Antiseizure Drugs: Class - Hydantoin (anticonvulsunt) Prototype - Phenytoin (Dilantin)

Phenytoin has a narrow therapeutic range of _______ mcg/mL

10 to 20 mcg/mL Below this range, seizures may not be controlled. Above this range is considered phenytoin toxicity Monitoring the therapeutic serum drug range is of utmost importance to ensure drug effectiveness.

True or False: Of all seizure cases, 75% are considered to be primary, or idiopathic (of unknown cause), and the remainder are secondary to brain trauma, brain anoxia (absence of oxygen), infection, or cerebrovascular disorders (e.g., cerebrovascular accident [CVA], stroke).

True

Which complementary and alternative medications may lower the seizure threshold when taken with antiseizure drugs? a) Evening primrose and borage b) Ginkgo c) Valerian root d) Echinacea

a) Evening primrose and borage

Which drug suppresses sodium influx among the listed options? a) Phenytoin b) Valproic acid c) Gabapentin d) Benzodiazepines

a) Phenytoin Valproic acid suppress CALCIUM Gapapentin promotes GABA release Benzodiazepine enhance the action of GABA

Patient Teaching What should patients be advised about the need for preventive dental checkups? a) To maintain oral hygiene b) To find the best-tasting toothpaste c) To avoid dental professionals d) To get free toothbrushes

a) To maintain oral hygiene Remember the side effect was Gingival hyperplasia which is an overgrowth of gums or reddened gums that bleed easily

Nursing Interventions for Antiseizure Drug Use: What is the recommended therapeutic range for monitoring serum drug levels of antiseizure medication like phenytoin? a) 5 to 10 mcg/mL b) 10 to 20 mcg/mL c) 20 to 30 mcg/mL d) 30 to 40 mcg/mL

b) 10 to 20 mcg/mL It is important to monitor serum drug levels of antiseizure medication to determine therapeutic range (10 to 20 mcg/mL).

What is epilepsy? a) A mental disorder b) A seizure disorder c) A heart condition d) A respiratory illness

b) A seizure disorder a seizure disorder that results from abnormal electric discharges from the cerebral neurons characterized by a loss or disturbance of consciousness and usually involuntary, uncontrolled movements

What causes seizures in epilepsy? a) High blood pressure b) Abnormal electric discharges from cerebral neurons c) Excessive caffeine intake d) Lack of sleep

b) Abnormal electric discharges from cerebral neurons Seizures occur when there is a disruption in the electrical functioning of the brain due to an imbalance in the excitation and inhibition of electrical impulses

Which medical tests are commonly used in diagnosing epilepsy? a) X-rays and ultrasounds b) Electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) c) Blood pressure measurement d) Urinalysis

b) EEG, CT, and MRI

Which complementary and alternative medication may decrease the effectiveness of certain antiseizure drugs such as phenytoin?

b) Ginkgo Ginkgo may decrease phenytoin, carbamazepine, and valproate effectiveness.

Do antiseizure drugs provide a cure for epilepsy? a) Yes, they cure epilepsy completely b) No, they do not cure epilepsy but manage and prevent seizures c) They cure the symptoms but not the underlying condition d) It depends on the specific drug used

b) No, they do not cure epilepsy but manage and prevent seizures These drugs prevent seizures but do not eliminate the cause or provide a cure.

Why do newborns, individuals with liver disease, and older adults typically require a lower dosage of antiseizure drugs like phenytoin? a) They have a higher metabolism b) They have a lower metabolism c) They are more resistant to seizures d) They have better drug tolerance

b) They have a lower metabolism They require a lower dosage because of a decrease in metabolism that results in more available drug.

Patient Teaching Why is it important for patients to not abruptly stop antiseizure drug therapy and instead withdraw the prescribed drug gradually under medical supervision? a) To save money on medications b) To decrease the risk of seizures c) To challenge the healthcare provider's recommendations d) To prevent dental issues

b) To decrease the risk of seizures Teach patients not to abruptly stop drug therapy but rather to withdraw the prescribed drug gradually under medical supervision to prevent seizure rebound (recurrence of seizures) and status epilepticus.

