Seizure Medication (EXAM 2) Flashcards
Anit-Epileptic Drugs
-Anticonvulasnts
-Goal of AED therapy is to control or prevent seizures while maintaining a reasonable quality of life.
-Most cases cannot eliminate seizures, so goal is to maximally reduce seizure incidence and minimize drug-toxicty
Anit-Epileptic Drugs: Subscribe
-Patient typically must take these drugs for the rest of their life
-If seizure free for 1-2 years can decrease or stop in some cases
Abruptly stoping AED’s
WILL CAUSE SEIZURES
AED: More information
-Not typical started after just 1 seizure because there is a 40% it wont happen again
-Drug chosen based on: efficacy for type of seizure, adverse effects, drug interactions, cost, ease of use, and pediatric availability
How medications are the prescribed
mono-therapy first
one drug and one does
Therapeutic Drug Monitoring
-Almost all AED require therapeutic monitoring
-Evaluate effectiveness and adherence
-Maintaining serum drug levels within therapeutic range helps control seizures and reduce adverse effects. (IT IS ALL ABOUT BALANCE)
-These have to be taken everyday without fail as presribed
Traditional AEDs
Barbiturates, hydantoins, and iminostilbenes, valproic acid
2nd and 3rd generation meds are also available—tend to have fewer adverse effects and drug interaction so may benefit older adults who have to take multiple medications
AED: MOA
-MOA is threefold:
- Increase the threshold of activity in the motor cortex—-making it more difficult fro a nerve to be excited or reduce the nerve’s response to incoming electrical or chemical activity
- Limit the spread of a seizure discharge from its origin—–suppressing the transmission of impulses from one nerve to the next
- Decrease the speed of nerve impulse conduction within a given neuron
Black Box Warning: ALL AED’s
-Increasing the risk of suicide, depression and mood changes.
Generalized Adverse Effects of AED’s
-Teratogenic: Even in patients that are not on meds, there is a higher rate of birth defects seen in AEDs
-Dizziness and Drowsiness
-GI upset
-If taking more than one the risk increases
AEDs: Hydantoins
phenytoin
Hydantonins: Indicated
-Tonic-clonic seizures and partial (focal) seizures
-First Line For Epilepsy
Hydantoins: adverse effects
-TONS
-GINGIVAL HYPERPLASIA. Related to longterm use; can be prevented with scrupulous dental care
-Hirsutism, osteoporosis, hypertrophy of subcutaneous facial tissue (Dilantin facies)
Hydantoins: Nursing consideration
-Therapeutic Monitoring
-Drug interacts with other drugs frequently because it is highly protein bound
-Be careful giving to people who are malnourished, low protein levels, kidney disease
-CYP450 Inducer. (Can increase the metabolism of other medications)
Valproic Acid
NO class
