Ch. 25 Drug Therapy for Seizures
What solution must you use when administering phenytoin Dilantin via the IV route?
0.9 normal saline
Epilepsy
A disorder of the brain that causes recurrent unprovoked seizures.
Generalized seizure
A seizure that involves most or all of the brain caused by electrical discharges originating from both sides of the brain.
Partial seizure
A seizure that starts in one part of the brain. the abnormal electrical activity may remain confined to one area or spread to the entire brain also called a focal or local seizure.
which type of seizure is common in children?
Absence
Second line drugs for seizures
Alternative drugs used for treatment of seizures
Before giving an anti seizure drug
Always get a complete list of drugs patient is taking Check baseline vitals, level of consciousness and gait. ask patient to describe nature of his or her seizures find out if aura occurs before each seizure ask patient to describe it and to notify healthcare providers if they sense one may occur.
Common seizure causing drug
Antidepressant Bupropion alcohol Cocaine and other street drugs Excessive doses of antiseizure drugs Oral contraceptives Phenothiazines Theophylline
Taking Dilantin phenytoin during pregnancy increases the risk of children born with
Cleft palate also Fetal hydantoin syndrome is a rare disorder caused by fetal exposure to phenytoin Dilantan symptoms include facial/skull abnormalties growth deficiencies underdeveloped nails and/or mild developmental delays
Only use normal saline with
Dilantin phenytoin because this drug precipitates forms solid particles due to chemical imcompatibility with dextrose solutions.
Dilantin phenytoin may cause
Diplopia double vision Nystagmus rapid involuntary eye movement Hypotention Gingival hyperplasia excessive growth of gum tissue Hypertrichosis excessive growth of hair in areas no normally hairy Rashes and can also lead to Stevens johnson syndrome a serious life threatening body wide systemic allergic reaction with a rash involving burn like sores on the skin and mucous membranes.
What are 3 common side effects of clonazepam Klonopin
Dizziness sedation, weakness
What are 3 common side effects of gabapentin Neurontin
Drowsiness, fatigue, dizziness, swelling in ankles, weight gain
The nurse is caring for a patient with a diagnosis of idiopathic (no known cause) seizures. What are some factors associated with this type of seizures?
Family history of seizures present
What are the most common causes of seizures in children?
Fever Central nervous system infections Hypoxia Electrolyte imbalances
Common causes for seizures in kids
Fever, head injury CNS infection hypoxia electrolyte imbalances
Depakote Depacon valproic acid & Dilantin phenytoin often cause
GI symptoms such as indigestion nausea and vomiting. prolonged bleeding time*
A newly admitted patient has just been diagnosed with seizures and asks the nurse what can cause them. The nurse tells the patient that during what times is a person with a seizure disorder most at risk for having a seizure?
Going through a divorce During pregnancy After pulling an "all-nighter" While having the flu When a person has a seizure disorder, seizures are more likely to occur during periods of increased emotional or physical stress. Risk factors associated with worsening of a well-controlled seizure disorder include pregnancy and lack of sleep, not sleeping soundly.
For most adults the most common causes of seizures are
Head injury Stroke Tumor
valproic acid Depakote can cause which serious adverse effect
Hepatotoxicity
Serious adverse effects of Depakote Depacon valproic acid include
Hepatotoxicity- liver damage Pancreatitis- inflammation of the pancreas
The nurse is discharging a patient who has been prescribed lamotrigine (Lamictal). What does the nurse tell the patient to do in order to minimize the risk of severe rashes?
Increasing the dose very slowly over 6 to 7 weeks
A seizure patient is being treated with phenobarbital (Luminal). What life-threatening adverse effects are associated with the use of this drug?
Laryngospasm Shock Neutropenia Serum sickness
Life threatening adverse effects of Phenobarbital
Laryngospasm- closure of the larynx which blocks the air to the lungs Shock circulatory collapse Neutropenia decreased number of WBCs additional adverse effects include respiratory depression CNS depression coma & death when high does are prescribed. swelling similar to that seen in urticaria hives can occur beneath the skin instead of on the surface. Angioedema- deep swelling around the eyes lips sometimes hands and feet hypersensitive reaction to the administration of a foreign serum serum sickness which is characterized by fever swelling skin rash and enlargement of lymph nodes.
