Anti-epileptic Drugs Final Exam

What needs to be done before and after administering phenytoin? How is phenytoin administered intravenously? if the patient has a tube feeding, when do you give phenytoin? what time does the patient usually take these medications and when is it best?

o Measure apical pulse for 60 seconds before, during, and after - It is very irritating to veins when injected and must be given by slow intravenous (IV) push (not exceeding 50 mg/min in adults) directly into a large vein through a large-gauge (20-gauge or larger) venous catheter - saline flush before and after injecting · Infiltration causes tissue necrosis - check patency it can cause exacerbation - Phenytoin is ONLY to be diluted in normal saline (NS) for IV infusion, and a filter must be used. o If your patient has tube feeding and you need to give Dilantin, wait 1 hour before & after o Take at same time each day, best at night; give vitamin and calcium supplements

What are the therapeutic blood levels of phenobarbital and primidone? what is the dosing and half life of this medication? what happens if the patient misses a dose? what is obtained prior to starting therapy and retested every 2 weeks?

o Therapeutic effects are generally seen at serum drug levels of 10 to 40 mcg/mL. o A major advantage of this drug is its long half- life, which allows once-a-day dosing. o Even if a patient takes his or her dose 12 or even 24 hours late, therapeutic blood levels may still be maintained. - CBC levels before initiating therapy & blood testing every 2weeks

What are the therapeutic blood levels of phenytoin? what are the S/S of toxicity (5)? this medication is highly bound to what? and therefore what lab values should be monitored and why? and who does it commonly occur in?

o Therapeutic levels are usually 10-20 µg/mL o Signs of toxicity - nystagmus, ataxia, encephalopathy, dysarthria, and dysmetria o Highly protein bound - so monitor albumin levels, bc if albumin level is low it will become toxic; also monitor hypoalbuminia, due to the free unbound phenytoin molecules will be present in the blood o (commonly occurs in pt's who are malnourished or have chronic renal failure)

Oxcarbazepine (Read over, kinda) how is this medication taken?

o This drug is to be taken as prescribed and is usually given in two divided doses. o The drug must be taken with food or snacks o Rash, abnormal walking or moving, or abdominal pain must also be reported, if present.

Gabapentin nursing evaluation (Read over, kinda) this medication is taken how?

o This is one of the antiepileptic drugs that can be taken without regard to meals. o If discontinuation of the drug is indicated, taper the dosage, as ordered, over at least I week to avoid rebound seizures.

what is the indication of Lamotrigine (3)? what are the adverse effects (4)? what are the drug interactions (3)?

o Used for simple or complex partial seizures & generalized tonic-clonic seizures; also used in treatment of bipolar disorder o Common adverse effects: relatively minor CNS and GI symptoms and possible Stevens-Johnson syndrome - The most common adverse effect is sleepiness. o Drug interactions chiefly involve other antiepileptic drugs as well as other CNS depressants and oral contraceptives

What is the indication for Ethosuximide (1)? this medication is not effective for? what are the contraindication (1)? what is the adverse effects (2)? what are the drug interactions (1)?

o Used in the treatment of uncomplicated absence seizures o Not effective for secondary generalized tonic-clonic seizures o Contraindication: known allergy o Adverse effects: GI and CNS effects o Drug interactions: hepatic enzyme-inducing drugs

Name the anti-epileptic drugs (read over, kinda)

o Valproic acid o Gabapentin o Lamotrigine o Felbamate o Levetiracetam o Topiramate o Zonisamide o Tiagabine o Pregabalin o Perampanel o Ezogabine o Vigabatrin o Eslicarbazepine o Clobazam o Brivaracetam

What is the indication of Topiramate (3)? what are the adverse effects (2)? interactions (2)? what is the risk of taking this drug while pregnant?

o Indication - Adjunct therapy for partial and generalized seizures, & for drop attacks In Lennox-Gastaut syndrome o Adverse effects: CNS related, angle-closure glaucoma (pt must report visual changes) · Interactions -involve chiefly other antiepileptic drugs and oral contraceptives · In 2011, the FDA notified health care professionals about an increased risk for cleft palate in children born to mothers who were taking topiramate during pregnancy.

