Pharm Exam 3 Antiepileptic Drugs

Which information would the nurse provide about how antiepileptics work? 1 Suppress brain activity. 2 Alter the movement of electrolytes. 3 Enhance the nerve transmission impulses. 4 Increase the spread of electrical impulses.

Alter the movement of electrolytes. Evidence shows that antiepileptic drugs alter the movement of sodium, potassium, calcium, and magnesium ions. These changes result in more stabilized and less excitable cell membranes. They do not suppress brain activity. They limit the spread of seizure discharge by suppressing, not enhancing, the transmission of impulses from one nerve to the next.

Which intervention will help maintain therapeutic levels of an antiepileptic drug? 1 Give the medication every 8 hours. 2 Administer the medication intravenously. 3 Administer the medication only during the day. 4 Establish a drug regimen based on the half-life of the medication.

Establish a drug regimen based on the half-life of the medication. Antiepileptic drugs should be administered by using as long an interval between doses as possible, depending on their half-life. Giving the medication every 8 hours, administering the medication intravenously, and administering the medication only during the day will not provide the best maintenance of therapeutic levels, as these measures do not take into account drug half-life or pharmacokinetics.

he nurse is administering intravenous diazepam. When will the nurse expect the onset of action to occur? 1 Immediately 2 Within 1 hour 3 Within 5 minutes 4 Within 15 minutes

Immediately When diazepam is given intravenously, the nurse would expect the onset of the drug to occur immediately.

When administering phenytoin via intravenous (IV) push, which action will the nurse perform? 1 Monitor for hypertension. 2 Always use an infusion pump. 3 Administer through peripheral IV sites only. 4 Flush the line with normal saline before and after administration.

Flush the line with normal saline before and after administration. Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. While there is a risk of hypotension with the use of intravenous phenytoin, hypertension is not a potential risk. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred. Flushing with normal saline before and after administration minimizes precipitation and vein irritation.

A nurse is caring for a patient who has been started on antiepileptic drug therapy for seizures. Which information should be included in the teaching plan for the patient? 1 Alter drug therapy based on normal meal times. 2 If there are side effects of therapy, stop the drug. 3 Take the medication at the same time each day. 4 If this medication is not effective, another drug will be added.

Take the medication at the same time each day. t is important that the patient maintain consistent serum drug levels of antiepileptic medication to prevent seizure occurrence; thus the medication should be taken at the same time each day. Medication administration should not be changed based on meals. If a patient has side effects, he should call his health care provider, but not stop the drug. Stopping the drug abruptly can cause withdrawal seizures. If therapy with one drug fails, the drug is tapered off while a second one is introduced. Patients do not start on multiple-drug therapy unless single-drug therapy fails.

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

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

The nurse is administering intravenous phenytoin. When will the nurse expect the drug to take affect? 1 Immediately 2 Within 5 minutes 3 Within 15 minutes 4 Within 1 to 2 hours

Within 1 to 2 hours

he nurse is caring for a patient who has been taking phenytoin for the past week and has developed a rash. Which action would the nurse take first? 1 Monitor the area. 2 Assess the patient. 3 Apply a topical steroid cream. 4 Notify the health care provider.

Assess the patient. Development of a rash is evidence of a reaction to the drug. The nurse would first assess the patient to make certain no other side or adverse effects are noted. After assessment, the nurse would notify the health care provider. Finally, a topical cream may be applied with additional monitoring of the area.

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

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. Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.

Which antiepileptic drug would the nurse anticipate being prescribed for a patient with a diagnosis of generalized seizures related to Lennox-Gastaut syndrome? 1 Pregabalin 2 Phenytoin 3 Lamotrigine 4 Gabapentin

Lamotrigine Lamotrigine is used to treat generalized seizures related to Lennox-Gastaut syndrome. Pregabalin is used to treat partial seizures. Phenytoin is used to treat generalized seizures not associated with Lennox-Gastaut syndrome. Gabapentin is used to treat partial seizures.

Which information would the nurse provide the patient who is taking an antiepileptic drug with a narrow therapeutic index? 1 Take the medication every other day. 2 Keep the medication with you at all times. 3 Make certain the drug is taken at the same time daily. 4 Crush the drug for better absorption.

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. The medication should not be taken every other day unless that is specifically how it is prescribed. It is not essential that the patient keep the medication with him at all times. Crushing the drug will not change the absorption and will not alter therapeutic index, unless it is a sustained-/extended-release formulation.