2nd line alternative drugs for seizures increase the body's threshold against seizure activity by blocking or slowing the spread of abnormal impulses.
Luminal phenobarbital Mysoline primidone Neurontin gabapentin Lamictal lamotrigine Klonopin clonazepam Lyrica pregabalin
which adverse effects must you watch for after giving a patient phenytoin dilantin
Neutropenia Stevens-Johnson syndrome Aplastic anemia
Adverse effects of both Tegretol carbamazepine and Dilantin phenytoin include
Neutropenia a decrease in the number of white blood cells with sore throat fever and chills are at risk for life threatening infections and Aplastic anemia anemia caused by not enough RBCs to carry oxygen to the tissues and cells too few red blood cells produced by bone marrow
Adverse Effects of Zarontin ethosuximide include
Neutropenia-decrease in the number of WBCs Pancytopenia- reduction in the number of erythrocytes all types of WBCs and blood platelets in the circulating blood Aplastic anemia- anemia caused by deficient RBC production in the bone marrow
The nurse is admitting a patient who has been taking phenytoin (Dilantin). What side effects and adverse effects of phenytoin (Dilantin) could be found in a patient on the nurse's physical assessment?
Overgrowth of gum tissues Severe skin rashes Double vision
what 2 drugs may become habit forming
Phenobarbital Luminal and clonazepam Klonopin
A patient was just brought in by ambulance to the emergency department (ED) after having several seizures at home. What actions should be taken if the patient experiences status epilepticus?
Protect the airway and apply oxygen Establish an IV as ordered. Administer diazepam (Valium) as prescribed. Protect the patient from injury.
A patient with a history of seizures has just been admitted. What actions should you take if the patient experiences a tonic-clonic seizure?
Protect the airway. Document the length and time the seizure started. Protect the patient from injury.
Two major partial seizures
Simple partial seizure Complex partial seizures
Epileptic cry
Spasm of the respiratory muscles cause forced exhalation sounding like a scream
A patient has a seizure that lasts longer than 30 minutes this situation is recognized as what kind of seizure?
Status epilepicus
Adverse Effects of Lamictal lamotrigine can lead to
Stevens Johnson syndrome a life threatening body wide or systemic allergic reaction with a rash involving the skin and mucous membranes can also lead to toxic epidermal necrolysis a life threatening skin disorder characterized by blistering and peeling of the top layer of skin
Teachings about anti-seizure drugs
Suddenly stopping an anti-seizure drug may cause seizures to occur. these drugs can cause dizziness or drowsiness alcohol increases it. avoid driving or operating machinery get out of bed slowly suggest that patient wears a medical alert bracelet
A patient who is taking antiseizure medications develops GI symptoms. What would you suggest to the patient?
Take drugs with food
which drug used to treat seizures decreases impulse transmission by affecting sodium channels in neurons
Tegretol carbamazepine
The nurse is obtaining a list of home medications for a patient who will be taking phenytoin Dilantin and an anticoagulant what is the possible interaction between these 2 drugs
The patient is at a higher risk for bleeding
Tegretol Carbamax carbamzepine can cause
Thrombocytopenia- low platelet count risk for severe bleeding passes into breast milk
6 types of generalized seizures
Tonic clonic or grand mal Tonic Atonic Absence Petit mal Myoclonic Clonic
The nurse is caring for a patient admitted with a diagnosis of seizures. The nurse knows that an "epileptic cry" is common with what type of seizure?
Tonic-clonic
primidone Mysoline
Turns into phenobarbital in the body and blocks or slows the spread of abnormal electrical impulses
Seizure
Uncontrolled electrical activity in the brain that may produce a physical convulsion minor physical signs thought disturbances or a combination of symptoms
A patient with a history of seizures has just had abdominal surgery. The nurse knows that what antiseizure medication may affect wound healing?
Valproic acid (Depakote
A patient is taking carbamazepine Tegretol what must you be sure to teach the patient about the drug?
Wear protective clothing and a strong sunscreen
First line drugs for Absence seizures
Zarontin ethosuximide Depakote valproic acid
seizure disorder
a pathologic condition resulting in a sudden episode of uncontrolled electrical activity in the brain.
