Karch's PrepU (Pharm) CH. 23 Antiseizure Agents
A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug? carbamazepine clorazepate felbamate gabapentin
carbamazepine Explanation: Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.
A female client's seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse's best response? "They are safe during pregnancy." "They are considered teratogenic." "They may interfere with conception." "They are contraindicated during the third trimester."
"They are considered teratogenic." Explanation: Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED.
The neurological nurse cares for several clients who have seizure disorders. Which client should the nurse monitor most closely for indications of drug dependence? A client with a history of tonic-clonic seizures who takes phenobarbital A client receiving IV phenytoin to prevent seizures post-neurosurgery A client receiving ethosuximide for the prevention of absence seizures A client with a history of myoclonic seizures who takes valproic acid
A client with a history of tonic-clonic seizures who takes phenobarbital Explanation: Barbiturates, such as phenobarbital, have an associated risk for dependence. This is not true of the other listed drugs.
A client is receiving carbamazepine therapy and the client's latest serum level of the drug is 13 mcg/mL. What action is most appropriate? Anticipate a reduction in dosage Call an emergency code Contact the provider to request a one-time supplementary dose Assess the client's renal function
Anticipate a reduction in dosage Explanation: A serum carbamazepine level of 13 mcg/mL is slightly over the therapeutic range of 4 to 12 mcg/mL, indicating need for a reduction in dosage. This not an emergency, though it needs to be addressed. This result does not threaten the client's renal function. 408
A nurse is caring for a hospital client who has just been prescribed phenytoin for a seizure disorder. What assessment should the nurse prioritize when assessing for adverse effects? Assessment of level of consciousness Assessment of urinary output and urine appearance Assessment of respiratory rate and oxygen saturation Assessment for chest pain or shortness of breath
Assessment of level of consciousness Explanation: The most common adverse effects of hydantoins are related to CNS depression, which would cause a decrease in LOC. Urine output and respiratory function are rarely affected. Chest pain or shortness of breath would signal a severe hypersensitivity reaction, but this is not common.
A client is receiving phenytoin. The nurse monitors the client's plasma drug level. Which level would alert the nurse to the possibility of toxicity? 27 µg/mL 10 µg/mL 15 µg/mL 18 µg/mL
27 µg/mL Explanation: Phenytoin plasma levels between 10 and 20 µg/mL give optimal anticonvulsant effect. However, many clients achieve seizure control at lower serum concentration levels. Levels greater than 20 µg/mL are associated with toxicity.
A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions? A client receiving pregabalin who is not responsive to verbal stimuli A client who will be discharged on carbamazepine and who requires education A client being treated with phenobarbital whose blood pressure is 106/69 mmHg A client who is anxious about undergoing electroencephalography to investigate a recent absence seizure
A client receiving pregabalin who is not responsive to verbal stimuli Explanation: A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice. The client with a blood pressure of 106/69 may require further monitoring and possible interventions, but this blood pressure is not so low as to be considered an emergency. Addressing clients' learning needs and anxiety is also important, but less time dependent than a client who is not rousable
An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Advise the client that these are normal reactions to the medication and he should continue the medication as ordered. Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Advise the client to decrease the dose because the client is getting too much of the medication. Advise the client to double the dose for 24 hours because the client is experiencing the symptoms of drug withdrawal.
Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Explanation: Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level.
A nurse is caring for a patient who is going to take ethosuximide. During the nurse's initial assessment, the nurse learns that the patient's history includes hepatitis. Which laboratory test should be done before therapy is started? Blood glucose level Blood urea nitrogen (BUN) Alanine aminotransferase (ALT) Partial thromboplastin time (PTT)
Alanine aminotransferase (ALT) Explanation: Because an adverse effect of ethosuximide can be liver function impairment, a baseline liver function study that includes the ALT should be done prior to starting ethosuximide. Baseline values will help the nurse determine if the drug is causing the abnormal values, and liver function studies will need to continue throughout the therapy. Blood glucose level would determine the glucose level in the blood. BUN would help determine urinary function. PTT is a test to assess the intrinsic system, which is the common pathway of clot formation in the blood. While these tests are important, they do not have a direct relationship to ethosuximide use.
A client has been prescribed valproic acid for the treatment of myoclonic seizures. When reviewing this client's latest laboratory results for signs of adverse effects, what results should the nurse prioritize? Liver enzymes Electrolytes White cell differential Creatinine clearance
Liver enzymes Explanation: Valproic acid is associated with liver toxicity, more so than leukopenia, renal damage or electrolyte disturbances.