Which action would the nurse include in the plan of care to prevent drug toxicities for a patient receiving antiepileptic drugs? 1 Examine oral cavity. 2 Monitor blood levels. 3 Administer with food. 4 Assess for seizure activity.

Monitor blood levels. The nurse would monitor blood levels of the antiepileptic medication to ensure levels stay in the therapeutic range to prevent toxicities. The oral cavity should be assessed due to the side effect of gingival hyperplasia when administering phenytoin. Taking antiepileptic drugs on an empty stomach can cause gastrointestinal upset, but not toxicities. Seizure activity may indicate less than therapeutic levels.

Which intervention is appropriate to include in discharge teaching for a patient prescribed phenytoin therapy? 1 Perform good oral hygiene. 2 See a physical therapist for tremors. 3 Stop the medication when you are seizure free. 4 Report drowsiness to your health care provider.

Perform good oral hygiene. The patient should perform good oral hygiene to help prevent the development of gingival hyperplasia. Drowsiness is a common side effect of antiseizure medication and should not be reported. The patient should continue the medication when a therapeutic response is seen, as discontinuation may result in the return of seizure activity.

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

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.

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.

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.

Which information would the nurse include when teaching a patient about the use of hydantoins to control seizures? 1 "Avoid sun exposure." 2 "Have annual eye exams." 3 "Maintain careful oral care." 4 "Report respiratory infections."

"Maintain careful oral care." Hydantoins can cause gingival hyperplasia, so good oral care is essential. Sun exposure is not a contraindicated with the use of hydantoins. Ezogabine can cause potential vision loss, which would necessitate annual eye exams. Respiratory infections can occur with barbiturates.

Which information would the nurse provide to a patient prescribed gabapentin? 1 "Refrain from alcohol consumption." 2 "Take the medication with citrus juice." 3 "Report any inflammation or skin sloughing." 4 "Notify the health care provider of any bleeding."

"Refrain from alcohol consumption" Many antiepileptic drugs (AEDs) including gabapentin should not be mixed with alcohol because this can lead to central nervous system (CNS) depression. Carbamazepine interacts with grapefruit juice. Lamotrigine can cause Stevens-Johnson syndrome, which causes inflammation and skin sloughing. Hydantoins such as phenytoin interfere with warfarin and can increase bleeding risks.

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

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 assessment indicates the patient is having a therapeutic response to valproic acid? 1 Nystagmus 2 Absence of seizures 3 Normal liver enzymes 4 Decrease in headaches

Absence of seizures Valproic acid is used to treat generalized seizures (absence, myoclonic, and tonic-clonic). Absence of seizures is the desired effect. Nystagmus is a potential side effect of some antiseizure medications. Elevation of liver enzymes is also a side effect. This medication does not decrease headache frequency.

Which food would the nurse instruct a patient to eliminate from the diet when taking carbamazepine? 1 Aged cheeses 2 Milk products 3 Grapefruit juice 4 Carbonated beverages

Grapefruit juice Grapefruit and its juice should be avoided in patients taking carbamazepine because it can lead to drug toxicity. Aged cheeses are avoided in patients taking monoamine oxidase inhibitors (MAOIs). Milk products and carbonated beverages should be eliminated in patients taking valproic acid.

The patient's serum phenytoin level is 31 mcg/mL. Which action by the nurse is appropriate? 1 Hold the medication. 2 Increase the medication dose. 3 Administer the medication intravenously. 4 Have the patient continue the current regimen.

Hold the medication. A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse would hold the medication then call the health care provider. Increasing the medication dose, administering the medication intravenously, and having the patient continue the current regimen are not safe options, as they will all lead to increased blood levels of the medication and further increase the risk of toxicity.

Which assessment is essential before a patient starts therapy with lamotrigine? 1 Platelet count 2 White blood cell count 3 Patient weight 4 Risk for Stevens-Johnson syndrome

Risk for Stevens-Johnson syndrome There are relatively few risks of side effects of lamotrigine therapy. However, there is a risk of a serious adverse effect, Stevens-Johnson syndrome. Patients of Asian descent should consider genetic testing for this condition. Patients with an HLA-B 1502 gene have an increased risk for Stevens-Johnson syndrome if they take this drug. The nurse would assess the patient for development of a rash if taking this medication. There is no need to assess platelet count, weight, or white blood cell count, as lamotrigine does not alter these patient characteristics.

