Chapter 15: Drugs for Seizures
A pregnant patient with no history of epilepsy or a seizure disorder is treated after having a seizure. For which health problem should the nurse assess this patient? a) Meningitis b) Hypoxia c) Brain tumor d) Eclampsia
d) Eclampsia
A patient recovering from an infection-induced seizure asks how a person "gets" epilepsy. Which response should the nurse make? a) "Epilepsy has one known specific cause." b) "Epilepsy is caused by hypernatremia." "c) Epileptic seizures are often symptoms of an underlying disease." d) "Epilepsy occurs in individuals with hyperglycemia."
"c) Epileptic seizures are often symptoms of an underlying disease." Epileptic seizures are symptoms of an underlying disorder. It is important to identify the cause of the seizure activity. Over 50% of seizures have no specific cause identified. Hypoglycemia and hyponatremia alter electrical impulse transmission and may cause seizures.
The nurse teaches a patient about a prescribed antiepileptic drug. Which patient statement indicates the need for additional teaching? a) "If I miss a dose, I can take a double dose the next time." b) "I should report any adverse effects I am experiencing to my healthcare provider." c) "I should take my medication at the same time every day." d) "If it causes my stomach to be upset, I can take my medication with food."
a) "If I miss a dose, I can take a double dose the next time."
A patient has multiple seizures with mixed patterns of activity and recovery. Which medication should the nurse anticipate being prescribed for this patient? a) Carbamazepine (Tegretol) b) Phenytoin (Dilantin) c) Methsuximide (Celontin) d) Fosphenytoin (Cerebyx)
a) Carbamazepine (Tegretol) Carbamazepine has become one of the most widely used AEDs in the world. It is indicated for the management of generalizedtonic-clonic seizures, for partial seizures with complex symptomatology, and for mixed seizure patterns. It is ineffective against absence seizures. Methsuximide, a succinimide, is indicated for treating absence seizures. Phenytoin and fosphenytoin are first-line drugs in the treatment of status epilepticus.
A patient has a new onset of a seizure disorder. Which step should the nurse take first when assessing this patient? a) Identify the cause of the seizure. b) Monitor for seizure activity. c) Start antiepileptic drug therapy. d) Teach strict medication adherence.
a) Identify the cause of the seizure. The first step to take with seizure activity is to identify the cause. Monitoring for seizure activity is not the first step. Antiepileptic drug therapy depends upon the reason for the seizures. Teaching about medication adherence is important, but it is not the first step.
An older patient newly diagnosed with a seizure disorder is prescribed an antiepileptic drug (AED). Which laboratory test result should the nurse monitor while the patient is taking this medication? a) Liver and kidney function b) Prothrombin time (PT)/international normalized ratio (INR) c) Urinalysis d) Hemoglobin and hematocrit
a) Liver and kidney function In the older patient, multiple medications can cause impaired kidney and liver function. This may result in toxic levels of the antiepileptic drug (AED). Kidney and liver function should be monitored regularly. Monitoring urinalysis, PT/INR, and hemoglobin and hematocrit are not necessary.
A patient taking phenytoin (Dilantin) reports being unable to take the medication at the same time every day. Which effect should the nurse expect? a) Elevation of seizure threshold b) Large changes in serum concentration c) Similar antidepressant effects to tricyclic antidepressants (TCAs) d) Hypertension and cardiovascular collapse
b) Large changes in serum concentration Phenytoin has a narrow therapeutic range, so it must be taken as prescribed and the patient should be instructed on the importance of maintaining a strict schedule for administration to avoid fluctuations in serum drug concentrations. If intravenous phenytoin is administered too quickly, it can result in cardiovascular collapse. Dibenzazepines are chemically similar to TCAs but do not have the antidepressant effect. Phenytoin does not elevate the seizure threshold.
A patient is having repeated seizures without recovery periods.Which type of seizure disorder should the nurse suspect? a) Myoclonic seizures b) Status epilepticus c) Lennox-Gastaut syndrome d) Complex partial seizures
b) Status epilepticus Status epilepticus is a medical emergency. It is characterized by continuous seizure activity which can lead to coma and death. Myoclonic seizures occur without loss of consciousness and last a few seconds. Lennox-Gastaut syndrome is a severe form of epilepsy. Complex partial seizures are associated with movements such as fumbling to remove clothing and no responses to verbal commands.
