Drugs for Epilepsy EAQ

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "Epilepsy medication does not reduce seizures in most patients." B. "These drugs will help control your seizures until you have surgery." C. "With proper treatment, we can completely eliminate your seizures." D. "Our goal is to reduce your seizures to an extent that helps you live a normal life."

D. "Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in most patients and can help the patient live a normal life. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

Which patient should be evaluted for potential toxic effects of antiepileptic therapy? A. The patient with a primidone level of 10 mcg/mL B. The patient with a phenobarbital level of 8 mcg/mL C. The patient with a valproic acid level of 50 mcg/mL D. The patient with a carbemazepine level of 15 mcg/mL

D. The patient with a carbemazepine level of 15 mcg/mL The only value listed that is above therapeutic plasma levels is the carbemazepine, which has a therapeutic range of 4 to 12 mcg/mL. This patient is most likely to have toxic effects of therapy. The other patients have ranges within (valproic acid, primidone) or below (phenobarbital) therapeutic range.

A patient is in status epilepticus. Which are essential nursing actions? Select all that apply. A. Call a code B. Administer diazepam as ordered C. Turn the patient's head to the side D. Assess oxygenation and apply oxygen E. Sit the patient in a high Fowler's position

B, C, D During status epilepticus, the nurse should keep the patient's head to the side, assess oxygenation, apply oxygen, and adminsiter diazepam or lorazepam as ordered. Calling a code is not necessary unless the patient's heart were to stop. A high Fowler's position would be extremely difficult and unsafe for a patient in status epilepticus.

The nurse needs to administer phenytoin [Dilantin] 400 mg IV bolus to a patient. At a minimum, over how many minutes should the nurse administer this dose? Record your answer using a whole number.

8 Minutes The nurse administers IV phenytoin no faster than 50 mg/min to reduce the risk of cardiovascular collapse. Calculation: (1 min/50 mg) × 400 mg = 400 ÷ 50 = 8 minutes.

Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy? A. Monitoring for side effects B. Monitoring serum drug levels C. Administering it by slow IV push D. Flushing the tubing after administration

C. Administering it by slow IV push The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing, and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? Select all that apply. A. Productive cough B. Measles-like rash C. Unusual hair growth D. Nausea and vomiting E. Swollen, tender gums

B, C, E Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid [Depakene] indicates a need for further teaching by the nurse? A. "The medication should not make me feel sleepy." B. "I should take the medication on an empty stomach." C. "I'll need to discuss a reliable form of birth control with my gynecologist." D. "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

B. "I should take the medication on an empty stomach." Gastrointestinal side effects, such as nausea, vomiting, and indigestion can occur when valproic acid is taken on an empty stomach; stating that the medication should be taken on an empty stomach indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

What information is essential to teach the client who will begin taking an antiepileptic drug? A. "You will most likely not be on this medication very long." B. "If you develop seizures while on this medication, you will always have seizures." C. "If you find you cannot tolerate the drug, stop it and call your healthcare provider." D. "There is a good chance that you will become seizure free on this one medication."

D. "There is a good chance that you will become seizure free on this one medication." About 70% of clients become seizure free on one medication. Most clients are on the medications for life. The client should not stop the medication as increased seizures can result. If a client has seizures while on a medication, then that medication can be decreased and another one tried. It does not mean they will always have seizures.

A client is in status epilepticus. What is an appropriate nursing action? A. Apply restraints. B. Hold the client's limbs steady. C. Administer intravenous pain medications. D. Administer intravenous antiepileptic drug therapy.

D. Administer intravenous antiepileptic drug therapy. During status epilepticus, the client is unable to swallow medications, and the appropriate treatment is to administer intravenous drug therapy to stop the seizure. Pain medications are not necessary. The nurse should not restrain the client or hold the limbs during this time, but the nurse should make certain the client is not injured.

The client's serum phenytoin [Dilantin] level is 31 mcg/mL. What is the nurse's best action? A. Hold the medication B. Increase the medication dose C. Administer the medication intravenously D. Have the client continue the current regimen

A. Hold the medication A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse should hold the medication and then call the healthcare provider.