A patient receiving phenytoin develops a measles-like rash. Which action by the nurse is appropriate? 1 Administer an antihistamine immediately. 2 Apply topical steroid cream for inflammation. 3 Instruct the patient to take oatmeal baths if it itches. 4 Stop the medication and notify the health care provider.

Stop the medication and notify the health care provider. The patient has a measles-like rash, which is an adverse effect of phenytoin. The nurse should stop administering the medication and notify the health care provider. Once the medication is stopped, the nurse should assess the patient and move on to interventions to assist in comfort care as needed.

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."

"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 information would the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? 1 "Do not take the medication if you have a fever." 2 "Lie in bed for at least an hour after taking your medication." 3 "Wait to see how you react to the medication before driving." 4 "Take the antiepileptic agent with milk or juice to prevent stomach upset."

"Wait to see how you react to the medication before driving." Antiepileptic medications suppress the central nervous system. The patient should know how the medication affects the central nervous system before attempting tasks such as driving. A fever is not a contraindication to taking an antiepileptic agent. The patient does not have to lie in bed for an hour after taking an antiepileptic agent. Several medications, including many antiepileptic agents, cannot be taken with milk or fruit juice, and the nurse would not instruct the patient to administer medication in this manner.

Which information would the nurse provide to increase safety for a patient with a new diagnosis of epilepsy who is being discharged on antiepileptic drugs (AEDs)? 1 "Obtain annual drug levels." 2 "Wear a medical alert bracelet." 3 "Refrain from driving for 3 years." 4 "Lower the dose if drowsiness occurs."

"Wear a medical alert bracelet." The patient should be instructed to wear a medical alert bracelet or necklace with the diagnosis of epilepsy as well as the drug prescribed to manage the disorder. Drug levels should be obtained more often than annually. Driving is limited for 6 months, not 3 years. Drowsiness is an anticipated side effect and the drug should not be lowered unless prescribed by the health care provider.

Which alteration represents the reason for many potential drug interactions with antiepileptic drug therapy? 1 Urinary output 2 Electrolyte balances 3 CYP450 enzyme metabolism 4 Renal function

CYP450 enzyme metabolism The mechanism for many drug interactions with antiepileptic therapy is the alteration of the CYP450 enzyme. The majority of antiepileptic drugs are metabolized through the CYP450 pathway rather than kidney metabolism; thus alterations in blood urea nitrogen and creatinine levels or urinary output are not a factor in drug interactions. Altered electrolyte balance does not necessarily interfere with antiepileptic drugs.

A patient with a seizure disorder is taking oral phenytoin and is nothing by mouth for elective surgery. Which nursing action is appropriate? 1 Draw a serum phenytoin level after surgery. 2 Administer the medication immediately postoperatively. 3 Call the health care provider to clarify medication orders. 4 Administer the oral phenytoin before the patient goes to surgery.

Call the health care provider to clarify medication orders. The nurse would call the health care provider to ask about administering the medication preoperatively. The medication could be given intravenously, but the nurse will need an order. Taking a serum phenytoin level will not help the nurse determine what should be done before surgery. The patient should not wait to get the medication after surgery, because blood levels may drop and precipitate a seizure. The nurse would not administer the oral form of the medication before surgery without an order.

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.

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.

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.

Which patient is most likely to have toxic effects of antiepileptic therapy? 1 The patient with a primidone level of 10 mcg/mL 2 The patient with a phenobarbital level of 8 mcg/mL 3 The patient with a valproic acid level of 50 mcg/mL 4 The patient with a carbamazepine level of 15 mcg/mL

The patient with a carbamazepine level of 15 mcg/mL The only value listed that is above therapeutic plasma levels is the carbamazepine, 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 and primidone) or below (phenobarbital) the therapeutic range. Toxicity does not typically occur with values at or below the therapeutic level.

A patient receiving lamotrigine therapy has started using oral contraceptives. Which information is appropriate for the nurse to teach the patient? 1 "This combination may cause liver toxicity." 2 "With oral contraceptive use, you may need more lamotrigine." 3 "This medication may stop your oral contraceptive from working." 4 "This medication, together with oral contraceptives, may cause toxicity."

"With oral contraceptive use, you may need more lamotrigine." When given with oral contraceptives, lamotrigine may need an increased dose to be effective because the oral contraceptives also compete for the CYP450 enzyme pathway. The combination should not cause liver toxicity or toxic drug levels. The medication combination should not cause the oral contraceptive to stop working.

