Med Quiz: Antiseizures Flashcards
Client is admitted for severe recurrent convulsive seizures. What drug should the nurse expect for use in emergency control of status epilepticus.
Gabapentin
Pregablin
Phenobarbital
Valproic acid
Phenobarbit emergency control of status epilepticus
Gabapentin, pregabalin, valproic acid are for partial seizures
How does Carbamazepine achieve therapeutic effects
Affecting gamma-aminobutyric acid (GABA) & Blocking sodium channels
Altering the permeability of neuron cell membrane
Reducing electrical activity in the thalamus and hypothalamus
Depressing conduction in the brainstem and cortex & slowing reuptake of dopamine
Carbamazepine affects GABA activities and inhibits sodium action potential.
Succinmides reduce electrical activity
Acetazolamides reduce electrical activity and alter sodium & calcium channels.
Barbiturates depress conduction in the brainstem and the cortex but don’t alter dopamine levels
A child while playing will have a brief pause of a few seconds then continue playing as they left off. What condition.
Status epilepticus
Tonic-clonic seizures
Myoclonic seizures
Absence seizures
Absence seizures: Abrupt loss of consciousness for 3 - 5 sec.
Tonic-clonic = Dramatic muscle movements, loss of consciousness, recovery period of confusion & exhaustion.
Myoclonic seizures Short sporadic periods of muscle contractions lasting several minute (Rare)
Status epilepticus = Most Dangerous rapidly occur one after another
ED patient has status epilepticus and nurse admin 300 mg phenobarbital IV. Family ask how long it will take to stop the seizures. Best response
We should see results in 10 to 30 minutes
It will take atleast 30 minutes before the seizures begin to subside
The seizures will probably stop in 5 minutes
It maybe an hour or slightly more before the seizures stops
We should see results in 10 to 30 minutes
Onset phenobarbital IV 5 minutes
Best response to a phenytoin level of 16 mcg/mL
Document therapeutic level. 10 - 20
School aged child diagnosed with seizure disorder, phenytoin prescribed. What are major SE
Rash
Sleepiness
Gum - overgrowth
Partial seizures (Face & Neck) which drug should be administered
Clorazpate
Felbamate
Gabapentin
Carbamazepine
Carbamazepine: For partial seizures
Clorazpate Anxiety, Alcohol Withdrawal, adjunct partial seizures
Felbamate causes Severe liver failure & aplastic anemia Last Resort
Gabapentin Adjunctive therapy in partial seizures & treatment of postherpetic neuralgia
Why is tapering down “Hydantoin” important
It reduces chance of Status Epilepticus seizures
Client is receiving Ethotoin to control seizure activity. Serum ethotoin level is 67 what is best nursing action.
Report to provider and monitor for signs of toxicity
Normal range 15 - 50
Why is a priority action in a toddler who had a seizure to check temperature?
In children a fever can give a clonic-tonic seizures.
Usually do not reappear
11 yr old on Phenytoin for seizures 100 mg bid. What statement by parents shows understanding
Stop drug immediately if any SE occurs
Frequent dental visits
High calorie foods & daily weighing
Take medicine on empty stomach
Frequent dental visits
Gingival hyperplasia common in clients esp. Children
Others not correct
Client with seizure disorder.
Contradiction for Carbamazepine
Allergy to sulfonamides
17 yrs old
Pancytopenia
Type 2 DM controlled with diet
Pancytopenia
Bone marrow suppression is a Contradiction for Carbamazepine
Safest for a client with liver cirrhosis & hep C.
Levetiracetam
Valproic acid
Lamotrigine
Phenobarbital
Levetiracetam
Not Metabolized by the liver
Antiseizure med
Children often require higher miligramos/ kilograms ratio than adults
T or F
T
Absorb & metabolize drugs quicker than adults
Which play a role in determining drug of choice for epilepsy
Gender
Culture & Ethnicity
Cognitive Status
Age
Type of epilepsy
Culture & Ethnicity
Age
Type of epilepsy
Which ethic groups may require reduced dosage of anticonvulsant meds.
Arab & Asian
Client is brought to ED in status epilepticus. Best drug to stop this activity.
Fosphenytoin
Carbamazepine
Ethotoin
Clorazpate
Fosphenytoin is Only Indicated for Status Epilepticus.
Clorazpate & Ethotoin are both for longterm treatment of partial seizure disorder alone or with other drugs.
Use of….
Ethosuximide & Methsuximide
Difference between…..
Ethosuximide & Methsuximide are indicated for control of absence seizures.
Ethosuximide should be used first (Methsuximide = Severe SE)
NO BLOODWORK NEEDED
Priority SE of valproic acid….
Liver enzymes
Which type of seizure is Rhythmic twitching in left hand for 90 seconds No loss of consciousness then stops. Repeats several time throughout the day
Simple partial
Psychomotor
Myoclonic
Jacksonian
Simple partial seizures: Occurs in single area of body or sensory alterations
Myoclonic seizures: Short, sporadic muscle contractions that last several minutes
Jacksonian: Start in one area of the brain and move to other area - can develop into generalized Tonic-clonic
Psychomotor Complex seizures that involve sensory, motor, and psychic components
Which assessment is most important for phenobarbital
Assessment of orientation
Assessment for tetany
Assessment of Deep Tendon Reflexes
Assessment of Respiration
Assessment of orientation
CNS depression is greatest concern with phenobarbital