A 25-year-old client takes ethosuximide for the treatment of absence seizures calls the clinic to report that she has developed a sore throat and a slight fever. The nurse will explain that she should come to the clinic to have what checked? Ethosuximide serum level Bleeding tendencies Blood cell count Pulse and blood pressure
Blood cell count Explanation: If clients who take ethosuximide develop signs of infection such as a sore throat and fever, blood cell counts should be checked. Periodic urinalysis and liver function studies will help to identify any early complications that might occur from the drug therapy. The drug serum level, bleeding tendencies, and pulse and blood pressure are not used in early identification of infection.
A nurse is treating a patient who is receiving carbamazepine for a seizure disorder. The nurse knows that carbamazepine is contraindicated in patients with which diseases or disorders? Bone marrow depression Bipolar disorder Allergy to sulfonamides Diabetes
Bone marrow depression Explanation: Carbamazepine is contraindicated in patients with previous bone marrow depression.
A client is diagnosed with trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder? Phenobarbital Carbamazepine Fosphenytoin Ethosuximide
Carbamazepine Explanation: Carbamazepine is prescribed to treat trigeminal neuralgia. Neither phenobarbital, fosphenytoin, nor ethosuximide is administered for trigeminal neuralgia.
A client in the clinic with a history of epilepsy has just tested positive for pregnancy. What is the nurse's next action? Advise the client to continue her current medication for epilepsy. Discuss the most serious birth defects that may occur due to treating epilepsy during pregnancy. Consult with the primary health care provider. Explain how to taper off her seizure medication as the risk for seizures decreases during pregnancy.
Consult with the primary health care provider. Explanation: The nurse should first consult with the primary health care provider. Research suggests an association between (a) the use of anticonvulsants by pregnant women with epilepsy and (b) an increased incidence of birth defects. The use of anticonvulsants is not discontinued in pregnant women with a history of major seizures because of the danger of precipitating status epilepticus. However, when seizure activity poses no serious threat to the pregnant woman, the primary health care provider may consider discontinuing use of the drug during pregnancy.
A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care? Take this medication with food to prevent nausea and vomiting. A mild headache may occur while taking this medication. Contact the health care provider immediately if rash appears. Seek assistance when walking if dizziness occurs.
Contact the health care provider immediately if rash appears. Explanation: GI upset, headache, rash, and dizziness are all adverse reactions of lamotrigine. The most important teaching point to emphasize is to notify the health care provider if a rash appears. A rash can develop into a Stevens-Johnson syndrome rash, a severe and potentially fatal rash.
What should the nurse include as a possible adverse effect when teaching a client about phenytoin? Liver toxicity Diarrhea Increased white blood cell count Physical dependence
Liver toxicity Explanation: Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.
What medication may be administered intravenously (IV) to assist in reducing status epilepticus seizure activity? Diazepam Ethosuximide Insulin Meperidine
Diazepam Explanation: IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Ethosuximide is prescribed for absence seizures, myoclonic seizures, and akinetic epilepsy. Neither meperidine nor insulin is administered for status epilepticus.
The nurse is reviewing the results of a hospital client's serum phenytoin level, which has just become available. The results indicate that the client's phenytoin level is 17.5 mcg/mL. What is the nurse's best action? Document the fact that the nurse checked the client's phenytoin levels Contact the care provider to communicate this result Raise the client's bed rails and maintain the client on bed rest Perform a focused neurological assessment
Document the fact that the nurse checked the client's phenytoin levels Explanation: The therapeutic range is 10 to 20 mcg/mL. Consequently, there is no action needed beyond documentation.
A child suffers from absence seizures. What is the drug of choice for absence seizures? Phenytoin Carbamazepine Fosphenytoin Ethosuximide
Ethosuximide Explanation: Ethosuximide is the drug of choice for absence seizures. Phenytoin and fosphenytoin are not recommended for absence seizures. Carbamazepine is typically prescribed for generalized tonic-clonic and mixed seizures.
A client diagnosed with a seizure disorder has had a recent change in medication. What assessment(s) should the nurse perform in order to evaluate the effectiveness of the new drug? Select all that apply. Evaluate the client's bowel pattern. Evaluate laboratory drug level. Assess for adverse effects. Assess for change in seizure activity. Assess for changes in mood.
