Week 5 Antiepileptic Drugs Flashcards
compensatory mechanisms in the brain that operate to maintain pressure w/in the cranial cavity in a safe range
intracranial regulation
Hydantion drug prototype
Phenytoin
Barbiturates drug prototype
phenobarbital
Benzodiazepine drug prototype
diazepam
Seizure that involves one area of the brain and does not spread throughout
partial (focal)seizure
Seizure that begins in one area of the brain and rapidly spreads throughout both hemisphere
generalized seizures
T or F drug choice depends largely on the type of seizure
TRUE!!
What drug classes action stabilizes neuronal membranes and prevents hyperexcitability caused by excessive stimulation; limits the spread of seizure activity
Hydantoins
Indication for Hydantoins
- treatment for tonic-clonic and psychomotor seizures
- prevention of status epilepticus
- treatment of seizures after neurosurgeries
What is the half-life of hydantoins
- 6-24 hrs
- shorter half-life than others
Contraindications of Hydantoins
- associated w/ specific birth defects and should NOT BE used in pregnancy unless the risk of seizures outweighs the potential risks
- edlder or debilitated pts may respond adversely to CNS depression
- coma, depression, or psychoses> can exacerbated CNS depression
Common adverse effects of Hydantoins
- CNS depression
- Steven- Johnsons syndrome
- bone marrow surpression
Drug-drug interactions of Hydantoins
- Avoid alcohol, increased risk of CNS depression
- Avoid ginko, increases risk for serious side effects
Nursing Considerations for Hydantoins
- get baseline physical assessment
- monitor elderly closely
- educate pregnant women
- weane> can’t just stop taking
- administer w/ food
- skin assess
- assess neuro
know seizure baseline/ background
The nurse evaluates the client’s latest serum phenytoin level which is revealed to be 16 mcg/mL. What is the nurse’s best action?
A. Contact the provider to discuss the need for an extra dose of phenytoin
B. Document the fact that the client’s phenytoin level is therapeutic
C. Promptly establish seizure precautions
D. Contact the provider to discuss withholding the next scheduled dose
B!
The therapeutic serum level range for phenytoin is between 10 and 20 mcg/mL. As such, there is no need to contact the provider. Seizure precautions are likely already in place, and if they are not, this laboratory result does not provide an indication for reinstituting them.
What drug classes action inhibits impulse conduction in the ascending reticular activating system (RAS), depresses the cerebral cortex, alters cerebellar function, and depresses motor nerve output
Barbiturates
Indication for Barbiturates
- long term treatment for generalized tonic-clonic and cortal focal seizures
- emergency control of certain acute convulsive episodes
Half-life of Barbiturates
- 79 hrs
- long half life> long term treatment
- low lipid solubility gives this drug a slow onset
Contraindications of Barbiturates
- same as hydantoins
- associated w/ specific birth defects
- elderly pts may respond adversely
- CNS depression exacerbation
Drug-drug interaction of Barbiturates
- Avoid alcohol, increases risk of CNS depression
common adverse reactions of Barbiturates
- insomnia, vertigo, lethargy, dizziness, hypotension, bradycardia, syncope
- sedation, hypnosis, coma
Nursing Considerations of Barbiturates
- know baseline assessment
- know seizure baseline and hx
- weane> do not stop rapidly
- assess orientation
- give IV med SLOWLY
- have emergency equipment on standby
A client has been administered phenobarbital during seizure activity. When assessing for adverse effects after resolution of the seizure, what assessment should the nurse prioritize?
A. Assessment of orientation
B. Evaluation of deep tendon reflexes
C. Assessment for tetany
D. Focused respiratory assessment
A.!
The most common adverse effects associated with barbiturates relate to CNS depression and its effects on body function. As a result, cognition would be a central focus.
What med classes action potentiates the effects of GABA, and acts in the limbic system as well as causing muscle relaxation and relieves anxiety
Benzodiazepines
Indication of Benzodiazepines
- adjunct in status epilectus
- management of epilepsy
- severe recurrent convulsive seizures
Half-life of Benzodiazepines
- 20-80 hrs
- short term and long term managment
Contradictions of Benzodiazepines
- same as hydantoins and barbiturates
- associated w/ birth defects
- elderly may respond adversely to CNS depression
- may exacerbate CNS depression
Adverse effects of Benzodiazepines
- paradoxical excitatory reaction> does oppoisite of what its supposed to do
- may be associated w/ physical dependence and withdrawal syndrome
- sedation, fatigue, lethargy
Drug to drug interactions with Benzodiazepines
- Avoid alcohol, increases risk of CNS depression
- avoid taking in combination with other CNS depressing drugs such as opioids
- the effects of benzos increase if they are taking oral contraceptives
Nursing considerations of benzodiazepine
- know if the pt is taking CNS depressant meds
- Push IV sLOWLY
- Oral route is #1 route
- Do NOT OPERATE a motor vehicle after taking
- taper dose gradually
- get a baseline physical assessment
A client is taking a benzodiazepine. The nurse evaluates teaching as effective when the client makes which statement?
A. “I should always take the medication with meals.”
B. “I should not stop this drug without talking to my health care provider first.”
C. “I should not take aspirin with this medication.”
D. “I should avoid grapefruit juice for the duration of treatment.”
B!
- gradually taper medication
- The client makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines requires careful monitoring and should be gradually withdrawn.
Children considerations with antiseizure meds
- can impact learning and development> CNS depressing
- more sensitive to sedating effects
- absorb dn metabolize these drugs more quickly than adults; require larger dosage per kg to maintain levels
Adult considerations with antiseizure meds
- monitor regularly for adverse effects
- education and support to deal w/ stigma and lifestyle changes
- associated w/ fetal abnormalities > encourage oral contraceptives
Older adult considerations with antiseizure meds
- more susceptible to adverse effects
- more likely to experience drug toxicity due to renal and hepatic impairment
- closely monitor serum levels; LOWER doses are usually taken
The nurse and provider have observed the rhythmic movements for 5 minutes. Anya’s O2 sats are currently 82% and the nurse notes a bluish discoloration around her lips.
Which verbal order is the nurse anticipating?
PO Levetiracetam
PR Diazepam
IV Midazolam
IM Lorazepam
PR Diazepam
> rectally
- never want to give a seizing child anything by mouth