A patient is taking ethosuximide (Zarontin) for absence seizures. Which adverse effect should the nurse instruct the patient to report while taking this medication? a) Heart block b) Suicidal ideation c) Hypertension d) Diplopia
b) Suicidal ideation Psychosis or extreme mood swings, including depression with suicidal behavior, can occur when taking ethosuximide. Behavioral changes are more prominent in patients with a history of psychiatric illness. Hypertension, diplopia, and heart block are not adverse effects of ethosuximide.
A patient is taking valproic acid for a seizure disorder. Which disorder should the nurse expect this patient to have? a) Febrile seizures b) Tonic-clonic seizures c) Lennox-Gastaut syndrome d) Atonic seizures
c) Lennox-Gastaut syndrome
A patient is prescribed a barbiturate to control seizure activity. For which medication should the nurse prepare teaching for this patient? a) Clonazepam b) Diazepam c) Phenobarbital d) Gabapentin
c) Phenobarbital Phenobarbital is a barbiturate that is used to control seizure activity. Clonazepam and diazepam are benzodiazepines. Gabapetin is categorized as "an other" drug that potentiates gamma-aminobutyric acid (GABA).
The nurse is preparing a presentation on seizure disorders. Which information should the nurse include? a) The term epilepsy is used to describe any seizure activity. b) Tonic-clonic seizures last a few seconds. c) Seizures are caused by abnormal or uncontrolled neuronaldischarges. d) Partial seizures have no aura.
c) Seizures are caused by abnormal or uncontrolled neuronaldischarges. Seizures are caused by abnormal or uncontrolled neuronal discharges. A seizure is used to describe a single occurrence whereas epilepsy is defined as two or more recurring seizures. Tonic-clonic seizures can last up to 2 minutes. An aura precedes a complex partial seizure.
A patient who has been taking an antiepileptic drug (AED) for several years wants to stop taking the medication. Which response should the nurse provide? a) "Your medication can be stopped because you have been seizure free for a year." b) "Your medication can be withdrawn over a 4-week period." c) "Your medication cannot be discontinued. Once you start an antiepileptic medication, you will be on it for the rest of your life." d) "Your medication must be withdrawn slowly over a period of 6 to 12 weeks."
d) "Your medication must be withdrawn slowly over a period of 6 to 12 weeks." Because seizures are likely to occur if AEDs are abruptly withdrawn, the medication is usually discontinued over a period of6 to 12 weeks. The timing to withdraw medication depends upon the patient's status. Medication can be discontinued slowly however it depends upon the patient's status and response to less or no medication to control seizure activity.
The teacher of a school-age patient taking an antiepileptic drug (AED) reports hyperactive behavior in the classroom. Which class of medication should the nurse suspect this patient is taking? a) Succinimide b) Hydantoin c) Benzodiazepine d) Barbiturate
d) Barbiturate Barbiturates can cause hyperactivity in children. Benzodiazepines, succinimides, and hydantoins do not cause hyperactivity in children.
The nurse is assessing a patient taking a benzodiazepine for seizure activity. For which finding should the nurse immediately contact the healthcare provider? a) Lethargy b) Drowsiness c) Ataxia d) Eye pain
d) Eye pain Increased intraoptic pressure that causes eye pain in patients with narrow-angle glaucoma may occur when taking benzodiazepines and should be immediately reported to the healthcare provider. Benzodiazepines can cause lethargy, drowsiness, and ataxia and do not need to be reported to the healthcare provider.
A patient is diagnosed with postherpetic neuralgia. Which antiepileptic drug (AED) should the nurse anticipate being prescribed for this patient? a) Phenytoin (Dilantin) b) Carbamazepine (Tegretol) c) Valproic acid d) Gabapentin (Neurontin)
d) Gabapentin (Neurontin) Gabapentin (Gralise, Horizant, Neurontin) has been used successfully to manage postherpetic neuralgia. Phenytoin (Dilantin), carbamazepine (Tegretol) and valproic acid are not used to treat postherpetic neuralgia.