What is the indication for Tiagabine (1)? MOA? why do you want to avoid off label use of this drug? what is the consequence? what is the adverse effects (2)?

o Indication - Adjunct therapy for partial seizures o Beneficial effects by inhibiting the reuptake of GABA from the neuronal synapses (spaces between neurons) in the brain o Avoid off label use of this drug it can cause paradoxical seizures - Reported in in nonepileptic patients who are treated with the drug for other indications. · Most of these cases involved patients being treated for bipolar disorder - Of even greater concern is that in some of these cases the seizure episodes progressed to status epilepticus o Adverse effects: CNS and GI symptoms

What is the indication for Levatiracetam (1)? adverse effects (1)?

o Indication: Adjunct therapy for partial seizures with or without secondary generalization o Contraindication - known allergy o Adverse effects: generally, well tolerated, CNS related - Like all antiepileptic drugs, the potential for excessive CNS depression exists when it is used in combination with other sedating drugs. o No drug interactions

What is the indication for Valproic Acid (3)? what are the contraindications (3)? this medication is bound highly to and who does it compete with? what is this medication metabolized by? is this medication a hepatic enzyme inducer?

o Indication: Treatment of generalized seizures (absence, myoclonic, and tonic-clonic), bipolar disorder, and controlling partial seizures o Contraindications: Include known drug allergy, liver impairment, and urea cycle disorders (genetic disorders of urea metabolism). o Highly protein bound & competes w/ other highly protein bound medications for binding sites - It is also metabolized by hepatic microsomal enzymes & competes for metabolism w/ other drugs - Not a hepatic enzyme inducer

What is the MOA of Pregabalin? indication (1) and then other indications (3)? and adverse effects (1)?

o MOA - is structurally related to GABA. o However, it does not bind to GABA receptors but rather to the alpha2-delta receptor sites, which affect calcium channels in CNS tissues. o Schedule V controlled substance o Indication: adjunct therapy for partial seizures - Other common uses: neuropathic pain, postherpetic neuralgia, and fibromyalgia o Adverse effects: CNS related

nursing evaluation general (Read over)

· Airway maintenance is of critical importance for epileptic patients because the tongue relaxes during seizure activity, falling backward and subsequently blocking the airway. · Avoid use of a tongue blade or other instrument to pry open the patient's mouth or clenched teeth, and ensure quick access to oxygen and suctioning equipment at all times · Administering the antiepileptic drug at the same time every day is also important to maintain blood levels. · If one or more doses of the antiepileptic drug is missed, the prescriber must be contacted immediately due to the increased risk for seizure activity. · With oral dosing, it is recommended that these drugs be ken with at least 6 to 8 ounces of fluid, preferably water, and with food, meals, or a snack to help decrease the risk for gastrointestinal upset, a frequently encountered adverse effect. · Oral suspensions are to be shaken and the solution mixed thoroughly.

Barbiturates nursing evaluation (read over, kinda) how do you administer this drug IV? how fast or slow can you administer this medication and what is the consequence?

· Barbiturates (e.g., phenobarbital): o Most of the oral dosage forms of this class of drugs are to be taken with water. o Elixir dosage forms may be safely mixed with fruit juice, milk, or water. o If IV infusions are indicated, calculate the dose carefully and use an IV infusion pump to administer the drug. o Too rapid an infusion of IV dosage forms may lead to cardiovascular collapse and respiratory depression. o If any signs or symptoms of cardiovascular or respiratory depression are noted, withhold the drug and contact the prescriber immediately while providing supportive care through maintenance of the airway, breathing, and circulation.

Other nursing assessments (Read over)

· Before administering the iminostilbene carbamazepine, a CBC is often ordered because of the possible adverse effect of drug-related anemias (e.g., aplastic anemia). o Significant contraindications include conditions or drugs involving and/or precipitating bone marrow suppression because of carbamazepine's adverse effect (though rare) of because the same. · Gabapentin requires a thorough neurologic assessment with attention to baseline energy levels, visual intactness, sensory and motor functioning, and any changes in speech. · Lamotrigine use requires a thorough neurologic assessment and documentation of baseline energy levels, vision acuity, and history of headaches for comparative purposes due to common adverse effects of headaches, vision changes, and drowsiness

Hydantoins nursing evaluation (read over, kinda) what two side effects will indicate the need to discontinue the IV infusion?

