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Pharm 2 > seizures > Flashcards

seizures Flashcards

1
Q

what are seizures

A
  • abnormal brain activity in the nerve cells (dysrhythmias in the brain, brain fucks around and finds out)
  • may or may not be visible
  • abnormal EEG patterns
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2
Q

what are some possible causes of seizures

A
  • hypoglycemia
  • electrolytes (low Na)
  • med overdose
  • med/alcohol withdrawal
  • secondary (something provoked the seizure)
  • idiopathic (no idea why)
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3
Q

describe a partial seizure

A
  • specific area
  • symptoms range from simple motor and sensory manifestations to bizarre behavior (chewing, vacant stare, pill rolling)
  • consciousness not impaired
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4
Q

describe a generalized seizure

A
  • nonspecific area of brain
  • manifestations: tonic clonic movements
  • brief but intense
  • status epilepticus
  • absent seizures (less common, staring off, unresponsive)
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5
Q

describe tonic-clonic movement

A
  • tonic: sustained msuscle contraction, abnormal postures
  • clonic: rapid rhythmic jerking movements
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6
Q

describe status epilepticus

A
  • life threatening emergency
  • repeated or prolonged seizures for 30mins or more
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7
Q

true or false

seizures may come from hyperkalemia

A

false

hypoglycemia, hyponatremia, fever, drug OD, head injuries, or tumors be some causes of seizures

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8
Q

a patient is having a seizure for longer than 30mins. what type of seizure is the patient experiencing?

  1. tonic only seizure
  2. absence seizure
  3. atonic seizure
  4. status epilepticus
A
  1. status epilepticus

this is a life threatening emergency with seizures lasting for several minutes

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9
Q

name a barbituate

A

phenobarbital

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10
Q

describe the pharmacokinetics of phenobarbital

A
  • may take 3 weeks to reach therapeutic levels
  • PO, IV, IM
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11
Q

describe the action of phenobarbital

A
  • depresses CNS
  • inhibits conduction
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12
Q

what are some uses of phenobarbital

A
  • generalized seizures
  • partial seizures
  • for maintenance
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13
Q

what are some adverse effects of phenobarbital

A
  • CNS depression/sedation
  • stevens-johnson syndrome (severe rash)
  • status epilepticus with studden withdrawal

black box warning: suicidal ideation

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14
Q

what are some nursing implications of phenobarbital

A
  • monitor for CNS depression (vitals, resp, LOC)
  • many drug-drug interactions like: opioids, steroids, oral birth control, oral anticoagulants, antidepressants, alcohol
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15
Q

describe patient education for phenobarbital

A
  • do not stop aburptly
  • have serum level monitored
  • may cause drowsiness
  • barrier contraceptive
  • wear medical alert bracelet
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16
Q

name some benzodiazepines

A

diazepam, lorazepam

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17
Q

how can diazepam be given

A

PO, IV, IM

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18
Q

describe the action of diazepam

A

increases GABA at receptor site

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19
Q

whats diazepam used for

A
  • seizures, status epilepticus (emergent)
  • broad range of other uses
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20
Q

what are some adverse effects of diazepam

A
  • CNS depression
  • confusion
  • bradycardia, hypotension

black box warning: combined with opioids - life threatening respiratory depression

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21
Q

what are some nursing implications of diazepam

A
  • alcohol and omeprazole (antacid) increase effects
  • monitor for resp depression
  • monitor HR
22
Q

describe patient education for diazepam

A
  • do not stop abruptly
  • do not use alcohol
  • avoid with other CNS depressants
  • wear medical alert bracelet
23
Q

name a GABA analog

A

gabapentin

24
Q

describe the action of gabapentin

A

unclear, affects postsynaptic responses to stabilize nerve membrane

25
Q

whats gabapentin used for

A
  • partial seizures
  • off label uses: nerve pain (neuropathy), fibromyalgia
26
Q

what are some adverse effects of gabapentin

A
  • CNS depression
  • GI upset
27
Q

what are some nursing considerations for gabapentin

A
  • give with food
  • do not crush ER tabs
  • can become drug of abuse with opioids
28
Q

