D5W

Cannot be abruptly because it increases the risk of seizure (all seizure meds)

Question 13

Oxycarbazepine

Answer 13

like carbamazepine but not as toxic

can be used as adjunctive therapy or mono therapy for partial seizure in children and adults

make absence and myoclonic works

Is a sodium channel blocker and is a better tolerated version off carbamazepine

Question 14

Nursing considerations for Oxycarbazepine

Answer 14

Use decrease efficacy of OC

must reduce dose in renal disease

Question 15

Valproic acid

Answer 15

Depakote

also known as valproate

affects GABA (what makes us feel good) to cause membrane stabilization. Increasing GABA calms down the neurons and slows down conduction through the axon (decreases the risk of seizures)

Question 16

Valproic Acid uses

Answer 16

Depakote

Used in absence, myoclonic, tonic-clonic, partial, neonatal seizures

used to treat acute mania in bipolar disorder (periods of depression and mania)

Question 17

Nursing considerations of Valproic acid

Answer 17

Depakote

Narrow therapeutic range so you have to check the levels

Can increase suicidal thoughts (within the first week) so educate them on it

Has to be diluted when giving IV with a least 50 ml NSS or D5W and has to be given over an hour (20 mg/min)

Sudden withdrawal could increase seizures and mania

Question 18

Labs for Valproic acid

Answer 18

LFT (because it causes liver toxicity)

Question 19

Side effects for Valproic Acid

Answer 19

GI side effects, sedation, dizziness

increased ammonia levels due to the way it affects the liver and can cause confusion (rare)

Question 20

Gabapentin

Answer 20

Can be put in any position and does a good job

Works on GABA by binding onto a protein that causes an increase in GABA (feel good)

Question 21

Gabapentin used for

Answer 21

used for partial seizures, can be used in kids over age 3

Can make myoclonic seizures worse

used for chronic neuropathic pain (nerve pain), anxiety, hot flashes/night sweats, and headaches