· Hydantoins: o If dysrhythmias or hypotension occur, discontinue the infusion immediately, monitor patient vital signs, and contact the prescriber immediately. o Implement safety measures, such as assisting the patient with ambulation and having the patient move slowly and purposefully, when this drug (or any other antiepileptic drug) is given because of the adverse effects of ataxia and dizziness. o IV dose administration requires even more cautious use because of the rapid onset of action. o CNS depression is always a concern o If infiltration of the IV site leads to subcutaneous tissue access, ischemia and sloughing may occur o If infiltration occurs, discontinue infusion of the solution immediately, but leave the IV catheter/needle in place until all orders from the prescriber have been received. o Complete blood counts are often monitored very closely within the first year of therapy (e.g., measured monthly for 1 year, then every 3 months).

Barbiturates nursing assessment (Read over, kinda) what type of assessment is needed for the patient (2)? what type of patients are sensitive to these drugs?

· If barbiturates have been ordered, carefully assess not only the neurologic system but also vital signs because of the CNS depression associated with this class of drugs. o identify patients at high risk for excessive sedation for safety purposes, o If the patient is in an acute care institution, assess the room and environment to ensure that safety measures are in place (e.g., side rails up or a bed alarm system in use depending on health care institution policy), noise level is controlled, and seizure precautions are available (oxygen, suctioning equipment, and airway devices nearby; padded side rails being used; and IV access obtained per health care institution policy). o Note the patient's age, the very young and the older adult react with more sensitivity to these drugs with paradoxical reactions, irritability, and hyperactivity

Valproic acid and new drugs nursing evaluation (read over)

· Valproic acid: o Oral dosage is not to be taken with carbonated beverages o Recommended to be taken with at least 4 to 6 oz of water, food, or snack to minimize GI upset · Miscellaneous new drugs: o Skin discoloration may occur and is permanent, and its use is recommended only if patient has not responded to other drugs. o With vigabatrin (Sabril), any onset of visual changes or disturbances must be reported to the prescriber immediately.

Where is phenytoin metabolized and what is the outcome? is this medication demanding on the liver and what should be avoided?

o Highly metabolized by the liver and is a hepatic enzyme inducer. o Which means that when the pt takes Dilantin it will cause an increase in metabolism, which causes the medication to be absorbed and metabolized faster, so you will not have the same therapeutic effects; basically, reduces their blood levels o Very demanding on the liver, alcohol decreases Dilantin levels.

Tiagabine nursing evaluation (read over) how is this med taken?

o Taken with food o Report problems with tremors, rash, or abdominal pain

Levetiracetam nursing evaluation (Read over)

o The most common adverse effect is sleepiness. o With the beginning of antiepileptic therapy, encourage the patient not to drive, operate heavy machinery, or make major decisions due to the sedation and CNS depression.

What are the contraindications of anti-epileptic drugs (2)? What are the interactions with anti-epileptic drugs (3)

- Antiepileptic Drugs: Contraindications o The only usual contraindication to antiepileptics is known drug allergy. o Pregnancy is also a common contraindication; however, the prescriber must consider the risks to mother and infant of untreated maternal epilepsy and the increased risk for seizure activity. - Antiepileptic Drugs: Interactions o Drug interactions are numerous o Many antiepileptic drugs interact with each other o Induce hepatic metabolism resulting in reduction of effects of other drugs including oral contraceptives o Avoid grapefruit with carbamazepine --> increases toxicity

What is the medication under Iminostilbenes? what is that medication related to? what is the indication (3)? What are the contraindications (4) and why? what are the adverse effects (5)

- Carbamazepine (Tegretol) *** o Second most prescribed antiepileptic in US after phenytoin o It is chemically related to the tricyclic antidepressants and is considered a first-line treatment for partial seizures and generalized tonic-clonic seizures, & trigeminal neuralgia o It may actually worsen myoclonic or absence seizures. o Contraindication: known drug allergy and bone marrow depression, myoclonic or absence seizures o Adverse effects: aplastic anemia, bone marrow suppression, dysrhythmias, exfoliative dermatitis, steven Johnson syndrome

What are the two medications under barbiturates? what is primidone metabolized into in the body? what is the indication (2)? which medication is less common to be used orally for seizure emergencies? what is the most common adverse effects (1) and others (5)? what are the interactions and what does it result in (2) ?

