Pharm - Chapter 14 - Antiepileptic Drugs

Which is the priority action when administering intravenous (IV) phenytoin therapy? 1 Monitor for side effects. 2 Monitor serum drug levels. 3 Flush the tubing after administration. 4 Administer by slow IV push.

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

A patient is receiving carbamazepine to treat trigeminal neuralgia. Which assessment finding indicates a therapeutic response to the medication? 1 Absence of facial pain 2 Improved ability to ambulate 3 Reduction in foot pain 4 Resolution of dizziness

1 Absence of facial pain Carbamazepine is indicated in the treatment of trigeminal neuralgia (a painful facial nerve condition). If the patient relates no facial pain, this is a therapeutic response to the medication. The medication is not used to assist a patient in walking or relieving foot pain or dizziness. It is also a first-line treatment for partial and generalized seizures.

Which information would the nurse include in the care plan of a young woman who has been prescribed phenytoin? 1 "Take your blood pressure daily." 2 "Use birth control while on this medication." 3 "Do not take this medication with grapefruit juice." 4 "If your weight increases, call your health care provider."

2 "Use birth control while on this medication." The nurse would tell the young woman to use birth control while on the medication because an increased incidence of fetal defects occurred in those who took phenytoin while pregnant. There is no need to take blood pressure daily or call the health care provider with weight increase. There is no contraindication with grapefruit juice.

Which medication would the nurse anticipate the health care provider to prescribe for a patient who has developed status epilepticus? 1 Diazepam 2 Lamotrigine 3 Gabapentin 4 Carbamazepine

1 Diazepam Diazepam is used to treat status epilepticus. Lamotrigine, gabapentin, and carbamazepine are used as primary and adjunct treatment of generalized seizures and will not be effective in stopping seizures during status epilepticus.

In administering barbiturate therapy for seizure disorders, which assessments are essential for the nurse to perform? Select all that apply. 1 Room safety measures 2 Neurologic assessment before administration 3 Drug levels before each dose of medication 4 Vital signs before medication administration 5 Electroencephalogram (EEG) monitoring before each dose of medication

1 Room safety measures 2 Neurologic assessment before administration 4 Vital signs before medication administration Before administering barbiturates, the nurse would assess the room for safety measures, perform a neurologic assessment, and assess vital signs. The patient should be taught the meaning of safety assessments and encouraged to remain in bed and ring the call bell for assistance. Monitoring drug levels is done periodically, depending on the potency of the medication, but is not performed with each dose. EEG monitoring is not performed before administering each dose of medication but may be performed before the start of therapy or to monitor therapy periodically.

A patient was prescribed gabapentin for neuropathic pain. Which information is appropriate to include in the patient's discharge teaching? 1 Take the medication before meals. 2 Do not drink alcohol while on this medication. 3 Take the medication with a full glass of water. 4 Stop the medication if you develop gastric upset.

2 Do not drink alcohol while on this medication. Gabapentin is effective as a single-drug therapy for new-onset epilepsy and is most commonly used for the treatment of neuropathic pain. It is essential to teach the patient that he should not drink alcohol while on the medication, as it contributes to neurologic depression and sleepiness. When a patient is prescribed gabapentin, a thorough neurologic assessment should be performed. The patient should be taught why he is receiving the drug and what should be done for side effects. This medication is taken without regard for meals and should not be stopped immediately, even for gastric upset. The health care provider should be notified, and if this is the best medication for the patient, interventions should be tried.

Which is the appropriate method for the nurse to prepare a dosage of a suspension medication for a pediatric patient? 1 Pour it into a teaspoon. 2 Draw it up in an oral syringe. 3 Pour it into a medication cup. 4 Pour the suspension without shaking.

2 Draw it up in an oral syringe. When preparing a dosage of a medication in suspension form for a pediatric patient, the nurse would shake the container well and draw the dosage up with an oral syringe, which provides more accurate dosing than a teaspoon or medication cup.

The health care provider has ordered once-daily phenytoin for an 8-year-old child who has a seizure disorder. The parents state the child cannot swallow pills. Which intervention would the nurse recommend to the health care provider? 1 Suggest another medication be prescribed. 2 Suggest the phenytoin be administered intramuscularly. 3 Ask for a suspension form of the medication to be prescribed. 4 Ask for an intravenous form of the medication to be prescribed.