The nurse should suspect that a female patient is experiencing phenytoin toxicity if which manifestation is noted? Select all that apply. A. The patient complains of double vision. B. The patient is walking with a staggering gait. C. The patient complains of excessive facial hair growth. D. The patient's gums are swollen, tender, and bleed easily. E. The nurse observes rapid back-and-forth movement of the patient's eyes.

A, B, E Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse should understand that this drug is only indicated for which seizure type? A. Absence B. Tonic-clonic C. Simple partial D. Complex partial

A. Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

What is the best instruction for the nurse to give the patient who is taking an antiepileptic drug with a narrow therapeutic index? A. "Take the medication every other day." B. "Keep the medication with you at all times." C. "Make certain the drug is taken at the same time daily." D. "Crush the drug and put it in applesauce for better absorption."

C. "Make certain the drug is taken at the same time daily." A drug with a narrow therapeutic index has toxic and therapeutic levels that are very close together. Consistent dosing of the drug at the same time daily is essential for maintaining stable serum drug levels. Crushing the drug will change the absorption. The medication should not be taken every other day unless that is specifically how it is prescribed. Keeping the medication with the patient at all times is not essential as many drugs are longer acting.

The nurse is administering phenytoin [Dilantin] intravenously. What intervention is essential? A. Push the medication quickly through a central line B. Mix the medication in 5% dextrose with 0.9% saline C. Administer the medication no faster than 50 mg/min D. Administer the medication in a 22-gauge or smaller catheter

C. Administer the medication no faster than 50 mg/min Intravenous phenytoin should be given no faster than 50 mg/min into a 20-gauge or larger catheter. It can only be mixed or diluted in normal saline for infusion. The medication should not be given with dextrose or given quickly through a central line.

Question 1 The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? Select all that apply. A. "It is very important to have good oral hygiene and to visit your dentist regularly." B. "You may continue to have wine with your evening meals but only in moderation." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." E. "You may have some mild sedation. Do not drive until you know how this drug will affect you."

A, D, E Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

Which instruction would be inappropriate to include in the teaching plan for a patient starting carbamazepine [Tegretol]? A. "Have complete blood counts performed periodically." B. "Take the medication with a glass of grapefruit juice each morning." C. "Notify the physician if you are gaining weight or your legs are swollen." D. "Nausea, vomiting, and indigestion are common side effects of carbamazepine."

B. "Take the medication with a glass of grapefruit juice each morning." Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Complete blood counts are monitored for patients taking valproic acid because of the risk of fatal aplastic anemia.

What information should the nurse include in the care plan of a young woman who has been prescribed phenytoin [Dilantin]? A. "Take your blood pressure daily." B. "Use birth control while on this medication." C. "Do not take this medication with grapefruit juice." D. "If your weight increases, call your healthcare provider."

B. "Use birth control while on this medication." The nurse should tell the young woman to use birth control while on the medication as an increased incidence of fetal defects occurred in those who took phenytoin while pregnant.

The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. What statement should be included in the plan of care? A. "You will only need to be on therapy for a few months." B. "Your medication is chosen based on your type of seizure." C. "You will be started on several drugs to control your seizures." D. "Medication therapy is not essential to treat seizure disorders."

B. "Your medication is chosen based on your type of seizure." Medication therapy for seizures is matched to the type of seizure the patient presents with. Single drug therapy must fail before multiple drug therapy is tried. Therapy, in most cases, is lifelong and essential for treating epilepsy.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? A. Atonic B. Absence C. Myoclonic D. Tonic-clonic

B. Absence This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

A patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention? A. Warn her not to withdraw this drug abruptly. B. Ensure that genetic testing for HLA-B*1502 is performed. C. Recommend that she take this medication at bedtime or with meals. D. Teach her family to assist with maintaining a seizure frequency chart.

