Pre Chapter 53: Drug Therapy for Seizure Disorders and Spasticity

An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse's most appropriate action?

Implement falls precautions-CNS depression creates a risk for falls, especially in older clients.

A nurse is caring for a patient who is starting gabapentin therapy. During the initial assessment the patient informs the nurse that he takes antacids every day. The nurse will stress to the patient that gabapentin should be taken

at least 2 hours after administering antacids.-The only important drug interaction of gabapentin is with antacids. Antacids reduce the bioavailability of the gabapentin by 20%. To avoid this interaction, gabapentin should be administered at least 2 hours after taking antacids.

A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?

dantrolene

What is the most common drug of choice prescribed for the treatment of seizure activity in adults?

phenytoin-The oldest and most widely used antiepileptic drug (AED), phenytoin is often the initial drug of choice, especially in adults. None of the remaining drugs are as widely prescribed.

What should the nurse include as a possible adverse effect when teaching a client about phenytoin?

Liver toxicity- Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.

A 44-year-old warehouse worker experienced a painful lower back injury that has not responded to treatment with nonsteroidal anti-inflammatory drugs. Consequently, the man's care provider is considering the short-term use of cyclobenzaprine (Flexeril). Which of the following assessment questions would inform the clinician's decision to prescribe this drug?

"Are you taking antidepressant medications these days?"

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."-Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders.

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."-Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.

A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment?

"This will likely make you drowsy, so don't take it before doing anything that would require alertness."-Cyclobenzaprine causes drowsiness because of CNS depression. There is no absolute prohibition against using the drug for more than five days; it is metabolized in the liver but is not noted to be highly hepatotoxic. Sedation is an anticipated adverse effect, not a sign of a serious drug reaction.

One week ago, a client began taking ethosuximide 500 mg/day PO for the treatment of absence seizures. The client reports gastrointestinal (GI) upset after taking with the drug. What health education should the nurse provide?

"Try taking your pills at the same time as you eat some food."

A nurse who gives care on a neurological floor is working with several clients. Which client should the nurse prioritize for further assessment and possible interventions?

A client receiving pregabalin who is not responsive to verbal stimuli-A client's decreased level of consciousness would be a priority for further assessment. It could be indicative of excessive CNS depression if the client is unable to be roused by voice.

The nurse is assessing the records of a client in preparation to administer an antiepileptic and notes the new order for periodic complete blood counts. Which new medication(s) does the nurse prepare to administer? Select all that apply.

A client taking carbamazepine or felbamate should be monitored closely for pancytopenia. Clients receiving phenytoin should have routine drug serum levels evaluated to monitor for possible toxicity. Valproic acid and zonisamide do not require a specific blood evaluation.

A client in status epilepticus has been brought to the emergency department. The nurse should anticipate which treatment measures?

Administration of intravenous lorazepam-Although diazepam has been the traditional treatment for status epilepticus, research has shown that lorazepam is more effective than diazepam or phenytoin used alone for cessation of seizures and has an effective duration of up to 6 hours compared to 20 minutes for diazepam. Oral medications are not administered during status epilepticus and neither zonisamide nor gabapentin are used to treat this health crisis.

A client has been admitted to the emergency department and is experiencing tonic-clonic seizures. What intervention should the nurse prioritize?

Administration of phenytoin IV as prescribed

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?

Hepatic dysfunction-Dantrolene therapy must be discontinued at any sign of liver dysfunction. Intermittent GI upset, visual disturbances, and urinary retention are associated adverse effects of the drug and, although problematic, do not necessitate discontinuing the drug.

The nursing instructor is teaching a group of students about drugs used for muscle spasms and cramping. The instructor determines the session is successful when the students correctly choose which instruction as relevant to skeletal muscle relaxants?

Avoid alcohol or other CNS depressants.-The nurse should instruct the client to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct clients taking drugs for osteoporosis to take them with 6-8 ounces of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct clients with gout to take drugs for treating gout with food.

The nurse is caring for a client who is being discharged home from the rehabilitation unit. Baclofen will be discontinued, and the client will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration when discontinuing the client's baclofen?

Baclofen must be tapered down over 1 to 2 weeks to prevent psychoses and hallucinations.- If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done. Four to 6 weeks is unnecessary for the transition.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation?

Baclofen-Baclofen is an example of a skeletal muscle relaxant.

The nurse is caring for an 84-year-old client in the acute care facility who was newly diagnosed with a seizure disorder. Before starting the client on an antiepileptic medication that will be continued after discharge, what laboratory studies should the nurse assess? Select all that apply.

Baseline kidney and liver function tests should be done and results will guide dosing of the antiepileptic medication because clients with liver or kidney disease will require lower dosages of medication. Serum drug levels will not be drawn until after specific medications are started. Cardiovascular and central nervous system function studies are not indicated.

A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug?

Carbamazepine is often the drug of choice for treatment of partial seizures, which are described in this scenario. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those clients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia.

A client with a musculoskeletal disorder is unable to ambulate due to significant pain and immobility issues. Which care should the nurse prioritize for this client?

Changing the client's position every 2 hours

A toddler brought into the clinic by the parents is flaccid and cyanotic. The parents relate that just prior to arrival, the toddler was running a fever of 104.3°F (40.2°C) and began twitching uncontrollably. What is the nurse's first priority?

Check the airway.-Basic life support guidelines require evaluation of airway, breathing, and circulation as the nurse's first priority.

A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care?

Contact the health care provider immediately if rash appears.

