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Pharmacology > Anti-seizure Meds Ch 23 > Flashcards

Anti-seizure Meds Ch 23 Flashcards

1
Q

Describe epilepsy

A

-Sudden discharge of excessive electrical energy from nerve cells
-May stimulate motor neurons causing contractions/muscle spasms
-Treatment depends on type of seizure and manifestations

Manifestation of seizures depends on:
-Location of cells initiating electrical impulse
-Pathways that are stimulated

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2
Q

What is are primary seizures?

A

-No underlying cause, there isn’t a reasoning its happening

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3
Q

What is secondary seizures?

A

-Could be cause by outside factor like head trauma, overdose, but a reasoning that is causing the excessive impulses

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4
Q

What is a generalized seizure?

A

-Begins in one area, spreads and involves LOC
-Involves both hemisphere and loss of consciousness
-Multiple classisfications like:
-Tonic clonic
-Absence
-Tonic
-Atonic
-Myoclonic
-Status epilepticus
-Febrile

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5
Q

What are partial seizures?

A

-Usually focal origin, does not spread
-Presentations depends on the area of the foci
-Involve one area of the brain,
-Pt can be presenting symptoms depending on where in the brain the seizures are happening

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6
Q

What is a tonic clonic seizure?

A

*Generalized seizure
-Motor type seizure with stiffening(tonic) and clonic (jerking)
-Person may have a vague sensation that warns them that the tonic contractions are about to begin

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7
Q

What are absence seizures?

A

*Generalized seizure
-Absent seizures, loss of consciousness from 3- 5 seconds
-could be just blinking and blank staring, no motion or contractions

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8
Q

What are atonic seizures?

A

Could be generalized or focal
Seizures that causes sudden loss of muscle tone
-Limp in extremities and facial muscles

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9
Q

What is the myoclonic seizure?

A

Can be either motor or non motor
-Muscle contractions that can be isolated to the face, trunk, extremity
-More rare and secondary seizures

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10
Q

What is status epilepticus?

A

-Seizures happening rapidly with out cognitive recovery in between
-Most sever form of generalized seizures and a medical emergency

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11
Q

What is a Febrile seizure?

A

-Mostly occur to children 3 months -6 years old
-High fevers that results in families

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12
Q

What do drugs that are for generalized seizures do?

A

-Stabilize nerve membrane by blocking channels in the cell membrane
-Effect mainly the CNS
-Effect the entire brain

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13
Q

What are drugs used for generalized seizures?

A

Hydantoins- phenytoin (Dilantin)
Barbituates- phenobarbital (Luminal)
Benzos- diazepam (Valium)
Succinimides- ethosuximide (Zarontin)

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14
Q

What are Hydantoins used for ?

A

Generalized seizures

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15
Q

What is Phenytoin(Dilantin)?

A

Hydantoins
which is used for generalized seizures

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16
Q

What is the therapeutic action of Phenytoin(Delantin)?

A

Hydantoins
-Stabilize nerve membranes throughout the CNS directly by influencing Ionic channels in the cell membrane, stopping sodium movement
-Less sedating than other anti epileptics
-Decreasing excitability and hyperexictlybilty to stimulation

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17
Q

What are the indications of phenytoin (Dilantin)?

A

Hydantoins
-Generalized seizures
-Help treat tonic clonic seizures
-Treatment of seizures after surgery
-Prevention of status epilepticus

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18
Q

What are pharmokinetics of phenytoin (Dilantin)?

A

Hydantoins
Well absorbed in the GI tract, metabolized in liver, and excreted in urine
-Therapeutic serum levels is 10-20 mcg/mL

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19
Q

What are adverse effects of phenytoin (Dilantin)?

A

Hydantoins
-CNS depression (esp when starting med)
Depression, confusion, drowsiness ,legarthy, fatigue, constipation ,dry mouth, anorexia, urinary retention
-Ataxia-seen with overdose/dose regulation
-severe Liver toxicity
-Bone marrow suppression
-Skin reactions
-Gingival hyperplasia(enlargement of gums)
-Dermatological reactions (hirsutism, stevens-Johnson syndrome)

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20
Q

What are contras for phenytoin (Dilantin)?

A

Hydantoins
Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities

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21
Q

What are cautions for phenytoin (Dilantin)?

A

Hydantoins
Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

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22
Q

What are drug to drug interaction for phenytoin (Dilantin)?

A

Hydantoins
ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

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23
Q

What is administration of phenytoin (Dilantin)?

A

Hydantoins
Do not stop abruptly! Can induce a seizure! Could put pt into status epilepticus
IV  sloooow, NS only, pain with IVP
Shake bottle well!! if in liquid
-Could be oral or IV

24
Q

What is phenobarbital (Luminal)?

A

Barbiturates

25
Q

What is the therapeutic actions of phenobarbital (Luminal)?

A

Barbiturates
-Inhibits impulses conduction in cerebellum, cerebral cortex, lower brainstem
-Decreases CNS excitation, motor response
-Reduce the tonic/clonic, muscular and emotional response to stimulation
-Not approved by FDA but given in US for emergency situations
SCHEDULE 4-risk for addiction and withdrawl

26
Q

What is the indications of phenobarbital (Luminal)?

A

-Barbiturates

-Generalized seizures

27
Q

What are adverse effects of phenobarbital (Luminal)?

A

Barbiturates

CNS depression
Sedation, hypnosis, anesthesia, respiratory depression, and deep coma
**Addiction/ withdrawal

28
Q

What are contras/cautions of phenobarbital (Luminal)?