- Phenobarbital and Primidone o Primidone is metabolized in the liver to phenobarbital and phenylethylmalonamide, both of which have anticonvulsant properties o Indication: is used for the management of status epilepticus and is an effective prophylactic drug for the control of febrile seizures. o Although phenobarbital is still used to treat seizure emergencies, the use of oral phenobarbital for seizure prevention is much less common. o Most common adverse effect: Sedation (Most common) o include cardiovascular, CNS, gastrointestinal (GI), and dermatologic reactions. o Phenobarbital interacts with many drugs because it is a major inducer of hepatic microsomal enzymes, including the cytochrome P-450 system enzymes, which causes more rapid clearance of some drugs. - May also cause hypotension and bradycardia.

What is steven johnsons syndrome? is it reversible or fatal? how is this syndrome avoided in regards to administration of Lamotrigine?

- Stevens Johnson syndrome - This condition involves inflammation and sloughing of skin, potentially over the entire body, in a manner that resembles a third-degree burn. · It is often reversible but can also be fatal. · To avoid this condition, doses are very slowly titrated over several weeks.

What medication is given to third world countries, bc of its low cost?

In third-world countries, oral phenobarbital is often the drug of choice for routine seizure prophylaxis because of its low cost.

How long is anti-epileptic medications used for and why? what is the exceptions? what happens if the patient abruptly stops taking their medication? when is multiple drug therapy tried? why are serum drug concentrations measured for these drugs (3)?

o AED therapy is usually lifelong o Treatment may eventually be stopped in some, but others will experience repeated seizures if constant levels of antiepileptic drugs are not maintained in the blood. - The majority of pediatric and adult epilepsy patients who have been seizure free for 1 to 2 years while taking antiepileptic drugs can eventually stop taking them with medical supervision. o Abrupt discontinuation of these drugs can result in withdrawal seizures. o Single-drug therapy started before multiple-drug therapy is tried o Serum drug concentrations must be measured o Therapeutic drug monitoring of serum drug concentrations provides a useful guideline in assessing the effectiveness of and adherence to therapy - Maintaining serum drug levels within therapeutic ranges helps not only to control seizures but also to reduce adverse effects o Serum concentrations of phenytoin, phenobarbital, carbamazepine, levetiracetam, and primidone correlate better with seizure control and toxicity than do those of valproic acid, ethosuximide, and clonazepam.

What are the adverse effects of Valproic Acid (9) what are the interactions (6)? what are the therapeutic levels? what are the available routes?

o Adverse effects: drowsiness, N/V, GI disturbances, tremor, weight gain, transient hair loss, hepatotoxicity, pancreatitis o Interactions: with aspirin, carbamazepine, oxcarbazepine, lorazepam, rifampin, tricyclic antidepressants o Therapeutic levels: 50-125mcg/mL - Given 15-60mg/kg/day PO, 10-15mg/kg/day over 1-hour IV infusion · Routes - Long-acting oral dosage forms are also available as divalproex sodium (Depakote), which comes in delayed- and extended-release tablets as well as capsules with long-acting granules (Depakote Sprinkles) that can be opened and sprinkled onto food.

What are anti seizure medications also known as? what percent of patients have relief using these medications and which require further interventions? What is the downside of anti-epileptic drugs? what is the goal of therapy (2)?

o Antiepileptic drugs are --> Also known as anticonvulsants o Approximately 70% of patients can expect to become seizure free while taking only one drug. o The remaining 30% of cases are more complicated, and often require multiple medications to be used o Antiepileptic drugs have many adverse effects, and it is often difficult to achieve seizure control while avoiding adverse effects. o Goals of therapy o To control or prevent seizures while maintaining a reasonable quality of life o To minimize adverse effects and drug-induced toxicity

What are the names of the antiepileptic classification drugs used to manage seizure disorders (4)? What does the choice of anti-epileptic drug depend on? when are these medications generally given?

o Antiepileptic drugs traditionally used to manage seizure disorders include: o Barbiturates o Hydantoins o Iminostilbenes plus valproic acid o Second- and third generation antiepileptics · Effects of AED's o Choice of drug depends on type of seizure o AED's drug levels must be maintained so they must be given at a precise time frame daily