Status Epilepticus
a prolonged seizure usually defined as lasting longer than 30 minutes or a series of repeated seizures a continuous state of seizure activity that may occur in almost any seizure type. rapid recognition and treatment are essential to prevent brain damage
Assess older adults who have been prescribed first line drugs for partial or generalized seizures for
abnormal heart rhythms and chest pain they are more sensitive to the effects of these drugs
clonazepam klonopin
action not well understood but most likely slows or stops tranmission of abnormal electrical impulses
Postictal phase
after the seizure phase often characterized by confusion headache sore muscles and fatigue
primidone Mysoline decreases the effects of
anticoagulant drugs so higher doses of an anticoagulant may be needed to achieve therapeutic effects
Clonic seizures
are characterized by muscle contraction and relaxation patients may bite their tongue or become incontinent
Adverse Effects of Clonazepam it is a
benzodiazepine CNS drug with the life threatening adverse reaction of respiratory depression.
phenobarbital Luminal
blocks or slows the spread of abnormal electrical impulses
Drugs for partial and generalized seizures Tegretol carbamazepine Depakote Depacon valproic acid Dilantin phenytoin
can increase the effects of anticoagulant watch for abnormal bleeding. can interfere with the effects of birth control have high likelihood of birth defects
Common first line drugs for partial and generalized seizures Tegretol
carbamazepine
A patient with a new diagnosis of seizures asks the nurse what medications are considered first-line drugs for partial and generalized seizures?
carbamazepine (Tegretol) phenytoin (Dilantin) valproic acid (Depakote)
After giving drugs for partial & generalized seizures
check gait remind them about importance of frequent and careful mouth care if GI symptoms develop give these drugs with food. Remind to drink plenty of water these drugs will dry mouth and increase urine excretion watch for signs of abnormal bleeding
common second line drugs for seizures Klonopin
clonazepam
What characterizes the period following a seizure aka postictal phase of a seizure
confusion lethargy decreased responsiveness
gabapentin Neurontin is often used to
control pain from chronic neuropathy and fibromyalgia
Zarontin ethosuximide
depresses the motor cortex and increases the CNS threshold to stimuli
Depakote valproic acid during pregnancy has been associated with
developmental defects, low IQ, birth defects, congenital anomalies and damage to infants liver this drug also passes into breast milk
a health care facility should plan to have which drug immediately available in the event a patient expreiences status epilepticus?
diazepam Valium
A patient taking phenytoin should be instructed to call the prescriber immediately if they develop what condition
difficulty coordinating movements
common side effects of 1st line drugs for generalized and partial seizures
dizziness loss of coordination drowsiness/sedation nausea vomiting hypotension phenytoin also may cause double vision nystagmus rap
diplopia
double vision
First line drugs for Absence Seizures Zarontin
ethosuximide
gingival hyperplasia
excessive growth of gum tissue
A seizure results from
excessive or disordered electrical activity in the brain
Phenobarbital and clonazepam may become habit forming and should only be taken
for the period of time prescribed
common second line drugs for seizures Neurotin
gabapentin
Actions of 2nd line or alternative drugs for seizures
gabapentin Neurontin & lamotrigine Lamictal stabilize the membranes of neurons to decrease seizure activity. the action of clonazepam Klonopin is not well understood but may be related to inhibition slowing or stopping of transmission of abnormal impulses. pregabalin Lyrica is used to decrease the frequency of partial seizures
Before giving 2nd line drugs for seizures be sure to schedule at least 2 hours between
gabapentin Neurontin and antacid drugs because antacids can decrease absorption of this drug
what can the nurse do to reduce nausea and vomiting in patient who is taking carbamazepine Tegretol
give med with food
Remind patients taking ANY anti-seizure drug to avoid
grapefruit and grapefruit because they increase the action of the drug and can lead to more side effects or adverse effects.
Safe use of Zarontin ethosuximide in children under 3 years old
has not been established
What conditions can cause seizures
head injury stroke tumor
which are essential aspects of care for a patient who is experiencing a tonic clonic seizure
help person to the floor loosen clothing around the neck remove any sharp objects
Tonic Seizures
include sudden increase in muscle tone loss of consciousness and autonomic signs such as rapid heart rate sweating pupil dilation flushing and loss of bowel function and bladder control for 30 seconds to several minutes. after patients are usually lethargic for an hr or more.
Sudden withdrawl of pregabalin can
increase the frequency of seizure activity drug should be gradually withdrawn over a week.
