Pharm - Antiepileptic drugs

Question 1

Medications used to control epilepsy and convulsions

Answer 1

Antiepileptics/Anticonvulsants

Question 2

Evidence indicates these drugs alter the movement of sodium, potassium, calcium, and magnesium ions resulting in more stabilized and less responsive cell membranes

Answer 2

Antiepileptics

Question 3

CNS dysfunction that can cause symptoms ranging from momentary sensory disturbances to convulsive seizures

Answer 3

Epilepsy

Question 4

Excessive stimulation of the neurons in the brain, leading to a brief episode of abnormal neuron activity.

Answer 4

Seizure

Question 5

A more severe seizure characterized by involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles.

Answer 5

Convulsion

Question 6

Primary (idiopathic) epilepsy

Answer 6

No identifiable cause

Question 7

Characterized by neuronal activity that originates simultaneously in the grey matter of both hemispheres. Several subtypes.

Answer 7

Generalized onset seizures

Question 8

Begin with muscular contractions throughout the body (tonic) and progress to alternating contraction and relaxation (clonic phase). Involve spasms of upper trunk with flexion of the arms

Answer 8

Tonic-clonic seizures

Question 9

originate in localized or focal region (1 lobe) of the brain

Answer 9

Focal onset seizures

Question 10

A subtype of generalized onset seizures that involves a brief loss of awareness but without loss of consciousness or spasmodic eye blinking.

Answer 10

Simple focal seizures

Question 11

level of consciousness reduced but not completely lost

Answer 11

Focal onset seizure

Question 12

Multiple seizures occur that last for 5 minutes or longer of continuous clinical or electrographic or both without recovery (returning to baseline)

Answer 12

Status epilepticus

Question 13

A metabolic process by which a drug stimulates production of enzymes that enhance its own metabolism. Leads to reduction in therapeutic drug concentration

Answer 13

Autoinduction

Question 14

A patient is experiencing temporary lapses in consiousness that last only a few seconds. Her teachers have said she “daydreams too much.” What type of seizure can this be classified as?
a)Simple
b)Generalized
c)Complex
d)Partial

Answer 14

b) generalized

Question 15

Which condition is a life threatening emergency in which patients typically do not regain consciousness?
a) status epilepticus
b) tonic-clonic seizures
c) epilepsy
d) primary epilepsy

Answer 15

a) status epilepticus

Question 16

Which of the following is true about the intravenous infusion of phenytoin (Dilantin)? Select all.
a) phenytoin is injected quickly
b) phenytoin is injected slowly
c) the injection of phenytoin is followed by an injection of sterile saline
d) phenytoin must not be infused continuosly
e) phenytoin is mixed with D5W (5% dextrose and water) for the infusion

Answer 16

b, c, d

Question 17

The nurse administers phenobarbital to a patient. What priority clinical manifestation should the nurse monitor as a possible adverse effect of this therapy?
a) constipation
b) gingival hyperplasia
c) drowsiness
d) dysrhythmias

Answer 17

c) drowsiness

Question 18

A patient with a history of epilepsy experiences status epilepticus. What medication can the nurse expect to prepare for this condition?
a) phenobarbital
b) diazepam (Valium)
c) valproic acid (Depakene)
d) phenytoin (Dilantin)

Answer 18

b) diazepam (valium)

Question 19

A patient who is experiencing neuropathic pain tells the nurse that the health provider is going to start him on a new med that is generally used to treat seizures. The nurse anticipates that which drug will be ordered?
a) phenobarbital
b) phenytoin (Dilantin)
c) gabapentin (Neurontin)
d) lamotrigine (Lamictal)

Answer 19

c) gabapentin

Question 20

Phenytoin (Dilantin) is prescribed for a patient. The nurse checks the patient’s current list of medications and notes that interactions may occur with which drugs or drug classes? (select all)
a) loop diuretics
b) warfarin (Coumadin)
c) sulphonamide antibiotics
d) corticosteroids
e) oral contraceptives

Answer 20

a, b, c

Question 21

A patient is unable to take oral meds and has received a loading dose of phenytoin (Dilantin) intravenously. The orders call for him to receive phenytoin 5mg/kg per day in three divided doses. The medication comes in a vial containing 50mg/mL. The patient weighs 90kg. How many mL of medication will be drawn up for each dose?
How many mG will the patient receive each day? For each dose?

Answer 21

3mL
450 mg/day
150mg/dose

Question 22

When teaching a patient about taking their antiepileptic meds, what is important to educate on ?

Answer 22

-Treatment is long term and usually lifelong (not a cure)
-Take same time each day
-Do not crush, chew, or open extended forms
-This med should not be discontinued abruptly
-Follow driving recommendations
-Keep a journal to monitor therapeutic response, seizure occurrence, and adverse effects.

Question 23

What is important when administering Dilantin IV?

Answer 23

-Diluted in NS only!
-Filter must be used
-Saline flush
-Slow IV directly into large vein (20 gauge or larger) venous catheter

Question 24

Treatment for status epilepticus

Answer 24

Diazepam (Valium)

Question 25

Drugs that have a narrow difference between safe and toxic levels. Monitoring of therapeutic plasma levels is required as well as their corresponding therapeutic levels.

Answer 25

Narrow therapeutic index

Question 26

The nurse is preparing to give medications. Which of the following is the most appropriate nursing action for IV phenytoin (Dilantin)?
a) give IV doses via rapid IV push
b) administer in normal saline solutions
c) administer in dextrose solutions
d) ensure continuous infusion of drug

Answer 26

b) administer in normal saline solutions

Question 27

The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise concern for interactions?
a) digoxin (Lanoxin)
b) acetaminophen (Tylenol)
c) diazepam (Valium)
d) warfarin sodium (Coudamin)

Answer 27

b) acetaminophen (Tylenol)

Question 28

Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 35 mcg/L?
a) ataxia
b) hypertension
c) seizures
d) no unusual response, this level is therapeutic

Answer 28

a) ataxia

Question 29

A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also indicated for which of the following?
a) postherpetic neuralgia
b) viral infection
c) parkinson’s disease
d) depression

Answer 29

a) postherpetic neuralgia

Question 30

The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition?
a) valproic acid (Depakote)
b) gabapentin (Neurontin)
c) carbamazepine (Tegretol)
d) lorazepam (Ativan)

Answer 30

d) lorazepam (Ativan)

Question 31

The nurse is administering an AED and will follow which guidelines? (select all)
a) monitor the patient for drowsiness
b) stop medications is seizure activity disappears
c) give the medications at the same time every day
d) give the medications on an empty stomach
e) notify the prescriber if the patient is unable to take the medication

Answer 31

a, c, e

Question 32

The nurse is providing education for a patient who will be taking an AED for the first time. Which statement by the patient indicates that further teaching is required?
a) I will take the medicine at the same time ever day
b) I will check with my doctor before taking any over the counter drugs
c) I will keep the appointments to check my bloodwork
d) I can drive to work again once my drug levels are normal

Answer 32

d) I can drive to work again once my drug levels are normal.