Nursing assessment (Read over)

o Assessment o Health history, including current medications o Drug allergies o Liver function studies, CBC o Baseline vital signs o Teach patients that therapy is long term and possibly lifelong (not a cure) o Monitor for therapeutic effects o Decreased or absent seizure activity o Monitor for adverse effects o Mental status changes, mood changes, changes in level of consciousness or sensorium o Eye problems, visual disorders o Sore throat, fever (blood dyscrasias may occur with Dilantin)

What is fosphenytoin? what is the dosaging and why? what precautions need to be implemented for both phenytoin and fosphenytoin and why?

o Fosphenytoin is an injectable water-soluble prodrug of phenytoin that can be given IM or IV (by IV push or continuous infusion) without causing burning on injection associated with phenytoin o Fosphenytoin is given at a rate of 150 mg PE/min or less to avoid hypotension or cardiorespiratory depression. o Implement fall-prevention measures after infusion of either phenytoin or fosphenytoin because of possible ataxia and dizziness.

Carbamazepine can be given with? what food needs to be avoided? and what needs to occur if the patient is prescribed another anti-epileptic medication?

o Given with meals to reduce risk of GI distress. o Should NOT be given with grapefruit because of increased toxicity of the AED. o If the drug is to be replaced with another AED, there should be a plan to decrease one drug prior to beginning low doses (at first) of the new AED.

Where is Carbamazepine metabolized? and when does that tend to occur? what are the therapeutic blood levels?

o Carbamazepine is associated with autoinduction of hepatic enzymes (hepatic enzyme inducer) o Autoinduction is a process in which, over time, a drug stimulates the production of hepatic enzymes that enhance its own metabolism, which leads to lower-than-expected drug concentrations. o With carbamazepine, this process usually occurs within the first 2 months after starting the drug. o Therapeutic levels 8-12mcg/ml

What is Gabapentin? What is the MOA? What is the indication (2)? is this medication good for new onsets of epilepsy? what are the adverse effects (5)? what 3 things need to be avoided when on this medication? and nursing considerations (read over, kinda) can the patient drive while on this medication?

o Chemical analogue of GABA (a neurotransmitter that inhibits brain activity) o MOA: Works by increasing the synthesis and synaptic accumulation of GABA between neurons o Indication: Used in the treatment of partial seizures and neuropathy, & prophylaxis of partial seizures - Evidence also shows gabapentin to be effective as a single-drug therapy for new-onset epilepsy o Adverse Effects: Can cause peripheral edema, drowsiness, nausea, and anorexia, visual/speech changes o Interacts w/ alcohol with additive CNS depression; avoid caffeine, alcohol, & cigarettes o Nursing Consideration - Take these drugs at the same time; more than 80% of the drug is excreted unchanged - Abrupt discontinuation may lead to withdrawal seizures - Very sedating - tell pt taking antiepileptic drugs not to drive/operate heavy machinery till you know how the drug works

What are the contraindications of Phenobarbital and primidone (4)? what is unique about these drugs in that which populations can take them (2)? the elixir dosage forms can be mixed with (3)? what can rapid IV infusions of these drugs cause ?

o Contraindications: known allergy, porphyria (A disorder of the synthesis of heme, a component of hemoglobin), liver or kidney impairment, and respiratory illness o Nursing Considerations: o Used in pediatrics, only AED used in pregnancy. o Assessment of vital signs due to central nervous system depression, assess the room for safety measures (side rails up), and the presence of seizure precautions (keeping oxygen, suctioning equipment, and airway nearby). o Mix elixir dosage forms with fruit juice, milk, or water. Rapid infusion of IV dosages may cause cardiovascular collapse and resp. depression, monitor vitals and infusion rates frequently.

Pregablin nursing evaluation (read over;kinda) how many doses is usually given?

o Daily dosage is usually given in two or three divided doses. o Monitor the patient for any excessive dizziness, ocular or visual changes, or edema.

