anticonvulsant

Question 1

what are anticonvulsants meant to do?

Answer 1

given for long-term protection against seizures like with patient with epilepsy and other long term chronic seizure disorders. LONG TERM AND LAST LONGER IN THE BODY AND PATIENTS can get very toxic!

Question 2

why is it used?

Answer 2

to manage seizure disorders and anxiety disorders

Question 3

Klonipin

Answer 3

CLONAZEPAM

Question 4

Valium

Answer 4

Diazepam

Question 5

Librium

Answer 5

CHLORDIAZEPOXIDE

Question 6

Ativan

Answer 6

Lorazepam

Question 7

Dilantin

Answer 7

Phenytoin

Question 8

Tegretol

Answer 8

CARBAMAZEPINE

Question 9

Keppra

Answer 9

LEVETIRACETAM

Question 10

LAMICTAL

Answer 10

LAMOTRIGENE

Question 11

Common side effects of anticonvulsants:

Answer 11

• drowsiness
• lethargy
• slurred speech
• hypotension=low blood pressure
• CNS depression
• GINGIVAL HYPERPLASIA (NCLEX)
• Mild skin rash or itching
• Discolored urine light rust color
• Hypoglycemia=LOW BLOOD SUGAR
• Dizziness, nervousness

Question 12

What are overdose symotoms?

Answer 12

• twitching’s eye movements
• loss of balance=ataxia
• fainting
• feeling light-headed
• slow or shallow breathing
• muscle stiffness or weakness
• slurred speech
• tremors
• nausea and vomiting’s
• dizziness
• drowsiness
• dry mouth
• aplastic anemia
• sleepiness
• weakness
• infection
• rash
• headache

Question 13

Nursing implications:

Answer 13

1. ) AVOID WITH patient that has LIVER DISEASE and DIABETES MELLITUS.
2. ) avoid alcohol
3. ) DO NOT CHEW OR CRUSH TABLETS= take whole
4. ) AVOID TAKING ANTACIDS at the same time as phenytoin- it inhibits absorption.
5. ) CARBAMAZEPINE should be taken with meals, AVOID GRAPEFRUIT JUICE.
6. ) Monitor liver function tests

Question 14

what should the nurse teach the patient on anticonvulsants?

Answer 14

• TO NOT STOP THEM ABRUPTLY
• WEAR A MEDIC ALERT BRACELET
• REPORT EASY BRUISING
• REPORT FEVER=high temperature
• REPORT BLOOD IN STOOL= black tarry stools.

Question 15

know that…

Answer 15

anticonvulsants:
-can become lethal in the body system

• cause drowsiness
• SHOULD NOT BE TAKEN WITH ANTACIDS AT THE SAME TIME SINCE IT DECREASES ABSORPTION so does NG tube feedings. so stop feedings 1 to 2 hours before and after administration of phenytoin.
• can raise blood sugar
• may change the urine color to a light rust color this is not dangerous to the patient
• will still allow the patient to have seizure despite being on the medication.. so watch for them!
• If your patient is on an ANVICONVULSANT initiate precautions.

Question 16

what should be the therapeutic range for phenytoin?

Answer 16

10 to 20

Question 17

a phenytoin below 10 what to do?

Answer 17

REPORT TO THE HCP since there’s a huge risk for seizure.

Question 18

a phenytoin above 20 what do you do?

Answer 18

Hold the medication and notify HCP! Due to the huge toxicity risk!

hold the phenytoin for levels higher than 20!!

Question 19

what needs to be monitored routinely in anticonvulsants like phenytoin?

Answer 19

ROUTINE BLOOD TESTS
BLOOD LEVELS MONITORED routinely.

we do this to check the therapeutic range of the drug as well as to monitor liver function. since any drug that causes toxicity affects the liver heavily.

Question 20

when is phenytoin taken?

Answer 20

take at the same time daily= because it has a narrow therapeutic index

Question 21

early TOXICITY signs to report to the HCP about phenytoin?

Answer 21

• ataxia (unsteady gait or gait disturbance)
• hand tremors
• slurred speech= having trouble forming sentences

Question 22

other adverse effects of phenytoin?

Answer 22

1. ) suicidal ideation
2. ) SKIN Rash that is “NEW”, “PAINFUL”= PRIORITY since it indicates Steven Johnson syndrome=REPORT TO THE HCP IMMEDIETLY.

Question 23

What are expected side effects of phenytoin or anticonvulsants?