whats some patient education to include for gabapentin

A
  • do not stop suddenly
  • take with food
  • call MD for severe N/V
29
Q

name a hydantoin

A

phenytoin

30
Q

how can phenytoin be given

A

PO, IV, IM

31
Q

what are the therapeutic levels for phenytoin

A

10-20 mcg/ml

32
Q

describe the action of phenytoin

A

decreases nerve excitability

33
Q

whats phenytoin used for

A
  • first line antiepileptic drug
  • seizure prevention after brain injury
34
Q

what are some adverse effects of phenytoin

A
  • CNS depression
  • GI upset
  • gingival hyperplasia (gums get huge and gross)
35
Q

what are some nursing implications for phenytoin

A
  • give with food
  • alcohol and omeprazole increase effects
  • IV is tissue toxic
  • avoid in pregnancy
36
Q

whats some patient education to include for phenytoin

A
  • do not stop suddenly
  • take with food
  • have serum level monitored
  • good oral hygiene/dental visits
  • use barrier contraception
  • wear medical alert bracelet
37
Q

name an iminostilbene

A

carbamazepine

38
Q

describe the action of carbamazepine

A

decreases action potentials

39
Q

whats carbamazepine used for

A

epilepsy

40
Q

what are some adverse effects of carbamazepine

A
  • respiratory depression
  • liver damage

black box warning: aplastic anemia and agranulocytosis

aplastic anemia is when the bone marrow stops doing its thing (decreased plts, RBCs, and WBCs)

agranulocytosis is when theres no WBCs so theres an increased risk for infection

41
Q

what are some nursing considerations for carbamazepine

A
  • drug to drug interactions with warfarin and MAOIs
  • give with food
  • monitor liver function (ALT/AST)
42
Q

whats some patient education to include for carbamazepine

A
  • take with food
  • do not stop suddenly
  • avoid other CNS depressants
  • use barrier contraception
  • wear medical alert bracelet
  • report bruising, bleeding, fatigue to MD
43
Q

describe levetiracetam

A
  • used commonly
  • treats a variety of seizures
  • adverse effects include CNS depression
  • contraindicated with pregnancy
44
Q

describe topiramate

A
  • used for seizures, migraines, weight loss
  • adverse effects include CNS depression
  • contraindicated in pregnancy
45
Q

describe valproate

A
  • used to treat general or absence seizures
  • use 2 forms of contraception
  • monitor for bleeding

black box warnings: pancreatitis, teratogenic, alterations to clotting times

46
Q

describe acetazolamide

A
  • used for treatment of seizures related to increased fluid/pressure around the brain
  • diuretic action
47
Q

describe lacosamide

A
  • used for partial seizures
  • use caution with cardiac issues
  • contraindicated with pregnancy
48
Q

describe lamotrigine

A
  • use with other meds for partial seizures
  • contraindicated with pregnancy

black box warning: skin rash

49
Q

what med would the nurse anticipate for a patient in status epilepticus

  1. phenytoin
  2. diazepam
  3. levetiracetam
  4. clobazam
A
  1. diazepam

status epilepitus is a life threatening emergency; IV diazepam will work in minutes to stop seizure activity

50
Q

a patient is taking phenobarbital for seizures. which of the following statements indicate the patient should be seen by a doctor immediately?

  1. i have a rash on my trunk and it spread to my arms and legs
  2. i rest when im tired
  3. i take my meds at the same time every day
  4. i have my blood levels checked if my breathing is slow
A
  1. i have a rash on my trunk and it spread to my arms and legs

phenobarbital has an adverse effect of stevens johnson syndrome. it needs to be addressed immediately

51
Q

a 12yo comes to the school nurse office after falling in gym. the nurse notes he has bruises all over his arms and legs. the student has a hx of seizures that are treated with valproate. what does the nurse suspect?

  1. abuse by the parents
  2. leukemia
  3. anemia from poor diet
  4. side effect from medication
A
  1. side effect from medication

valproate is associated with changes in bleeding times including thrombocytopenia, bleeding, and bruising

Pharm 2 (34 decks)

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