3 Ask for a suspension form of the medication to be prescribed. Suspensions are an alternative to pills for young children. Because the majority of medications are in pill form, it is unlikely that switching the medication is the best intervention. The nurse would first attempt to have the patient take the prescribed drug. Phenytoin is never administered intramuscularly. Intravenous administration is not practical for home use in a child.

Which nursing action is appropriate for a patient in status epilepticus? 1 Apply restraints and remain with the patient. 2 Apply restraints, start an intravenous line, and administer intravenous diazepam. 3 Start an intravenous line and administer intravenous diazepam. 4 Start an intravenous line and administer intravenous pain medications.

3 Start an intravenous line and administer intravenous diazepam. During status epilepticus, the nurse would monitor oxygenation, start an intravenous line, protect the patient from injury, and administer intravenous diazepam. If the seizures do not stop, the patient may have apnea, hypotension, and cardiac dysrhythmias. The patient should not be restrained, because this could lead to further harm. Pain medication is not administered. Other intravenous medications that may be administered are phenytoin, phenobarbital, and lorazepam.

The nurse is reviewing laboratory results for four patients receiving antiepileptic drugs. Which result needs to be immediately reported to the health care provider? 1 Levetiracetam 30 mcg/mL 2 Valproic acid 100 mcg/mL 3 Phenobarbital 32 mcg/mL 4 Carbamazepine 30 mcg/mL

4 Carbamazepine 30 mcg/mL The therapeutic range for carbamazepine is 4 to 12 mcg/mL. A patient's result of 30 mcg/mL is a toxic level and should be reported immediately to the health care provider because this indicates toxicity and may lead to adverse effects. The therapeutic range for levetiracetam is 12 to 46 mcg/mL; valproic acid, 50 to 125 mcg/mL; and phenobarbital, 15 to 40 mcg/mL, and the patients have normal blood levels of these drugs.

Which drug would the nurse expect to administer to a patient as the first line of treatment for generalized tonic-clonic seizures? 1 Pregabalin 2 Topiramate 3 Valproic acid 4 Carbamazepine

4 Carbamazepine Carbamazepine is usually the first-line treatment for generalized tonic-clonic and partial seizures. Pregabalin and topiramate are used as adjunct therapy for partial seizures. Valproic acid is used mainly for absence, myoclonic, and tonic-clonic seizures.

Which information is important to teach the patient taking valproic acid for seizure management? 1 Do not take the medication with meals. 2 Take the medication every other day only. 3 Take the medication an hour before or after other medications. 4 Do not take the medication with milk or carbonated beverages.

4 Do not take the medication with milk or carbonated beverages. Oral forms of valproic acid are not to be given with milk, because this may cause the drug to dissolve early and irritate the mucosa. Carbonated beverages must also be avoided during the time of drug administration. The medication can be taken with meals. The medication is taken daily to maintain blood levels and can be given with other medications.

Which antiepileptic drug may cause gingival hyperplasia? 1 Phenytoin 2 Gabapentin 3 Phenobarbital 4 Levetiracetam

1 Phenytoin The antiepileptic drug phenytoin may cause gingival hyperplasia. Gingival hyperplasia refers to an increase in the size of the gums. Gabapentin, which is an antiepileptic drug, may cause visual and speech changes, edema, and dizziness. The antiepileptic drug phenobarbital may cause apnea and hypotension. Levetiracetam, an antiepileptic drug, may cause hyperactivity and behavioral changes, such as anxiety, hostility, agitation, or suicidal ideation.

The nurse is assessing four patients who have seizures and are started on medication therapy. Which nursing assessment is correct for the prescribed therapy? 1 Barbiturate therapy being assessed for a rash. 2 Gabapentin therapy being assessed for anemia. 3 Iminostilbene therapy being assessed for neurologic symptoms. 4 Levetiracetam therapy being assessed for neuropsychiatric symptoms.

4 Levetiracetam therapy being assessed for neuropsychiatric symptoms. The patient prescribed levetiracetam should be assessed for neuropsychiatric symptoms to prevent drug-related agitation and depression. The patient prescribed barbiturates should be monitored for neurologic symptoms and vital signs for adverse effects, not assessed for a rash. The patient prescribed gabapentin should be assessed for neurologic symptoms, not anemia. There is no risk for anemia with this drug. The patient prescribed iminostilbene should be assessed for aplastic anemia because of possible drug interactions. There is no risk of specific neurologic side effects with this drug therapy.