Evaluate laboratory drug level. Assess for adverse effects. Assess for change in seizure activity. Explanation: The nurse should interview and assess for any change in seizure activity; interview and assess for the avoidance of adverse drug effects, especially those that impair safety; when available, check laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. Mood and bowel patterns are unlikely to be affected, and neither parameter suggests success or failure of treatment.
The nurse is caring for an 84-year-old client who is taking an AED and recognizes that this client is at increased risk for which condition? Falls Seizure activity Cardiac dysfunction Renal dysfunction
Falls Explanation: In older adults, decreased elimination by the liver and kidneys may lead to drug accumulation, with subsequent risks of dizziness, impaired coordination, and injuries due to falls.
A client is receiving a hydantoin as treatment for tonic-clonic seizures. The nurse includes a discussion of what when teaching the client about this drug? Possible leukocytosis Physical dependence Withdrawal syndrome Gingival hyperplasia
Gingival hyperplasia Explanation: Hydantoins may cause gingival hyperplasia, severe liver toxicity, and bone marrow suppression. Physical dependence and withdrawal syndrome are associated with benzodiazepines.
The nurse is formulating a care plan for a client with a seizure disorder. Which intervention would be an appropriate for the nurse to include? Informing the client and family that unrealistic expectations can occur Informing the client and family that seizure control is not gained immediately Informing the client and family that seizure control is gained immediately Informing the client and family that excessive frustration is to be expected
Informing the client and family that seizure control is not gained immediately Explanation: The nurse should inform the client and family that seizure control is not gained immediately when drug therapy is started. The goal is to avoid unrealistic expectations and excessive frustration while drugs and dosages are being changed in an effort to determine the best regimen for the client.
What best reflects the action of barbiturates when used to control seizures? Inhibition of impulse conduction Stimulation of the cerebral cortex Enhancement of cerebellar functioning Stimulation of motor nerve output
Inhibition of impulse conduction Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex, depress cerebellar functioning, and depress motor nerve output.
A primary health care provider has prescribed phenytoin parenterally for a client experiencing seizures. The nurse prepares to administer this drug via which route? Intradermally Subcutaneously Intramuscularly Intravenously
Intravenously Explanation: Phenytoin can be administered orally and parenterally. If the drug is administered parenterally, the intravenous (IV) route is preferred over the intramuscular (IM) route because, with the IM route, erratic absorption of phenytoin causes pain and muscle damage at the injection site. The drug is not administered intradermally or subcutaneously.
The nurse examines reviews the medical administration record and notes the medication lamotrigine needs to be administered. The client has developed a red scaly rash with fluid-filled blisters and purpuric areas all over the client's body. Which action(s) should the nurse take? Select all that apply. Notify the primary care provider immediately. Assess vital signs. Administer the dose of lamotrigine. Document the skin assessment. Cleanse affected areas with soap and water.
Notify the primary care provider immediately. Assess vital signs. Document the skin assessment. Explanation: The nurse observes that the client is exhibiting a severe hypersensitivity rash that is potentially fatal, called Stevens-Johnsons Syndrome, and must notify the health care provider (HCP) immediately, and hold the dose of lamotrigine awaiting orders from the PCP. The nurse should assess vital signs for signs and symptoms of infection, which may occur from bacteria entering large areas of compromised skin. The nurse should document the skin assessment and the actions taken, including holding the drug and calling the primary care provider immediately. The nurse should not cleanse the skin with soap and water because the soap will dry out the skin leading to further breakdown.
A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug? Observe respirations frequently. Monitor blood glucose levels. Monitor body temperature. Record fluid input and output.
Observe respirations frequently. Explanation: When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently. The nurse need not monitor blood glucose levels or body temperature. The nurse need not record fluid input and output. The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant.
A nurse is preparing to administer an anticonvulsant that produces its effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Which medication would the nurse administer? Phenytoin Valproic acid Ethosuximide Lorazepam
Phenytoin Explanation: Hydantoins like phenytoin elicit their effects by stabilizing the hyperexcitability postsynaptically in the motor cortex of the brain. Valproic acid increases the levels of GABA to help stabilize the membranes. Ethosuximide depresses the motor cortex, creating a higher threshold before the nerves react to the convulsive stimulus. Lorazepam elevates the seizure threshold by decreasing postsynaptic excitation.