If the patient has a seizure disorder and is taking medications, is it advised to lock rooms?

o Do not lock rooms, for example bathrooms, just in case seizure or fall occurs

What is the MOA of anti-epileptic drugs? What are the pharmacologic effects of these medications (3)?

o Exact mechanism of action is not known o Evidence indicates that they alter the movement of sodium, potassium, calcium, and magnesium ions. - The changes in the movement of these ions result in more stabilized and less excitable cell membranes. o Regardless of the mechanism, the overall effect is that antiepileptics stabilize neurons and keep them from becoming hyperexcited and generating excessive nerve impulses to adjacent neurons. o Pharmacologic effects: o Increase threshold of activity in the motor cortex (makes it more difficult for a nerve to be excited) o Limit or suppress the spread of electrical activity from the point of origin o Decrease the speed at which an impulse travel

General nursing care for patients with AED (Read over )

o Fall precautions & education on safety when performing activities involving machinery, etc o Taking meds with a full glass of water or liquid may reduce GI upset symptoms o Teach importance of notifying HCP for suicidal thoughts, involve family o CNS depression and GI symptoms usually improve after taking meds for a while o Do not discontinue/hold meds abruptly to prevent risk of rebound seizure o Avoid ETOH, caffeine products o Emphasize long term therapy, possibly lifelong o Refer to community sources

What are generalized seizures? what were they previously known as? What are the different types of generalized seizures and explain them (4)?

o Formerly known as grand mal seizures o Are characterized by neuronal activity that originates simultaneously in the gray matter of both hemispheres. o There are several subtypes of generalized seizures - Tonic-clonic seizures: begin with muscular contraction throughout the body (tonic phase) and progress to alternating contraction and relaxation (clonic phase). - Atonic: known as drop attacks, involve sudden global muscle weakness & syncope - Myoclonic: characterized by brief muscular jerks, not as extreme as others - Absence seizures: occurs in children, pt has repetitive spasmodic eye blinking for 30secs

What are the adverse effects of anti-epileptic medications (3)? what is the black box warning? What are the effects of an epileptic pregnant woman on the infant and what does the mother need to do?

o Numerous adverse effects—vary per drug o GI side effects, such as nausea, vomiting, or diarrhea are common side effects of most antiepileptic drugs o Adverse effects often necessitate a change in medication o Black box warning as of 2008 o Black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behavior. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. o Birth defects in infants of epileptic mothers are higher than normal, regardless of whether the mother was receiving drug therapy. o Epileptic women need to be monitored closely during pregnancy by both an obstetrician and a neurologist.

Oral drugs and IV drugs nursing implications (read over)

o Oral drugs: Take regularly, same time each day o Take with meals to reduce GI upset o Do not crush, chew, or open extended-release forms o If patient is NPO for a procedure, contact prescriber regarding AED dosage o Intravenous forms: Follow manufacturer's recommendations for IV delivery—usually given slowly o Monitor vital signs during administration o Avoid extravasation of fluids o Use only normal saline with IV phenytoin (Dilantin)

What is oxcarbazepine and its indications (2)? what are the adverse effects (3)? is this medication a hepatic enzyme inducer?

o Oxcarbazepine - chemical analogue of carbamazepine; for partial seizures & secondarily generalized seizures o Adverse reactions: headache, dizziness, nausea o Unlike, carbamazepine - this drug is not a hepatic enzyme inducer

What is the medication under Hydantoins? what is the indication (2)? what is the contraindication (3)? What are the longterm adverse effects (5)? what are the common adverse effects (4)? what type of care can be done to prevent gingival hyperplasia? what is recommended for osteoporosis?

o Phenytoin has been used as a first-line drug for many years and is a prototypical drug o Indication: for the management of tonic-clonic and partial seizures o Contraindication: include known drug allergy and heart conditions that involve bradycardia or blockage of electro-cardiac function (heart block). o Adverse effects: Long term therapy: gingival hyperplasia, acne, hirsutism (excess body or facial har in woman), Dilantin facies (hypertrophy of subcutaneous facial tissue), and osteoporosis (long-term consequence) o Most common adverse effects - lethargy, abnormal movements, confusion, cognitive changes o Scrupulous dental care can help prevent gingival hypertrophy. - Educate pt to go to the dentist more frequently, at least every 6 months o For osteoporosis - vitamin D therapy may help to prevent this, particularly in women

