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
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)
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
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)
5
Q
describe tonic-clonic movement
A
- tonic: sustained msuscle contraction, abnormal postures
- clonic: rapid rhythmic jerking movements
6
Q
describe status epilepticus
A
- life threatening emergency
- repeated or prolonged seizures for 30mins or more
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
8
Q
a patient is having a seizure for longer than 30mins. what type of seizure is the patient experiencing?
- tonic only seizure
- absence seizure
- atonic seizure
- status epilepticus
A
- status epilepticus
this is a life threatening emergency with seizures lasting for several minutes
9
Q
name a barbituate
A
phenobarbital
10
Q
describe the pharmacokinetics of phenobarbital
A
- may take 3 weeks to reach therapeutic levels
- PO, IV, IM
11
Q
describe the action of phenobarbital
A
- depresses CNS
- inhibits conduction
12
Q
what are some uses of phenobarbital
A
- generalized seizures
- partial seizures
- for maintenance
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
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
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
16
Q
name some benzodiazepines
A
diazepam, lorazepam
17
Q
how can diazepam be given
A
PO, IV, IM
18
Q
describe the action of diazepam
A
increases GABA at receptor site
19
Q
whats diazepam used for
A
- seizures, status epilepticus (emergent)
- broad range of other uses
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
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
whats gabapentin used for
- partial seizures
- off label uses: **nerve pain** (neuropathy), fibromyalgia
26
what are some adverse effects of gabapentin
- CNS depression
- GI upset
27
what are some nursing considerations for gabapentin
- give with food
- do not crush ER tabs
- can become drug of abuse with opioids
28
whats some patient education to include for gabapentin
- do not stop suddenly
- take with food
- call MD for severe N/V
29
name a hydantoin
phenytoin
30
how can phenytoin be given
PO, IV, IM
31
what are the therapeutic levels for phenytoin
10-20 mcg/ml
32
describe the action of phenytoin
decreases nerve excitability
33
whats phenytoin used for
- first line antiepileptic drug
- seizure prevention after brain injury
34
what are some adverse effects of phenytoin
- CNS depression
- GI upset
- gingival hyperplasia (gums get huge and gross)
35
what are some nursing implications for phenytoin
- give with food
- alcohol and omeprazole increase effects
- IV is tissue toxic
- avoid in pregnancy
36
whats some patient education to include for phenytoin
- do not stop suddenly
- take with food
- **have serum level monitored**
- good oral hygiene/dental visits
- use barrier contraception
- wear medical alert bracelet
37
name an iminostilbene
carbamazepine
38
describe the action of carbamazepine
decreases action potentials
39
whats carbamazepine used for
epilepsy
40
what are some adverse effects of carbamazepine
- 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
what are some nursing considerations for carbamazepine
- drug to drug interactions with warfarin and MAOIs
- give with food
- monitor liver function (ALT/AST)
42
whats some patient education to include for carbamazepine
- 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
describe levetiracetam
- used commonly
- treats a variety of seizures
- adverse effects include CNS depression
- contraindicated with pregnancy
44
describe topiramate
- used for seizures, migraines, weight loss
- adverse effects include CNS depression
- contraindicated in pregnancy
45
describe valproate
- 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
describe acetazolamide
- used for treatment of seizures related to increased fluid/pressure around the brain
- **diuretic action**
47
describe lacosamide
- used for partial seizures
- **use caution with cardiac issues**
- contraindicated with pregnancy
48
describe lamotrigine
- use with other meds for partial seizures
- contraindicated with pregnancy
**black box warning: skin rash**
49
what med would the nurse anticipate for a patient in status epilepticus
1. phenytoin
2. diazepam
3. levetiracetam
4. clobazam
2. diazepam
*status epilepitus is a life threatening emergency; IV diazepam will work in minutes to stop seizure activity*
50
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
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
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
4. side effect from medication
*valproate is associated with changes in bleeding times including thrombocytopenia, bleeding, and bruising*
