Seizures Flashcards
1
Q
Barbiturates: examples
A
- Phenobarbital (Luminal) - May take several weeks for dosing to achieve optimal level, less adverse effects
- Amobarbital (Amytal)
- Mephobarital (Mebaral)
2
Q
Barbiturates: characteristics
A
- Mechanism of Action- enhances GABA, suppresses neuronal discharges that cause seizure activity
- Potential for auto-induction – induce own metabolism in the liver = drug-to-drug interactions
- Slow onset and long duration of action
- Can be given orally and parenterally
- Tolerance develops and increased dose may be needed to achieve therapeutic effect
3
Q
Barbiturates: adverse effects
A
- Not first line drugs due to adverse effects/low safety margin:
Respiratory and CNS depression, sedation (coma and death, OD for suicide), bradycardia, syncope, hypotension, ataxia, dizziness, mood changes
4
Q
Barbiturates: nursing considerations and uses
A
- Monitor respiratory status and sedation level
- High potential for dependence
- Monitor use closely in those clients with impaired liver and kidney function
- Educate client about compliance with therapy
- Educate the client to avoid consuming alcohol
- contraindicated in pregnancy
- Long term treatment of tonic-clonic seizures
- Emergency treatment of status epilepticus
- Might be used as adjuncts to anesthesia
5
Q
Benzodiazepines: uses/characteristics
A
- Used in treatment of Tonic-Clonic Seizures, Absence Seizures, Myoclonic and Status Epilepticus
- Can also use as muscle relaxers and anti anxiety meds
- Mechanism of Action: Binding of BZ to GABA Receptors
6
Q
Benzodiazepines: examples
A
- Diazepam (Valium) used IV or PR for status epilepticus
- Clonazepam (Klonopin)- primary use is for refractory myoclonic seizures
- Lorazepam (Ativan) used (IV) for status epilepticus, alcohol withdrawal**
- Clorazepate (Tranxene) used as adjunctive agent for partial seizures
7
Q
Benzodiazepines: adverse effects
A
- Adverse effects: Sedation, drowsiness, dizziness, blurred vision, ataxia, behavior changes, v RR
- Administer slowly IV to prevent bradycardia (Be careful with which ones)
- Tolerance and dependency can occur
- Can cause thrombocytopenia, leukopenia and hepatotoxicity (liver and CBC tests)
- Stopping use of benzodiazepines after chronic use can cause withdrawal manifestations
8
Q
Benzodiazepines: nursing considerations
A
- contraindicated in pregnancy
- Education (Decrease effectiveness of oral contraceptives)
- Drug History should be obtained including use of other CNS depressants
- Assess for dependence and abuse and respiratory depression
- Assess for CNS DEPRESSION
- Pregnancy Status
- Assess for behavior changes, Ataxia
- Can ^ IOP in glaucoma PT
- HTN
9
Q
Benzodiazepine OD TX drug
A
Flumazenil (Romazicon)
10
Q
Hydantoins: examples and uses
A
- Phenytoin (Dilantin)
- Ethotoin (Peganone)
- Fosphenytoin (Cerebyx) – changes into phenytoin
- Used to treat partial and generalized tonic-clonic seizures; phenytoin might be used for status epilepticus
- Might decrease the effectiveness of some BCPs
- Narrow therapeutic index so drug levels must be monitored
11
Q
Hydantoins: actions and adverse effects
A
- Mechanism of action: delay the influx of sodium across the neuron cell membrane thereby decreasing excitability thus stabilizing nerve endings
- Adverse effects- gingival hyperplasia*** (gums that are red and bleed easily), slurred speech, confusion, sedation and drowsiness, nausea, vomiting, blurred vision, diplopia (double vision), ataxia, nystagmus, headaches, blood dyscrasias (decreased platelet and WBC counts), hyperglycemia, alopecia (some people get more hair some lose), hirsutism, rash (Steven Johnson syndrome), pruritus, hepatotoxicity, CNS depression
- May need to change drug at first sign of rash
12
Q
Hydantoins: nursing considerations
A
- Use cautiously in liver & renal impaired clients
- Contraindicated in pregnancy
- Monitor for hypotension, bradycardia, vital signs changes, adverse effects, therapeutic effects, for bone marrow suppression
- Tube feedings may interfere with absorption of enteral hydantoins
- Avoid alcohol
Don’t discontinue drug without proper instruction - ***Monitor blood levels
If give phenytoin intravenously dilute with NS and use an in-line filter; must give slowly IV due to potential for hypotension and cardiac dysrhythmias
13
Q
Iminostilbene: example(s) and characteristics
A
- Carbamazepine (Tegretol)
- Used to treat seizures that have not responded to other medications
- ***Drug of choice in the management of trigeminal neuralgia
- Mechanism of action: suppression of sodium and calcium across the cell membrane; stimulates GABA
14
Q
Iminostilbene: adverse effects
A
- Adverse effects include: drowsiness, dizziness, nausea, vomiting, dry mouth (kinda anticholinergic), constipation, rash (SJS), visual abnormalities, blood dyscrasias, headache
- Avoid grapefruit juice and ginko
- Can also auto-induce
15
Q
Succinimides: example(s) and characteristics
A
- ethosuximide(Zarontin)
- methsuximide(Celontin): more side effects
- Work by delaying the influx of calcium into the cell
- Work best for absence seizures
- Used for seizures that have not responded to other drugs