What is the indications for anti-epileptic drugs (3)

o Prevention or control of seizure activity o Long-term maintenance therapy for chronic, recurring seizures o Acute treatment of convulsions and status epilepticus o In this case, diazepam or lorazepam are considered to be the drugs of choice

Nursing care for patients with anti seizure meds (read over)

o Record seizure date, time, type, (as detailed as possible). Teach pt. family to keep a log o Follow driving regulations per state o Pt should wear a medical alert bracelet and keep a list of medications/dose for reconciliation o If seizure occurs keep patient safe, maintain airway, prevent injury, sided lying position or HOB elevated with chin slightly down if possible. Keep suction & O2 equipment at bedside o ONLY Normal Saline with IV and IVP phenytoin, @ 50 mg/min, fosphenytoin @ 150mg/min. Monitor IV site and cardiovascular status very closely during administration o Monitor serum levels closely and check for drug interaction o When monitoring and evaluating the effects of AED's nurse needs to constantly assess pt for mentals status, mood changes, behavioral changes, changes in LOC, visual disorders, sore throat and fever o The occurrence of vomiting, diplopia, cardiovascular collapse, & steven Johnson's syndrome indicates toxicity of the bone marrow, and HCP should be contacted STAT o Encourage pt to avoid alcohol and smoking while taking AED's, reoccurrence of seizure activity is usually due to lack of compliance, pt should be encouraged to avoid any form of stimulants (Caffeine) bc of higher risk of seizure activity. o Inform the HCP if any glandular swelling, fever sore throat, tarry stools, back pain, hematuria, easy bruising, lethargy, or mouth ulcers occur

What is a seizure? what is a convulsion? what is epilepsy? what are primary seizures? what is secondary seizures and what can cause them (4)?

o Seizure:Brief episode of abnormal electrical activity in nerve cells of the brain, which may or may not lead to a convulsion o Convulsion: Is a more severe seizure characterized by involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles o Epilepsy: Chronic, recurrent pattern of seizures (occurs most in children and older adults) o Primary (idiopathic) o Cause cannot be determined o Roughly 50% of epilepsy cases o Secondary (symptomatic) o Distinct cause is identified - Trauma, infection, cerebrovascular disorder - Febrile in young children (6months of 5yrs of age) - children usually outgrow these seizures

What are simple seizures and what was it previously known as? what is complex seizure? What is status epilepticus? is it a medical emergency? what are the consequences of status epilepticus (4)?

o Simple (formerly known as petit mal seizures): brief loss of awareness, but no loss of consciousness o Complex: level of consciousness is reduced but not completely lost o Secondary generalized tonic-clonic o Unclassified seizures - Status Epilepticus (True medical emergency) o Multiple seizures occur with no recovery between them o Result: Hypotension, Hypoxia, Brain damage & Death

What is zonisamide? what is the indication (1)? what is the adverse effects (2)? what are the interactions (1)?

o Sulfonamide derivative o Indication - Used for a variety of seizure types o Adverse effects: CNS and GI symptoms o Interactions - Zonisamide interacts with a number of drugs metabolized by cytochrome P-450 enzymes, which increase or decrease clearance of zonisamide

Nursing assessment anti seizure (Read over)

· A complete neurologic assessment with documentation of baseline CNS functioning is also important before administering antiepileptic drugs. o This may include testing and grading the response of deep tendon reflexes, bilateral and upper- and lower-extremity sensory and motor testing, and questioning about the presence of any headaches, photosensitivity, occurrence of auras, or visual changes.

Hydantoins nursing assessment (Read over)

· With hydantoins like phenytoin, the previously mentioned assessment data are also appropriate. o Perform a skin assessment, and document intactness and the presence or absence of any rashes, because of the possibility of a measles-like rash. o In addition, baseline dental hygiene habits and an oral assessment, such as the status of the patient's gums and teeth, are important because of the adverse effects of gingival hyperplasia. o Assessment of baseline neurologic functioning is crucial with the use of these CNS-altering medications and needs to include the following: - (1) a focus on vision with attention to any abnormalities, especially those related to eye movement - (2) baseline neuromuscular stability with attention to coordinated movements, gait, and reflexes -(3) assessment of speech for clarity and ability to form and express words appropriately. · In addition, when the phenytoins are administered, baseline liver function studies and complete blood counts are needed.