Anticonvulsants

Question 1

Seizure

Answer 1

Brief episode of abnormal electrical activity in nerve cells of the brain

Question 2

Convulsion

Answer 2

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

Question 3

Epilepsy

Answer 3

Chronic, recurrent pattern of seizures

Question 4

Primary Epilepsy

Answer 4

Idiopathic

Question 5

Secondary

Answer 5

Symptomatic

Trauma, infection, cerebrovascular disorder

Question 6

Status Epilepticus

Answer 6

Multiple seizures occur with no recovery between them
Results in hypotension, hypoxia, brain damage, and death
Treated with diazepam or lorazepam IV push, followed by phenytoin infusion

Question 7

Antiepileptic Drugs/Anticonvulsants

Answer 7

Therapy is usually lifelong
Controls and prevents seizures while maintaining a quality of life
Single-drug therapy before multiple-drug
Serum drug concentrations must be monitored

Question 8

AEDs Used to Manage Seizure Disorders

Answer 8

Barbiturates
Hydantoins
Iminostilbenes plus valproic acid
Second and third generation antiepileptics

Question 9

AED Indications

Answer 9

Prevention/control of seizure activity
Long-term maintenance therapy
Acute treatment of convulsions and status epilepticus

Question 10

AED Averse Effects

Answer 10

Black Box Warning: Suicidal thoughts and behavior

Long-term therapy with phenytoin may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies

Question 11

Phenytoin

Answer 11

First-line drug
Therapeutic drug levels are 10-20 mcg/mL
IV administration using normal saline and slow injection
Adverse Effects: gingival hyperplasia, acne, hirsutism, osteoporosis
PO or IV

Question 12

Phenytoin Nursing Interventions

Answer 12

Teach about ineffectiveness of oral contraceptives, do not let them discontinue abruptly, tell patient to take medicine at the same time every day, monitor serum drug levels, shake suspension well for 5 minutes

Question 13

Carbamazepine (Tegretol)

Answer 13

Second most commonly prescribed antiepileptic drug in the United States
Autoinduction of hepatic enzymes
Used for partial seizures and generalized tonic-clonic seizures
PO only

Question 14

Gabapentin (Neurontin)

Answer 14

Chemical analogue of GABA, a neurotransmitter that inhibits brain activity
Increases synthesis and synaptic accumulation of GABA between neurons
Adverse Effects: CNS and GI symptoms
Contraindications: Known drug allergy

Question 15

Valproic Acid

Answer 15

Used in treatment of generalized seizures, bipolar disorder, and partial seizures
Contraindications: drug allergy, liver impairment, urea cycle disorders
Adverse Effects: Hepatotoxicity and pancreatitis
Given PO or IV
Highly protein-bound

Question 16

Phenobarbital

Answer 16

Sedative and anticonvulsant
Used for seizure prevention
Adverse Effects: Sedation, respiratory depression, CV and CNS and GI reactions
Therapeutic Level: 10-40 mcg/mL
Contraindications: drug allergy, porphyria, liver/kidney impairment, respiratory illness
PO or IV