A

Barbiturates

-Renal/hepatic dysfunction
- Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities
-Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

29
Q

What are drug to drug interactions with phenobarbital (Luminal)?

A

Barbiturates

ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

30
Q

What is diazepam (Valium)?

A

Benzodiazepines

31
Q

What is the therpeutic actions of diazepam (Valium)?

A

Benzodiazepines
-Potentiate the effects of GABA-stabilizing nerve endings, decreasing nerve excitability
-Cause muscle relaxations and relieve anxiety
-reduce tonic-clonic, muscular, and emotional responses to stimuli

32
Q

What are indications of diazepam (Valium)?

A

Benzodiazepines
Generalized seizures
calm the brain increasing gaba

33
Q

What is the adverse effects of diazepam (Valium)?

A

Benzodiazepines
-CNS depression: Depression, confusion,drowsiness, lethargy, fatigue, constipation,dry mouth, anorexia, cardiac arrhythmias and changes in blood pressur, urinary retention, loss libido
-Physical dependence and withdrawal
Watch for paradoxical effects
increased talkativeness, emotional release, excitement, and excessive movement

SCHEDULE 4-risk for addiction and withdrawl

34
Q

What is the Contras/cautions of diazepam (Valium)?

A

Benzodiazepines
-Pregnancy/lactation  weigh risks. Come with risk of fetal abnormalities
-Renal/ hepatic dysfunction** Can increase risk of liver toxicity if pt already has hepatic dys

35
Q

What is the drug-drug interactions of diazepam (Valium)?

A

ETOH, CNS depressants. BECAUSE its already a cns depressant , you will have increase cns depression

36
Q

What is a drug for Absence seizures?

A

valproic acid (Depakote)

37
Q

What is the therapeutic actions of valproic acid (Depakote)?

A

For absence seizures

38
Q

What are indications of valproic acid (Depakote)?

A

Absence seizures
Mania
Migraine prevention
focal seizures
Drugs for Absence Seizures

39
Q

What are adverse effects of valproic acid (Depakote)?

A

-CNS depression
-Liver toxicity
-Follow liver functions (LFTs), esp. first 6 months

-Thrombocytpenia
-pancreatitis
-hyperammonemia
Drugs for Absence Seizures

40
Q

What are contras/cautions of valproic acid (Depakote)?

A

-Severe liver/renal disease
-Pregnancy/lactation (weigh risk)
Drugs for Absence Seizures

41
Q

What are drug-drug of valproic acid (Depakote)?

A

May potentiate diazepam, barbiturates, anticoag meds
Drugs for Absence Seizures

42
Q

What is a drugs used for partial seizures

A

gabapentin (Neurontin)
levetiracetam (Keppra)
lamotrigine (Lamictal
**carbamazepine (Tegretol)

43
Q

What is carbamazepine(Tegretol)?

A

Drugs Used for Partial Seizures

44
Q

What is therapeutic actions of carbamazepine(Tegretol)?

A

Stabilizes nerve endings by altering sodium and calcium channels
Increasing activity of GABA

45
Q

What is Pharmacokinetics of carbamazepine(Tegretol)?

A

Oral
Long half-life (25-65 hrs)

46
Q

What are adverse effects of carbamazepine(Tegretol)?

A

-CNS depression
-GI effects (N/V, anorexia)
-BBW: Increased risk for suicidality
-Taper off  risk for sz if sudden withdrawal
-Edema
-Bone marrow supression

47
Q

What are contras of carbamazepine(Tegretol)?

A

Existing bone marrow suppression-not given to pt w bone. Marrow supression
Pregnancy/ lactation

48
Q

How do seizure medications affect children?

A

May impact on social/learning
May be more sensitive to sedation
May metabolize meds faster; increase dose by age/kg for control
Educate parents, involve children

49
Q

How do seizure medications affect older adults?

A

More sensitive to toxic effects, dose reduction

50
Q

What are ethnic considerations with seizure medications?

A

Arab/Asian Americans-metabolize differently. Metabolize drugs faster,so increased dose
Cultural considerations- Box 23.3 page 394
Ask about this

51
Q

Nursing Considerations:
Anti-Seizure medications
What should you assess?

A

Allergies
Co-morbidities
Pregnancy/ lactation status
Description of sz. Ask how frequently nd duration
VS, Neuro assessment
Physical assessment
Labs

52
Q

Nursing Considerations:
Anti-Seizure medications
What are nursing diagnosis?

A

Risk for injury r/t CNS effects of medication
Disturbed thought process r/t CNS effects
Risk for infection r/t bone marrow suppression

53
Q

Nursing Considerations:
Anti-Seizure medication
What are implementations?

A

Discontinue medication for toxic effects
Educate pt on administration:
Administer with food (if GI upset)
Take regularly, same time each day
Do not abruptly stop!
Do not crush, chew, open extended-release forms
Monitor for adverse effects
Educate pt on adverse effects and when to notify PCP
Monitor CBC, LFTs, therapeutic drug levels
Provide safety measures to protect against injury/ falls
Suggest wearing medic-alert bracelet
Pregnancy counseling
Dental/ mouth care (phenytoin)

54
Q

Nursing Considerations:
Anti-Seizure medication
What should you evaluate?

A

Patient compliance
Seizure control

55
Q
A
56
Q
A

Pharmacology (39 decks)

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