When gabapentin Neurontin is prescribed for a patient who is taking Morphine duramorph
increased levels of gabapentin can occur possibly leading to toxicity so lower dose or gabapentin morphine or both may be required
Possible consequences of exposure to phenytoin Dilantin during pregnancy
increased risk for cleft palate growth deficiencies skull abnormalities
nystagmus
involuntary movements of the eyes
Myoclonic Seizure
involves brief jerking or stiffening of the extremities that last a few seconds may involve one or more extremities and the jerking contractions may be asymmetric stronger on one side of the body or symmetric or the same on both sides of the body typically a sudden loss of muscle tone for a few seconds followed by Postictal or after seizure confusion.
A patient tells the nurse that he/she has absence seizure. The nurse knows that what occurrence is normal with this type of seizure?
it only last a few seconds
Common second line drugs for seizures Lamictal
lamotrigine
Children have higher incidence of rashes with
lamotrigine gabapentin may cause fever hyperactivity and hostile or aggressive behavior.
Tonic clonic or grand mal seizures
last 2 to 5 minutes with stiffening or rigidity of the arm and leg muscles and immediate loss of consciousness.
The disadvantage is phenobarbital Luminalis that it can
lead to physical dependence primidone Mysoline is turned into phenobarbital Luminal by the body and acts in the same way.
Children younger than 2 years of age are at increased risk for
liver damage Hepatotoxicity that may lead to death with Depakote valproic acid
Ataxia
loss of coordination clumsiness
thrombocytopenia
low platelet count
neutropenia or leukopenia
low white blood cell count
When seizure drugs are prescribed together
lower doses may be needed
Absence or petit mal seizures
more common in children and tent to occur in families are brief a few seconds with loss of consciousness and blank staring a child may appear to be daydreaming after the child returns to normal immediately.
Complex partial seizures
patients lost consciousness for 1 to 3 minutes may have automatisms automatic unconscious actions such as lip smacking patting or picking at clothes & often experience amnesia after seizure.
Common second line drugs for seizures Luminal
phenobarbital
Common first line drugs for partial & generalized seizures Dilantin
phenytoin
common second line drugs for seizures Mysoline
primidone
Older adults may develop unusual restlessness or excitement with
primidone. lamotrigine and gabapentin are more slowly eliminated from older adults
Tell patients with diabetes that gabapentin Neurontin may affect a dipstick test for
protein in urine or Proteinuria
A patient taking valproic acid Depakote has developed a nosebleed and bruises resulting from very minor injuries this patient may be developing which adverse effect?
reduced platelet count
A person with repeated seizures has a
seizure disorder sometimes called epilepsy. about 2 million people in the U.S have this brain disorder and 10% of american s will experience a seizure sometime during their lives Most of them 60% never experience another seizure.
gabapentin Neurontin
stabilizes the membranes of neurons to decrease seizure activity
Aura
strange sensations such as tingling smell or emotional changes that occur before a seizure.
First line drugs for seizures
the exact action of first line drugs for partial or generalized seizures is not known but these drugs causes a decrease in the voltage frequency and spread of electrical impulses within the motor cortex of the brain which leads to decreased seizure activity.
Simple partial seizures
the patient remains conscious before the seizure the patient may report an aura. One sided movement of an extremity unusual sensations or autonomic changes heart rate, flushing, epigastric discomfort may occur.
If patient develops a rash hold the drug and notify the prescriber immediately
to minimize the risk of sever rashes the dose of Lamictal lamotrigine can be increased very slowly over 6 to 7 weeks. when taking this drug skin rash can be the 1st sign of Stevens Johnson syndrome or toxic epidermal necrolysis
First line drugs for absence seizure and partial & generalized seizures Depakote Depacon
valproic acid
common first line drugs for partial & generalized seizures Depakote,Depacon
valproic acid
What 1st line drug used for partial or generalized seizures increases the availability of the neurotransmitter GABA?
valproic acid Depakote
Drug actions for partial & generalized seizures drugs
valproic acid Depakote, Depacon- The action may be related to increased availability of the neurotransmitter GABA gamma aminobutyric acid. carbamazepine Tegretol- decreases impulse transmission by affecting sodium channels in neurons phenytoin Dilantin- Changes ion transport but exact action is not known
Zarontin ethosuximide can make the eyes more sensitive to light. Instruct patient to protect eyes by
wearing dark glasses in bright light