A 15-year-old is observed having a tonic-clonic seizure at school. Which behavior would allow the school nurse to recognize the clonic phase of the seizure? A sustained contraction of the skeletal muscles Abnormal posturing Rapid rhythmic and symmetric jerking movements Loss of consciousness
Rapid rhythmic and symmetric jerking movements Explanation: The tonic phase of a tonic-clonic seizure involves sustained contraction of skeletal muscles, abnormal postures, and absence of respiration. The clonic phase of the seizure is characterized by rapid rhythmic and symmetric jerking movements of the body.
A nurse is preparing to administer carbamazepine to a client. The nurse should question the health care provider about this order if which disorder is noted in the client's history? Bipolar disorder Renal impairment Hearing impairment Respiratory depression
Renal impairment Explanation: Carbamazepine is contraindicated among clients with renal impairment. It can be prescribed to treat bipolar disorder. The drug is not contraindicated in clients with hearing impairment or respiratory depression. Hearing impairment is an adverse reaction to quinidine. Barbiturates, sedatives, and hypnotics can depress the respiratory system as an adverse reaction.
A client with seizures presents for follow-up after being prescribed lamotrigine. Which finding(s) on assessment should the nurse prioritize? Select all that apply. Reports of muscle pain Lesions on the mucous membranes Blisters on the face and neck Recurrence of seizure activity Dizziness
Reports of muscle pain Lesions on the mucous membranes Blisters on the face and neck Explanation: This client is at risk of developing Stevens-Johnson syndrome (SJS). SJS is manifested by fever; cough; muscular aches and pains; headache; and lesions of the skin, mucous membranes, and eyes. The lesions appear as red wheals or blisters, often starting on the face; in the mouth; or on the lips, neck, and extremities. Recurrence of seizure activity and dizziness are not associated with this condition. The recurrence of seizure activity would indicate either the dose needs to be increased or a different antiepileptic needs to be tried. Dizziness is a sign of toxicity.
An older adult client experiencing seizures is prescribed diazepam. Which assessment should the nurse prioritize? Respiratory rate and depth Blood glucose levels Swallowing ability Speech quality
Respiratory rate and depth Explanation: Apnea and cardiac arrest can occur when diazepam is administered to older adults, very ill clients, and individuals with limited pulmonary reserve. Therefore, monitoring the client's respiratory rate and depth would be most important. If the client is prescribed diazepam and antidiabetic medications, there may be an increase in the blood glucose level. The nurse should test the client's swallowing ability by offering sips of water before giving the drug. If there is difficulty swallowing, hold the drug and contact the health care provider as soon as possible. Slurred speech is an adverse reaction of hydantoins. It is also a potential sign of toxicity; however, the most important would be to determine the respiratory status and if that is functioning within reasonable parameters, then address the toxicity issue, if present.
The nurse is participating in the care of a client in status epilepticus who is receiving phenobarbital IV. Which nursing diagnosis should the nurse prioritize during this client's current care? Risk for injury related to seizure activity Acute confusion related to seizure activity and drug effects Disturbed thought processes related to seizure activity Disturbed sensory perception related to adverse drug effects
Risk for injury related to seizure activity Explanation: Seizures present an acute risk for injury which the nurse must prioritize when caring for the client. Cognitive and/or sensory disruptions are likely as well, but none of these presents such a high risk to the client's safety as the risk for injury.
A patient is prescribed daily doses of phenytoin for seizures. The nurse knows that a single dose should not be missed during the course of treatment. Which condition could result if a dose is missed? CNS depression Hypotension Status epilepticus Nystagmus
Status epilepticus Explanation: Status epilepticus may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.
The nurse is teaching a client who has been started on antiseizure medications. The nurse should inform the client that abrupt withdrawal from the medications can cause which problem? Hypertensive crisis Cardiac arrhythmia Respiratory arrest Status epilepticus
Status epilepticus Explanation: In clients receiving drug treatment for seizure disorders, the most common cause of status epilepticus is abruptly stopping antiseizure drugs. Stopping antiseizure medications does not cause hypertensive crisis, respiratory arrest or cardiac arrhythmias.
A patient with partial seizures has been prescribed succinimides at a health care facility. The patient experiences GI upset after succinimides administration. What should the nurse instruct the patient to do? Take the drug once only at bedtime. Take the drugs before meals. Take the drug with food or milk.
Take the drug with food or milk. Explanation: If the patient experiences GI upset after succinimides administration, the nurse should instruct the patient to take the drug with food or milk. The nurse need not instruct the patient to take the drug once only at bedtime, before meals, nor avoid taking fruit juice.
A client is prescribed topiramate. The nurse cautions the client to avoid the intake of alcohol for which reason? The client is at risk for increased CNS depression. A disulfiram-like reaction can occur. The client's risk for dependence is increased. The combination may lead to a hypertensive crisis.
