Antiepileptic Drugs

A patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply.) A. Tremors B. Weight gain C. Hepatoxicity D. Hypoglycemia E. Insomnia

A, B, C

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). Which condition will the nurse suspect that the patient experiences? A. Absence seizures B. Tonic-clonic seizures C. Panic attacks D. Partial seizures

A. Ethosuximide is used to treat absence seizures.

What should the nurse teach a patient about abruptly stopping the drug therapy?

Avoid abrupt withdrawal of the antiepileptic drug to prevent rebound seizure activity.

When administering intravenous phenytoin (Dilantin), which action will the nurse perform? A. Always use an infusion pump. B. Flush the line with normal saline before and after administration to prevent precipitation. C. Administer through peripheral intravenous sites only. D. Monitor for hypertension.

B. Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. Flushing with normal saline before and after minimizes precipitation. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred.

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication? A. Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months. B. Reducing seizure occurrence to one per week. C. Maximally reducing seizure activity while minimizing side effects of medication therapy. D. Maximizing drug dosages to control seizure activity.

C. Anticonvulsant medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects.

What is a consideration when giving antiepileptic drugs to the elderly?

Elderly patients may experience paradoxical reactions to antiepileptic drugs, resulting in hyperactivity and irritability versus sedation.

What are the three parts to which antiepileptic drugs work?

First, they increase the threshold of activity in the area of the brain called the motor cortex. Second, they act to limit the spread of a seizure discharge from its origin by suppressing the transmission of impulses from one nerve to the next. Third, they can decrease the speed of nerve impulse conduction within a given neuron.

The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common side effect is the nurse educating the patient about for this medication?

Gingival hyperplasia: A side effect of phenytoin is overgrowth of gum tissue, or gingival hyperplasia. This can be minimized by frequent oral hygiene

What could happen if a person in status epilepticus does not have proper interventions?

In status epilepticus, multiple seizures occur with no recovery between them. If appropriate therapy is not prompt, hypotension, hypoxia, brain damage, and death can quickly ensue.

What are some other uses for an antiepileptic drug?

Some other illnesses that can be treated with antipileptics are psychiatric disorders, migraine headaches ad neuropathic pain syndromes.

The laboratory results indicate that the patient's valproic acid level is at toxic levels, but the patient insists that he has not taken extra doses of medication. "I take it the same way at the same time every morning," he states emphatically. Upon further questioning, the patient mentions that he also takes aspirin two or three times a day for muscle aches. "Could that have any effect on my drug level?" he asks. What is the nurse's best response?

Taking aspirin along with the valproic acid would result in displacement of valproic acid from plasma protein binding sites, thus increasing free valproic acid levels. This results in an increased risk of toxicity. As a result, the patient may be at a higher risk for experiencing toxic effects. The nurse will remind the patient not to take any over-the-counter medications or herbal products without first checking with the prescriber.

What are the antiepileptic drugs used?

The antiepileptic drugs traditionally used to manage seizure disorders include barbiturates, hydantoins, and iminostilbenes, plus valproic acid.

What is the goal of antiepileptic drug therapy?

The goal of antiepileptic drug therapy is to control or prevent seizures while maintaining a reasonable quality of life.

What are some of the lab work that a patient may undergo before starting therapy?

The laboratory test results may include the results of red blood cell and white blood cell counts, clotting studies, and renal and/or liver function studies.

A patient is starting an antiepileptic drug and has many questions about it. The patient states, "I can't wait to be able to drive to work." What is the priority issue for the nurse to consider when replying?

The priority in this situation is ensuring safety. Many antiepileptic drugs cause sedating effects, such as drowsiness and dizziness. Until a steady state has been achieved (usually between four and five half-lives), the patient needs to take measures to prevent injury. The patient needs to avoid driving, operating heavy machinery, and making major decisions until a steady state has been achieved. Some states have certain restrictions regarding driving with a diagnosis of epilepsy; the patient needs to check with the state's department of motor vehicles for more information.

What do serum drug levels provide us with?

Therapeutic drug monitoring of serum drug concentrations provides a useful guideline in assessing the effectiveness of and adherence to therapy. For certain antiepileptic drugs, the safe and toxic levels are very close together; that is, they have a narrow therapeutic range.

The nurse is about to administer the morning dose of phenobarbital to a patient with a history of seizures. Before the dose is given, the laboratory calls to report that the patient's phenobarbital blood level is 8 mcg/mL. What is the priority action at this time?

Therapeutic levels for phenobarbital are between 10 and 40 mcg/mL; therefore, this patient's drug level is too low to be effective. The priority action by the nurse is to contact the prescriber immediately and to expect an adjustment in the medication dosage. In addition, seizures are more likely to occur with a subtherapeutic medication level; the nurse will monitor the patient closely for seizure activity and implement safety measures.

Describe Tonic-Clonic Seizures

Tonic-clonic seizures begin with muscular contraction throughout the body (tonic phase) and progress to alternating contraction and relaxation (clonic phase).