Ch. 14 Antiepileptic Drugs

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). Which condition will the nurse suspect that the patient experiences? A. Absence seizures B. Tonic-clonic seizures C. Panic attacks D. Partial seizures

A. Absence seizures Ethosuximide is used to treat absence seizures.

1. The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common side effect is the nurse educating the patient about for this medication? A. Gingival hyperplasia B. Oral candidiasis C. Increased risk of dental abscesses D. Increased incidence of dental caries

A. Gingival hyperplasia A side effect of phenytoin is overgrowth of gum tissue, or gingival hyperplasia. This can be minimized by frequent oral hygiene.

While completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that what potential complication could occur if he or she abruptly stopped taking the antiepileptic drug? A. Rebound seizure activity B. Acute withdrawal syndrome C. Hypotension D. Confusion and delirium

A. Rebound seizure activity Abrupt withdrawal of antiepileptic drugs can cause rebound seizure activity.

A patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply.) A. Tremors B. Weight gain C. Hepatoxicity D. Hypoglycemia E. Insomnia

A. Tremors B. Weight gain C. Hepatoxicity The main adverse effects of valproic acid (Depakote) include drowsiness; nausea, vomiting, and other gastrointestinal disturbances; tremor; weight gain; and transient hair loss. The most serious adverse effects are hepatotoxicity and pancreatitis. It is not known to cause hypoglycemia.

When administering intravenous phenytoin (Dilantin), which action will the nurse perform? A. Always use an infusion pump. B. Flush the line with normal saline before and after administration to prevent precipitation. C. Administer through peripheral intravenous sites only. D. Monitor for hypertension.

B. Flush the line with normal saline before and after administration to prevent precipitation. Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. Flushing with normal saline before and after minimizes precipitation. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred.

A postoperative craniotomy patient is received in the intensive care unit. The nurse makes sure which prescribed drug is readily available to treat acute seizure activity? A. gabapentin (Neurontin) B. diazepam (Valium) C. ethosuximide (Zarontin) D. flumazenil (Romazicon)

B. diazepam (Valium) Therapy for acute seizure activity is typically diazepam (Valium), which is considered by many to be the drug of choice. Other drugs used for acute therapy include lorazepam, fosphenytoin, phenytoin, and phenobarbital.

The patient asks the nurse why she is receiving a different drug than her usual phenytoin (Dilantin). The patient is NPO (nothing by mouth) secondary to illness and is receiving intravenous fosphenytoin (Cerebyx). Which is the nurse's most accurate response? A. "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug." B. "Phenytoin is not effective while you are NPO, so your health care provider has changed your medication to a more effective drug." C. "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin." D. "Since you are NPO, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will be transferred back to phenytoin after you recover from this illness."

C. "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin." Fosphenytoin (Cerebyx) was developed in an attempt to overcome some of the physical shortcomings of phenytoin sodium. Fosphenytoin is a water-soluble, phosphorylated phenytoin derivative that can be given intramuscularly or intravenously without causing the pain associated with the present product. The pH of fosphenytoin is less alkaline and easier on the veins. Once administered, it is converted in the body to phenytoin.

The patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic? A. 8 mcg/mL B. 30 mcg/mL C. 12 mcg/mL D. 6 mcg/mL

C. 12 mcg/mL Therapeutic serum drug levels for phenytoin are between 10 and 20 mcg/mL.

While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication? A. Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months. B. Reducing seizure occurrence to one per week. C. Maximally reducing seizure activity while minimizing side effects of medication therapy. D. Maximizing drug dosages to control seizure activity.

C. Maximally reducing seizure activity while minimizing side effects of medication therapy. Anticonvulsant medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects.