Seizure Disordes Antiepileptic Drugs Flashcards
The nurse is preparing to give medications. Which of the following is the most appropriate nursing action for IV phenytoin (Dylantin)?
A) give IV doses via rapid push
B) administer in normal saline solutions
C) administer in dextrose solutions
D) ensure continuous infusion of drug
B
The nurse is reviewing the drugs currently taken by a pt who will be starting drug therapy with carbamazepine (tegretol). Which drug may raise a concern for interactions?
A) digoxin
B) acetaminophen
C) diazepam (valium)
D) warfarin sodium (Coumadin)
B
Due to increased risk of toxicity
Which response would the nurse expect to find in a pt with a phenytoin (Dilantin) level of 35 mcg/L?
A) ataxia
B) hypertension
C) seizures
D) ni unusual response, this level is therapeutic
A
The nurse is assessing a newly admitted pt who has a hx of seizures. During the assessment, the pt 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
B) gabapentin
C) carbamazepine
D) diazepam (valium)
D
The nurse is administering an antiepilectic drug and will follow which guidelines? Select all that apply
A) monitor the pt for drowsiness
B) stop medication if seizure activity disappears
C) give the medication at the same time every day
D) give the medication on an empty stomach
E) notify the prescriber if the pt is unable to take the medication
A, C, E
What is status epilepticus?
- continuous seizure stage
- life threatening condition
- seizures that are prolonged or occur 1 after another without full recovery between them
S&S:
- tachycardia
- cardiac dysrhythmias
- hyperglycaemia (due to catecholamine release)
- then hypotension
- elevated temperature
- metabolic acidosis
- hypoxia
- brain damage
- possible death
Needs medical treatment immediately
What is the goal of drug therapy with anti epileptics?
- control or prevent seizures while maintaining reasonable quality of life
- reduce length of seizures
- minimize AE and drug induced toxicity
What are the indications for antiepileptic drugs?
And what are their general overall actions?
- prévention or control of seizure activity
- long term maintenance therapy for chronic/ recurring seizures
- acute treatment of convulsions and status epilepticus
Overall effects:
- neurons are stabilized
- neuron hyper excitability is decreased
- spread of excessive nerve impulses is decreased
What are usually the two main drugs to treat status epilepticus?
- lorazepam (Ativan)
- diazepam (Valium)
What are some interventions to be done when seizure lasts for long appart from medication?
- give oxygen
- suction their mouth so they don’t choke
- clear airway
- put them in a safe side position
- remove the blankets
- put the side rails up
- padding on the side rails of the bed
- monitor how long it lasts
- prevent injury
What is the prototype medication for antiepileptics ?
What is it’s class?
Prototype: Phenytoin (Dilantin)
Hydantoin antiepileptic/anticonvulsant
What are some contraindications to the use of phenytoin (Dilantin)?
- pregnancy
-KDA - psychiatric conditions
- bradycardia
- SA, and AV heart block
What are some possible AE with phenytoin (Dilantin)?
- gingival hyperplasia
- hypotension
- bradycardia
- cardiac arrest
- suicidal tendencies
- agression
- headache
- stevens Johnson syndrome
- urine discoloration
- slurred speech
- myelosuppression
- lethargy
- ataxia( mental confusion, abnormal movement, cognitive changes)
- blurred vision
What are some drug interactions with phenytoin (Dilantin)?
Decrease effects with: alcohol (chronic use), antacids, barbiturates, high dose of calcium, folic acid, carbamazepine
Increase effect with: benzodiazepines, TCAs, salicylates, diazepam, alcohol (immediate use), H2 antagonists, estrogens, sulfonamides
Increased bleeding: warfarin
What are some nursing implications with phenytoin (Dilantin) ?
- assess for phenytoin hypersensitivity syndrome 3-12weeks after initiation
- teach pt to wash mouth often due to risk of gingival hyperplasia
- assess for serious skin disorders rash may indicate Stevens Johnson syndrome
- FALL PREVENTION : due to orthostatic hypotension possible
- monitor CBC results regularly
- needs to be given round the clock
- advise women to use non hormonal contraceptives
- compatible only with NS (IV)
What are signs and symptoms of phenytoin hypersensitivity syndrome?
And when does it usually occur?
S&S:
- rash
- fever
- lymphadenopathy
- renal failure
- hepatotoxicity
Usually occurs 3-12 weeks after initiation of therapy
What is needed to monitor during IV infusion of phenytoin (Dilantin)?
- Monitor closely for bradycardia and hypotension during infusion
What are some food interactions with phenytoin (Dilantin)?
- avoid juices, milk, carbonated drinks
- avoid caffeine, alcohol and smoking (may increase risk for seizures)
How and when should phenytoin (Dilantin) be taken?
- should be taken with at least 180-240 mls of water and with food to decrease GI upset
- should be taken round the clock
- only compatible with NS for IV infusion
- avoid juices, milk, carbonated drinks, caffeine, alcohol and smoking
What is the therapeutic plasma range for phenytoin (Dilantin)?
10-20mcg/L
What are some patient teaching tips about phenytoin (Dilantin)?
- teach pt to keep a journal to monitor (response to antiepileptic, seizure occurrence and description, AE)
- encourage pt to wear a medical alert bracelet or necklace
- don’t discontinue abruptly or can cause seizures
- driving may be impaired until drug levels is stabilized
- therapy is usually life long
- monitor for signs of suicidal thoughts or depression
- have seizure safety precautions and fall precautions
- avoid caffeine, smoking, alcohol, milk, juices and carbonated beverages
- frequent mouth care to help prevent gingival hyperplasia
- women should take non Hormonal contraceptive
- take each time everyday
What are some S&S of phenytoin (Dilantin) toxicity?
- nystagmus (uncontrollable, rapid and repetitive up and down and vertical movements of the eyes)
- ataxia (condition affecting the brain, clumsy movement, difficulty walking, difficulty with balance, hand coordination, speech, swallowing and eye movements)
- dysarthria (slurred slow speech, facial paralysis, or tongue)
- encephalopathy (altered mental state)
A pt is admitted into the ER with status epilepticus, the nurse anticipates this medication will be prescribed…
A) flumazenil
B) haloperidol
C) diazepam
D) midazolam
C