Patient Teaching Why should patients avoid driving or performing hazardous activities when initiating antiseizure therapy? a) To avoid getting too tired b) To reduce the risk of falling asleep c) To save fuel and energy d) To improve overall health

b) To reduce the risk of falling asleep Advise patients not to drive or perform other hazardous activities when initiating antiseizure therapy because drowsiness may occur. Remember that pheyntoin has a slight sedative effect so when INITIATING the medication it's important not drive

Patient Teaching Why is it important for healthcare providers to encourage patient compliance with their antiseizure medication regimen? a) To increase healthcare costs b) To reduce the risk of side effects c) To minimize the need for laboratory tests d) To challenge the patient's memory

b) To reduce the risk of side effects

Antiseizure Drugs and Pregnancy What risk do approximately one-third of females with a seizure disorder face during pregnancy? a) Hypertension b) Anemia c) An increase in seizures d) Elevated blood sugar levels

c) An increase in seizures

What are drugs used for epileptic seizures commonly referred to as? a) Antibiotics b) Antivirals c) Antiseizure drugs d) Antipyretics

c) Antiseizure drugs They are are also called anticonvulsants, or antiepileptic drugs (AEDs)

How are antiseizure drugs classified in terms of their effect on the central nervous system (CNS)? a) As stimulants b) As analgesics c) As depressants d) As antipyretics

c) As depressants Antiseizure drugs are classified as central nervous system (CNS) depressants.

Patient Teaching Why is it important to determine whether a patient taking phenytoin is receiving adequate nutrients? a) To assess their aesthetic preferences b) To prevent weight gain c) Because phenytoin may cause anorexia, nausea, and vomiting d) To provide dietary advice

c) Because phenytoin may cause anorexia, nausea, and vomiting

Patient Teaching Why should patients be warned to avoid alcohol and other central nervous system (CNS) depressants when taking antiseizure drugs? a) To save money b) To experience enhanced relaxation c) Because they can cause an added depressive effect on the body d) To improve their social life

c) Because they can cause an added depressive effect on the body Warn patients to avoid alcohol and other central nervous system (CNS) depressants because they can cause an added depressive effect on the body.

Antiseizure Drugs and Febrile Seizures At what age range do seizures associated with fever typically occur in children? a) Newborns b) Adolescents c) Between 3 months and 5 years of age d) Adults

c) Between 3 months and 5 years of age Seizures associated with fever usually occur in children between 3 months and 5 years of age. Epilepsy develops in approximately 2.5% of children who have had one or more febrile seizures.

What is the initial treatment for status epilepticus, a continuous seizure state that is considered a medical emergency? a) Administration of high-dose barbiturates b) IV administration of phenytoin c) Diazepam or lorazepam d) Propofol and midazolam

c) Diazepam or lorazepam Status epilepticus, a continuous seizure state, is considered a medical emergency. If treatment is not begun immediately, death could result. The choices of pharmacologic agents are diazepam administered by IV or lorazepam followed by IV administration of phenytoin. For continued seizures, midazolam or propofol and then high-dose barbiturates are used. These drugs should be administered slowly to avoid respiratory depression.

Antiseizure Drugs and Pregnancy When is oral vitamin K supplementation typically given to pregnant women taking antiseizure drugs? a) During the first trimester of pregnancy b) During labor and delivery c) During the last week or 10 days of pregnancy d) After the infant's first birthday

c) During the last week or 10 days of pregnancy Antiseizure drugs tend to act as inhibitors of vitamin K, contributing to hemorrhage in infants shortly after birth. Frequently, pregnant women taking antiseizure drugs are given an oral vitamin K supplement during the last week or 10 days of the pregnancy, or vitamin K is administered to the infant soon after birth.