B. Ensure that genetic testing for HLA-B*1502 is performed. Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B*1502. The U.S. Food and Drug Administration (FDA) now recommends that patients of Asian descent undergo genetic testing before taking carbamazepine.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? A. Phenobarbital 30 mg IM B. Lorazepam [Ativan] 4 mg IV over 2 minutes C. Phenytoin [Dilantin] 200 mg IV over 4 minutes D. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

B. Lorazepam [Ativan] 4 mg IV over 2 minutes Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

The nurse is assessing a patient who is receiving antiepileptic drug therapy with phenytoin. What assessment finding requires immediate action? A. Pale skin B. Nystagmus C. Weight gain D. Heart rate 60 beats/min

B. Nystagmus The patient who has nystagmus may be presenting with adverse effects to phenytoin therapy and should be assessed for other signs of toxicity. Pale skin, weight gain, and heart rate of 60 beats/min are not assessment findings that require immediate action. Nystagmus is the only symptom presented that could be determined to be a toxic effect of therapy.

Which action is the highest priority for a patient who is receiving antiepileptic drug therapy for the first time? A. Weighing the patient weekly B. Observing for suicidal tendencies C. Teaching the patient about side effects of therapy D. Encouraging regular checkups with the healthcare provider

B. Observing for suicidal tendencies The nurse should observe the patient for changes in mental status and suicidal tendencies and teach the patient's family to observe for these potential side effects when the patient returns home. Teaching about side effects would be an appropriate second priority. Encouraging checkups and weighing the patient would most likely be prudent but not the highest priority for the patient.

A parent calls the clinic to state that a child, who has a history of a seizure disorder, has a rash all over the torso. What is the most appropriate assessment question for the nurse to ask? A. Ask the parent if the child has seasonal allergies. B. Ask the parent if the child has been outside today. C. Ask the parent if the child is on any new medication. D. Ask the parent to hold all medications and come into the clinic.

C. Ask the parent if the child is on any new medication. The most appropriate question is to ask if the child is on any new medication. Several antiseizure medications can cause a rash as an adverse effect. Seasonal allergies are unlikely to cause a rash on the torso. Holding all medications should not be recommended without first assessing what medications the child is taking. If a child received a rash as a result of coming in contact with something outside, it is most likely to occur on the hands and arms or other exposed skin, not on the torso.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? A. Consult the prescriber to recommend an increased dose. B. Tell the patient to hold today's dose and return to the clinic. C. Continue as planned, because the level is within normal limits. D. Have the patient call 911 and meet the patient in the emergency department.

C. Continue as planned, because the level is within normal limits. The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block? A. Tiagabine [Gabitril] B. Felbamate [Felbatol] C. Lacosamide [Vimpat] D. Levetiracetam [Keppra]

C. Lacosamide [Vimpat] Lacosamide can prolong the PR interval and should be used with caution in patients with cardiac conduction problems and in those taking other drugs that prolong the PR interval, such as calcium channel and beta blockers. Felbamate, tiagabine, and levetiracetam do not affect the PR interval.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? A. Reddened, swollen gums B. Increased risk of infection C. Nausea, vomiting, and indigestion D. Central nervous system depression

C. Nausea, vomiting, and indigestion Valproic acidis generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.

The nurse is administering morning medications. Which administration technique is an error? A. The nurse administers intravenous Dilantin with a filter. B. The nurse adminsters phenobarbital elixir with fruit juice. C. The nurse administers carbamazepine with grapefruit juice. D. The nurse administers gabapentin without checking when the patient ate.

C. The nurse administers carbamazepine with grapefruit juice. Carbamazepine is not to be given with grapefruit juice as this can lead to increased toxicity of the drug. Dilantin is adminstered IV with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.

A provider has ordered once-daily phenytoin [Dilantin] for an 8-year-old child who has a seizure disorder, and the parents say that it is impossible to have the child take pills by mouth. What intervention would the nurse recommend? A. The parents should learn to administer shots, and phenytoin could be given IM. B. The parents should open the medication and put it in food without the child's knowledge. C. The parents should ask the healthcare provider for a suspension form of the medication. D. The parents should request a chewable form of phenytoin and put it into the child's food.

C. The parents should ask the healthcare provider for a suspension form of the medication. Suspensions are an alternative to pills for young children. Phenytoin is never administered IM. Children's medications should not be mixed with food unknowingly, as this could lead to the child avoiding certain types of food. There is also the risk the child would not eat all of the food. Children should not be bribed with treats they are not normally allowed to eat as this can lead to manipulative behavior. Chewable forms of phenytoin should not be used for once-daily dosing.