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.

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.

The patient taking carbamazepine should be instructed to avoid taking the medication with which beverage? 1 Grape juice 2 Apple juice 3 Orange juice 4 Grapefruit juice

Grapefruit juice The patient who is taking carbamazepine should avoid drinking grapefruit juice because it may lead to toxicity of the medication. There are no contraindications for grape, apple, or orange juice.

A patient who has stopped taking her antiepileptic medication is admitted. Which assessment by the nurse is appropriate? 1 Assess for hypotension. 2 Assess for confusion and delirium. 3 Monitor for rebound seizure activity. 4 Monitor for acute withdrawal syndrome.

Monitor for rebound seizure activity. Abrupt withdrawal of antiepileptic drugs can cause rebound seizure activity. The nurse would monitor the patient for seizures and restart antiepileptic therapy with the patient's consent. Stopping antiepileptic therapy does not increase the patient's risk for developing hypotension or confusion and delirium. Acute withdrawal syndrome is associated with antidepressant medications, not antiepileptics.

A patient reports switching from brand-name antiepileptic drug therapy to generic drug products. Which intervention by the nurse is appropriate? 1 Call the insurance company. 2 Request a decrease in the patient's dose. 3 Request an increase in the patient's dose. 4 Monitor the patient's neurologic status closely.

Monitor the patient's neurologic status closely. Increased monitoring of the patient's neurologic status is necessary because there is concern that generic drugs may not be as effective as brand-name medications. When the patient switches preparations, the patient may have seizures if the blood level does not remain therapeutic. There is no need to call the insurance company. There is no need to suggest an increase or decrease in doses until the effects of the new drug are known.

The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. Which statement would the nurse include? 1 "You will only need to be on therapy for a few months." 2 "Your medication is chosen based on your type of seizure." 3 "You will be started on several drugs to control your seizures." 4 "Medication therapy is not essential in treating seizure disorders."

Your medication is chosen based on your type of seizure." Medication therapy for seizures is matched to the seizure diagnosis and is essential in treating seizure disorders. Therapy, in most cases, is lifelong unless used prophylactically. Single-drug therapy must fail before multiple-drug therapy is tried.

A patient is receiving phenytoin. Which information will the nurse include in the discharge teaching plan? Select all that apply. 1 "This medication may cause confusion." 2 "Check-ups with a cardiologist are essential." 3 "Respiratory assessments should be performed daily." 4 "Good dental care is essential while on this medication." 5 "Don't drive until you determine how the medication affects you."

"This medication may cause confusion." "Good dental care is essential while on this medication." "Don't drive until you determine how the medication affects you." The most common side effects of phenytoin are lethargy and cognitive changes as well as gingival hyperplasia. Confusion can be a result of this therapy. Good dental care is essential because the medication can cause gingival hyperplasia. The patient should evaluate how the drug affects him before driving. Cardiac and respiratory assessments are not necessary because phenytoin does not lead to respiratory or cardiac side or adverse effects.

The nurse instructs a patient receiving phenytoin to visit the dentist regularly and perform frequent oral hygiene. Which side effect will these interventions assist in preventing? 1 Oral candidiasis 2 Gingival hyperplasia 3 Dental abscesses 4 Dental caries

Gingival hyperplasia A side effect of phenytoin is overgrowth of gum tissue, or gingival hyperplasia. This can be minimized by frequent oral hygiene. Oral candidiasis, dental abscesses, and dental caries are not seen as risks of side effects from the use of phenytoin. While the risk of these conditions may be decreased with frequent oral hygiene, the question specifically asks what side effect related to phenytoin will this intervention assist in preventing. The only noted oral side effect with the use of phenytoin is hyperplasia of the gums, there is no increased risk of candidiasis, abscesses, or dental caries.

What is the goal of antiepileptic therapy? 1 Reducing seizure occurrence to once per week 2 Maximizing drug dosages to control seizure activity 3 Maximally reducing seizure activity while minimizing side effects of medication therapy 4 Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months

Maximally reducing seizure activity while minimizing side effects of medication therapy Antiepileptic medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects. It is not appropriate to put a limit on the number of seizures expected, such as one or two per week. The absolute goal is to control seizure activity as completely as possible. The goal is directed toward controlling the seizure activity, not maximizing drug dosages. If the medication is controlling the seizure activity, the patient should not be weaned off of the medication, as seizures then will most likely recur.