The nurse is caring for a client who has just been prescribed cyclobenzaprine 100 mg PO t.i.d. What is the nurse's best action?

Contact the prescriber to confirm the dose.-The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be increased to a maximum of 60 mg/day. As a result, the nurse must clarify this potentially unsafe dose.

The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine?

Cyclobenzaprine produces an anticholinergic response-Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Dantrolene-Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

The nurse is administering phenytoin to a client who is also receiving a continuous nasogastric enteral feeding and is aware of what possible effect?

Decreasing the absorption of the AED-The use of continuous nasogastric enteral feedings may decrease the absorption of phenytoin administered through the same route, predisposing the client to the risk of seizure activity.

A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?

Drowsiness

Which type of seizures involves a loss of consciousness?

Generalized seizures-

When reviewing a journal article about seizure disorders, the nurse would expect to find tonic-clonic seizures and myoclonic seizures being classified as which type of seizures?

Generalized seizures- Tonic-clonic seizures and myoclonic seizures are classified as generalized seizures. Partial seizures can be simple or complex. Complex seizures are partial seizures that involve impaired consciousness and variable unconscious repetitive actions, staring gaze, and hallucinations/delusions. Atonic seizures are a type of generalized seizure involving the loss of muscle tone where the person suddenly drops.

A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug?

Observe respirations frequently.-When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently.The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant.

A client is to receive ethotoin. The nurse would expect to administer this drug by which route?

Oral

The nurse has administered anakinra to a client. Which assessment finding should the nurse prioritize?

Pancytopenia-Due to the immunosuppressive properties of DMARD drugs, pancytopenia is an adverse effect of anakinra, a DMARD, and the client should be monitored for it closely. Administration of anakinra may also cause headache and irritation at the injection site, but not constipation, abdominal pain, or retinal changes. Constipation is a potential adverse reaction to cyclobenzaprine. Retinal changes are potential adverse reactions to hydroxychloroquine. Pancytopenia is a potential adverse reaction to sulfasalazine, alendronate, ibandronate, risedronate, allopurinol, and colchicine.

A nurse is administering lorazepam to a client with status epilepticus. The nurse will be prepared to administer which additional drug to treat the status epilepticus for the next several hours?

Phenytoin

The nurse has completed a teaching with a client prescribed phenytoin daily for seizure activity. The nurse determines the session is successful after the client correctly chooses which potential adverse reaction that can occur if the client misses a dose of medication?

Recurrence of seizures-Recurrence of seizure activity may result from abrupt discontinuation of the drug, even when the anticonvulsant is being administered in small daily doses. Abrupt discontinuation of the drug does not cause CNS depression, hypotension, or nystagmus. CNS depression, hypotension, and nystagmus are adverse reactions of phenytoin.

A nurse is preparing to administer carbamazepine to a client. The nurse should question the health care provider about this order if which disorder is noted in the client's history?

Renal impairment

A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication?

Review the client's laboratory blood work.

A 77-year-old client is being admitted to a long-term care facility. The client has a history of absence seizures has been treated with ethosuximide for many years. While the nurse is creating a plan of care on the client, the nurse understands the potential adverse effects of this drug and would consequently prioritize which nursing diagnoses?

Risk for Falls- Common adverse effects of ethosuximide are drowsiness, dizziness, and lethargy- which potentiates the risk for fall in this client. Respiration, urinary function, and skin integrity are not normally affected by the use of ethosuximide.

A client has been prescribed a subcutaneous medication to treat rheumatoid arthritis (RA). The nurse should teach the client to do which?

Rotate sites when administering the injections.

The nurse is conducting an ongoing assessment on a client who was administered ethotoin. Which finding should the nurse prioritize?

Slurred speech-The nurse should monitor the client for slurred speech, which is a sign of toxicity. Constipation, diarrhea, and urinary frequency are potential adverse reactions; however, these are not signs of ethotoin toxicity.

A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action?

Tell the client to take no further doses and come be assessed at the clinic immediately.-The nurse should inform the client to discontinue the drug and return to the clinic. Rashes associated with the use of lamotrigine can be life-threatening. The client needs to return to the clinic to be evaluated and will need a change of medication. Recommending another medication is insufficient, and is also beyond the nurse's scope. High-fat foods are of no benefit.

A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider?

The client's most recent laboratory results show an upward trend in AST and ALT levels

A client with a family history of malignant hyperthermia is to have bowel resection surgery and has been prescribed dantrolene 2.5 mg/kg IV one hour before surgery. The client weighs 185 lbs. The nurse reconstitutes dantrolene to a concentration of 50 mg/mL and should add how many mL to the IV minibag? Provide your answer to one decimal place.

The client's weight must first be converted to kg by dividing by 2.2. This yields 84.1 kg. The client is to receive 2.5 mg/kg and 2.5 X 84.1 = 210.25 mg. Dividing 210.25 by 50 mg/mL = 4.2 mL.

What is a common risk for epileptic seizures during late infancy to early childhood?

fever- Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.

A nurse is working with a 39-year-old client who is experiencing muscle spasms associated with multiple sclerosis. The client reports needing help with basic care The client's health care provider has prescribed baclofen (Lioresal). The nurse and the client agree that an appropriate goal related to helping to maintain self-worth would be to:

increase self-care in activities of daily living.

The nurse is providing education to an adult client who has been prescribed lamotrigine for a seizure disorder. The nurse should inform the client that the medication must be stopped if what unexpected reaction develops?

skin rash

What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness?

status epilepticus