The client is at risk for increased CNS depression. Explanation: Combining alcohol with topiramate increases the client's risk for CNS depression. Topiramate combined with alcohol does not result in a disulfiram-like reaction. Drug dependency is not associated with the use of topiramate and alcohol. The combination of topiramate and alcohol is not associated with the development of a hypertensive crisis.
The nurse is preparing to administer the next dose of methsuximide to a client experiencing partial seizures. The client remarks about hoping their stomach will do better this time. Which suggestion from the nurse will best assist this client when administering this next dose? Daily at bedtime Immediately before eating a meal With some food or milk First thing in the morning on arising
With some food or milk Explanation: If the client experiences GI upset after succinimide administration, the nurse should instruct the client to take the drug with food or milk. The nurse need not instruct the client to take the drug once only at bedtime, before meals, or immediately on arising in the morning.
In a person being treated for a diagnosed seizure disorder, what is the most common cause of status epilepticus? abusing drugs and/or alcohol abruptly stopping the antiseizure medications hypoxia-inducing experience experiencing a brain injury
abruptly stopping the antiseizure medications Explanation: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. In other clients, regardless of whether they have a diagnosed seizure disorder, causes of status epilepticus include brain trauma or tumors, systemic or central nervous system (CNS) infections, alcohol withdrawal, and overdoses of drugs (e.g., cocaine, theophylline).
What is the primary medication prescribed to relieve pain associated with shingles? meperidine morphine sulfate naproxen sodium gabapentin
gabapentin Explanation: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.
What herbal supplement should a client being treated for tonic-clonic seizures with phenytoin specifically avoid? evening primrose ginger ginkgo feverfew
ginkgo Explanation: Clients being treated with divalproex or phenytoin should be advised not to use ginkgo because it may lower the medication's effectiveness. Clients being treated for epilepsy should be advised not to use the herb evening primrose because it increases the risk of having seizures. Neither of the other options are known to affect phenytoin's effectiveness.
A nurse is caring for a client with trigeminal neuralgia at a health care facility. The health care provider has prescribed carbamazepine. In which case is the use of carbamazepine contraindicated in clients with: nervous breakdown. renal impairment. hearing impairment. respiratory depression.
renal impairment. Explanation: The nurse should know that carbamazepine is contraindicated among clients with renal impairment. Carbamazepine is not contraindicated in those with nervous breakdown, hearing impairment, and respiratory depression.
The nurse is caring for a 26-year-old client with partial seizures and has been prescribed oxcarbazepine as monotherapy. It will be critical for the nurse to inform the client of which needed action? the client should allow for periods of rest during the day. since she is taking oral contraceptives, she will need to use an additional form of birth control. she must have an eye exam at least every other month during oxcarbazepine therapy. GI problems are to be expected.
since she is taking oral contraceptives, she will need to use an additional form of birth control. Explanation: Oxcarbazepine causes the circulating levels of oral contraceptives to decrease by up to half. The nurse should teach the client that she will need to use an additional form of birth control. Fatigue may be a concern, and the client should allow for rest periods during the day. Diplopia and abnormal vision can be adverse effects of the drug and eye exams should be part of the client's treatment regimen but they are not needed every other month. Informing the client that GI problems are common adverse effects is important but not as critical as preventing an unplanned pregnancy.
What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? status epilepticus akinetic motor febrile
status epilepticus Explanation: Status epilepticus is a life-threatening emergency characterized by generalized tonic-clonic convulsions lasting for several minutes or occurring at close intervals during which the client does not regain consciousness. None of the other options present with this described experience.
An adolescent taking oral contraceptives has been prescribed an anticonvulsant medication. The nurse should tell the client to do which? use another form of birth control, such as condoms. watch for signs of hyperglycemia, such as increased thirst, hunger, and urination. be aware that these two drugs will interact and increase seizure activity initially. stop driving due to the increased depressant effects and excessive drowsiness.
use another form of birth control, such as condoms. Explanation: Anticonvulsants and oral contraceptives interact, leading to decreased effectiveness of birth control. This can result in breakthrough bleeding or unintended pregnancy. Anticonvulsants and antidiabetic medications interact, resulting in increased blood glucose levels. Anticonvulsants and antiseizure medications taken together may increase seizure activity. Anticonvulsants interact with analgesics and alcohol, not oral contraceptives, to cause increased depressant effects.