Answer 23

1.) bradycardia=low heart rate

2.) hypotention =low blood pressure
since it is a CNS depressant meaning that we expect to the vitals will be low and slow.

3.) GINGIVAL HYPERPLASIA (NCLEX!)
overgrowth of gum tissue around the teeth resulting in big gums that bleed very easily. this is expected so do not stop the drug for this!

Question 24

what is the teaching on gingival hyperplasia?

Answer 24

1. ) GOOD DENTAL HYGIENE with soft toothbrush
2. ) regular dental visits and follow up care
3. ) teach the patient to inform dentist that they are taking phenytoin
4. ) perform or assist with other care every shift

5.) skin rash, fatigue, and dyspnea (SOB) ARE PRIORITY!!!
REMEMBER ANYTYPE OF skin rash can mean Steven Johnson syndrome.

Question 25

statements that require immediate intervention when on an anticonvulsant or phenytoin?

Answer 25

- I noticed a rash on my stomach last week=Steven Johnson - lately I find myself thinking about driving off a cliff - If i start having adverse effects I will stop taking this medication immediately=never stop abruptly or immediately. instead always taper off

Question 26

patient teaching for phenytoin or anticonvulsant?

Answer 26

1. ) no oral contraceptives=since it deactivates the pill and can lead to accidental pregnancies. SO WE TEACH PATIENTS TO USE ALTERNATIVE BIRTH CONTROL LIKE IUD. 2. ) DO NOT STOP ABURTLY 3. ) TAKE FOLIC ACID, CALCIUM, and VITAMIN D=ANTICONVULSANTS DECREASES FOLIC ACID ABSORPTION and bone density.

Question 27

what foods should be encouraged when on phenytoin or anticonvulsant?

Answer 27

encourage foods like milk, cantaloupe, and kale since they are foods high in folate and vitamin D.

Question 28

how is phenytoin administered with tube feedings?

Answer 28

tube feedings decrease the absorption of phenytoin and cause seizures so instead it is recommended: 1.) STOP TUBE FEEDINGS FOR 1 TO 2 HOURS BEFORE AND AFTER ADMINISTRATION!! mentioned multiple times as a priority!!! 2.) with tube feedings we FLUSH with 30-50 mL's of TAP WATER BEFORE AND AFTER THE DRUG IS GIVEN!! normal saline is not required

Question 29

how is phenytoin administered on IV insertion?

Answer 29

make sure to flush with NORMAL SALINE BEFORE AND AFTER

Question 30

Don't let the NCLEX trick you?

Answer 30

1.) gums typically bleed= this is normal because of overgrowth of the gum tissue so please do not report this!! But NOT THE FACE so you do not need to use an electric razor! 2. ) NO METALLIC TASTE. But is seen in METRONIDAZOLE 3. ) NO PHOTOSENSITIVTY

Question 31

When is LEVETIRACETAM given?

Answer 31

to prevent and treat seizures for THOSE THAT ARE AT A HIGH RISK such as: -brain tumor -surgery or trauma on the brain which can increase intracranial pressure

Question 32

why is LEVETIRACETAM preferred over phenytoin?

Answer 32

due to minimal drug to drug interactions. however it is a CNS depressants just like phenytoin.

Question 33

big common side effects of LEVETIRACETAM?

Answer 33

low and slow body with: drowsiness fatigue

Question 34

major adverse effects for LEVETIRACETAM? and what to key words to report?

Answer 34

just like phenytoin: -suicidal ideation REPORT KEY WORDS like: - NEW ANXIETY - NEW AGITATION - DEPRESSION - MOOD CHANGES -Steven Johnson syndrome REPORT KEY WORDS like: - rash - blistering - muscle joint pain - conjunctivitis

Question 35

key points for LEVETIRACETAM? PATIENT teaching?

Answer 35

PATIENT TEACHING: the patient needs to get PERMISSION FOR DRIVING FROM THE HCP & FOLLOW TRANSPORTATION DEPARTMENT GUIDELINES. since LEVETIRACETAM causes DROWSINESS AND FATIGUE WHICH IS COMMON IN THE FIRST 4 TO 6 WEEKS WHEN STARING THE MEDICATION. DO NOT LET NCLEX FOOL YOU!!! ALWAYS MAKE SURE TO GET DRIVING PERMISSION.

Question 36

What permission is needed for LEVETIRACETAM?

Answer 36

get PERMISSION FOR DRIVING FROM THE HCP & FOLLOW TRANSPORTATION DEPARTMENT GUIDELINES.