Patient Teaching What should patients be advised about regarding herbs and antiseizure drugs? a) They have no interaction with antiseizure drugs. b) Dose adjustment is never required. c) Herbs can interact with antiseizure drugs, and dose adjustment may be required. d) Herbs can replace antiseizure drugs.

c) Herbs can interact with antiseizure drugs, and dose adjustment may be required. Ginkgo may decrease phenytoin, carbamazepine, and valproate effectiveness. Evening primrose and borage are complementary and alternative medication that may decrease the effectiveness

What may be a reason for children requiring an increased dosage of antiseizure drugs? a) Slower metabolism b) Lower body weight c) Higher metabolic rate d) Reduced drug tolerance

c) Higher metabolic rate individuals with an increased metabolic rate, such as children, may require an increased dosage.

Which class of antiseizure drugs includes phenytoin, the first antiseizure drug used to treat seizures? a) Barbiturates b) Benzodiazepines c) Hydantoins d) Gabapentinoids

c) Hydantoins Hydantoins inhibit sodium influx, stabilize cell membranes, reduce repetitive neuronal firing, and limit seizures.

Which of the following conditions can lead to seizures that are not associated with epilepsy, and typically cease when the underlying condition is corrected? a) High blood pressure b) Allergies c) Hypoglycemic reaction d) Visual disturbances

c) Hypoglycemic reaction Seizures that are not associated with epilepsy could result from fever, stress, hypoglycemic reaction, electrolyte imbalance (hyponatremia), metabolic imbalance (acidosis or alkalosis), and alcohol or drug use disorders. When these conditions are corrected, the seizures cease.

Besides controlling seizures, what additional therapeutic effect does phenytoin have in the cardiac tissue? a) Reducing blood pressure b) Limiting blood clot formation c) Increasing the electrical stimulation threshold as an antidysrhythmic d) Stimulating heart rate

c) Increasing the electrical stimulation threshold as an antidysrhythmic By increasing the electrical stimulation threshold in cardiac tissue, it also acts as an antidysrhythmic. It has a slight effect on general sedation, and it is nonaddicting.

Pharmacokinetics of pheyntoin How does a decrease in serum protein or albumin levels affect the free phenytoin serum level? a) It has no effect b) It reduces the therapeutic effects c) It increases the free phenytoin serum level d) It accelerates the metabolism of phenytoin

c) It increases the free phenytoin serum level It is a highly protein-bound (90% to 95%) drug; therefore a decrease in serum protein or albumin can increase the free phenytoin serum level.

What is a significant caution when using phenytoin during pregnancy? a) It may cause weight gain. b) It can lead to addiction in the fetus. c) It may have a teratogenic effect on the fetus. d) It can enhance fetal development.

c) It may have a teratogenic effect on the fetus. A teratogen is something that can cause birth defects or abnormalities in a developing embryo or fetus upon exposure. THIS DRUG SHOULD NOT BE USED DURING PREGNANCY

What are the less severe side effects of hydantoins, which may include constant, involuntary, cyclical movement of the eyeball and overgrowth of gums or reddened gums that bleed easily? a) Nausea and vomiting b) Depression and anxiety c) Nystagmus and gingival hyperplasia d) Seizures and arrhythmias

c) Nystagmus and gingival hyperplasia Less severe side effects include gingival hyperplasia (overgrowth of gums or reddened gums that bleed easily), and nystagmus (constant, involuntary, cyclical movement of the eyeball). The other less side effects are N/V, constipation, drowsiness, headaches, slurred speech, confusion

Antiseizure Drugs and Pregnancy What impact do antiseizure drugs have on folate (folic acid) in pregnant women? a) They promote folate absorption. b) They have no effect on folate levels. c) They increase the loss of folate. d) They prevent the absorption of folate.

c) They increase the loss of folate. Antiseizure drugs also increase the loss of folate (folic acid) in pregnant women; thus pregnant individuals should take daily folate supplements.