The nurse is asked to explain the use of phenytoin (Dilantin) to treat seizures. Which information should the nurse include to explain the mechanism of action? a) It depresses the motor cortex by inhibiting the influx of calcium. b) It enhances the action of gamma aminobutyric acid (GABA), which inhibits abnormal neuronal discharges. c) It increases the amount of gamma aminobutyric acid (GABA), which suppresses abnormal neuron discharges. d) It suppresses seizure activity by delaying the influx of sodium.
d) It suppresses seizure activity by delaying the influx of sodium. Phenytoin (Dilantin) suppress seizure activity by delaying the influx of sodium. Ethosuximide (Zarontin) depresses the motor cortex by inhibiting the influx of calcium. Diazepam (Valium) enhances the action of GABA, which suppresses abnormal neuron discharges. Valproic acid (Depacon, Depakene, Depakote) increases GABA production, which suppresses abnormal neuron discharges.
A patient is diagnosed with atonic seizures. For which manifestation should the nurse assess this patient? a) Repetitive movements b) Seizures lasting more than 30 minutes c) Sudden bending forward d) Loss of muscle control and randomly falling
d) Loss of muscle control and randomly falling With atonic seizures, all muscle control and function is lost throughout the body. The patient will stumble and fall for no reason. Status epilepticus is continuous seizure activity which can lead to coma and death. No specific seizure disorder has sudden bending forward as a symptom. Repetitive movements occur with tonic-clonic seizures.
A patient taking an antiepileptic drug (AED) learns of being pregnant. Which adverse effect should be a concern for the nurse? a) Cephalopelvic disproportion b) Placenta previa c) Preterm labor d) Neural tube defect in the fetus
d) Neural tube defect in the fetus When pregnancy occurs, caution is necessary because many AEDs are pregnancy category D. Some AEDs may cause folate deficiency, a condition correlated with fetal neural tube defects. AEDs do not increase the risk for placenta previa, preterm labor, or cephalopelvic disproportion.
A patient is prescribed phenytoin (Dilantin) for tonic-clonic seizures. Which adverse effect should the nurse instruct the patient to report? a) Redness, dilated blood vessels, papules, and pustules on the face b) Blisters that ooze and weep and form hard plaques c) Painful rash in a linear pattern d) Red or purple skin rash with possible blisters and sunburn
d) Red or purple skin rash with possible blisters and sunburn Red or purple skin rash with possible blisters and sunburn may be a sign the patient has developed Stevens-Johnson syndrome. Blisters that ooze and weep and form hard plaques describes eczema. A painful rash in a linear pattern describes shingles. Redness, dilated blood vessels, papules, and pustules on the face describes rosacea. Eczema, shingles, and rosacea are not adverse effects of phenytoin (Dilantin).
A patient is diagnosed with Lennox-Gastaut syndrome. Which type of medication should the nurse expect to be prescribed? a) Barbiturate b) Succinimide c) Dibenzazepine d) Valproic acid
d) Valproic acid In a severe form of epilepsy called Lennox-Gastaut syndrome (LGS), valproic acid (Depakene), lamotrigine, felbamate, topiramate (Topamax, Trokendi XR), and rufinamide (Banzel) may be used for treatment. LGS is characterized by tonic, atonic, atypical absence, and myoclonic symptoms. There is usually no single AED that will control symptoms of this particular syndrome. Dibenzazepines, succinimides, and barbiturates are not identified as treatment for this syndrome.
A patient has a history of complex partial seizures and frequent migraines. Which medication should the nurse expect to be prescribed? a) Fosphenytoin (Cerebyx) b) Primidone (Mysoline) c) Ethosuximide (Zarontin) d) Valproic acid (Depacon, Depakene, Depakote)
d) Valproic acid (Depacon, Depakene, Depakote) Valproic acid is used to treat complex partial seizures. Depakote ER is also approved for the prevention of migraines. Primidone is used to treat all types of seizures except absence seizures. However, primidone has no other approved uses and would not be used for migraine treatment. Fosphenytoin is used with tonic-clonic seizures and status epilepticus. Ethosuximide is used in the treatment of absence seizures.
A patient is experiencing agitation from severe dementia. Which medication should the nurse suspect may be prescribed for this patient? a) Diazepam (Valium) b) Lorazepam (Ativan) c) Phenytoin (Dilantin) d) Valproic acid (Depakene)
d) Valproic acid (Depakene) Valproic acid (Depakote ER) is used off-label for behavioral disturbances such as agitation due to dementia. Lorazepam and diazepam are used to prevent seizures in alcohol withdrawal and to treat status epilepticus. Phenytoin is not used to treat agitation caused by severe dementia.