Patient Teaching What advice should be given to female patients who are taking oral contraceptives and antiseizure drugs like phenytoin? a) They should discontinue antiseizure drugs immediately. b) They don't need additional contraceptive methods. c) They should use an additional contraceptive method. d) They should avoid all medications.

c) They should use an additional contraceptive method. You can get preggo on pheyntoin use better contraceptive

How do antiseizure drugs work in the treatment of epilepsy? a) They eliminate the root cause of seizures b) They stimulate nerve cell membranes c) They suppress abnormal electrical impulses in the cerebral cortex d) They induce sleep

c) They suppress abnormal electrical impulses in the cerebral cortex Antiseizure drugs stabilize nerve cell membranes and suppress the abnormal electric impulses in the cerebral cortex.

Patient Teaching What is the purpose of monitoring a patient's complete blood count (CBC) levels when they are taking antiseizure drugs? a) To detect changes in mood and behavior b) To assess liver function c) To detect early signs of blood dyscrasias d) To evaluate cardiovascular health

c) To detect early signs of blood dyscrasias Remember that it is an adverse side effect Thrombocytopenia (low platelet count) and f) Leukopenia (low white blood cell count). It's important to ensure your patient

Antiseizure drugs work in one of three ways. Select all that apply: A) Suppress sodium influx B) Suppress potassium influx C) Suppress calcium influx D)Enhance action of serotonin E) Enhance action of GABA

A, C, E Antiseizure drugs work in one of three ways: (1) by suppressing sodium influx through the drug binding to the sodium channel when it is inactivated, which prolongs the channel inactivation and thereby prevents neuron firing; (2) by suppressing the calcium influx, which prevents the electric current generated by the calcium ions to the T-type calcium channel; or (3) by increasing the action of GABA, which inhibits neurotransmitters throughout the brain

Which adverse effects are associated with hydantoins? (Select all that apply) a) Depression b) Suicidal ideation c) Stevens-Johnson syndrome d) Ventricular fibrillation e) Thrombocytopenia (low platelet count) f) Leukopenia (low white blood cell count) g) Injection site reactions h) Purple glove syndrome (swollen, discolored, and painful extremities)

ALL OF IT!! Think about it. This drug is a CNS depressant, it may cause someone to be depressed and have suicidal ideation For ventricular fibrillation, hydantoins like phenytoin can affect the heart's electrical activity and lead to ventricular fibrillation. Phenytoin is a vesicant, meaning that if it leaks from the vein into the surrounding tissue it can cause a burning sensation and tissue/skin damage hence a patient can have injection site reactions Blood DyscrasiasThrombocytopenia (low platelets)Leukopenia (low white blood cells)

TRUE OR FALSE phenytoin is effective in treating tonic-clonic and partial seizures but is not effective in treating absence seizures.

TRUE Absence seizure Also called petit mal seizure is brief loss of consciousness lasts less than 10 seconds. This type usually occurs in children. It wouldn't be helpful to use

What are the two seizure categories described in the International Classification of Seizures? a) Generalized and complex b) Tonic-clonic and absence c) Partial and psychomotor d) Generalized and partial

d) Generalized and partial Generalized seizure involve both cerebral hemispheres of the brain. Partial seizure Involves one hemisphere of the brain; no loss of consciousness occurs in simple partial seizures, but there is a loss of consciousness in complex partial seizures.

Patient Teaching What is the advice for patients with diabetes regarding monitoring serum glucose levels when taking phenytoin? a) There is no need for monitoring. b) Monitor serum glucose levels less frequently than usual. c) Monitor serum glucose levels as usual. d) Monitor serum glucose levels more closely than usual.

d) Monitor serum glucose levels more closely than usual. Advise patients with diabetes to monitor serum glucose levels more closely than usual because phenytoin may inhibit insulin release, causing an increase in glucose level.

Patient Teaching What is the significance of monitoring serum phenytoin levels closely during pregnancy? a) To predict the baby's gender b) To avoid prenatal care c) To prevent anemia in the mother d) To address increased seizure frequency

d) To address increased seizure frequency Monitor serum phenytoin levels closely during pregnancy because seizures tend to become more frequent due to increased metabolic rates.