Anticonvulsants & Antiepileptics

Question 1

Phenytoin

Answer 1

• Suppress Na influx
• PO, IV
  - PO: shake well for 2 min
  - IV: in-line filter; monitor for extravasation
• Side effects: harmless pink-red urine, headache, dizziness, sedation, diplopia, nystagmus, dysrhythmia, bradycardia, hypotension, syncope, gingival hyperplasia, hirsutism
• FALL RISK
• Contraindications: pregnancy
• Nursing: warm against falls & driving
• Decreases effectiveness of oral contraceptives & warfarin
• Diabetics need to monitor for hyperglycemia
• Blood dyscrasia & monitor for rash (Stevens-Johnson)
• Has narrow therapeutic range
• Do not discontinue abruptly

“Please Hang Grandmas Purple Hair Down Stairs With Others”
“Don’t Need No Hot Guys”

Question 2

Valproic Acid

Answer 2

• Suppress Ca influx
• Side effects: dizziness, ataxia, diplopia, impaired cognition, nervousness, pancreatitis (abd pain, N/V), thrombocytopenia
• Contraindication: pregnancy & children <2 years old
• Narrow therapeutic range

”

Question 3

Gabapentin

Answer 3

• Promotes GABA release
• Secondary indications: neuropathic pain, restless leg syndrome, fibromyalgia, phantom pain & paresthesia
• Side effects: ataxia & fall risk, angioedema, GI distress (N/V, diarrhea, constipation)
• Monitor for dizziness/drowsiness, confusion, depression, suicidal thoughts

GABA = GI, ataxia, blundering (falls), angioedema

Question 4

Phenobarbital

Answer 4

• Enhance action of GABA; long acting barbiturate
• Indication: anti-epileptic, sedative, hypnotic
• NO REVERSAL AGENT (usually replaced by benzos)
• Narrow therapeutic window; easy to overdose
• Side effects: respiratory depression, bradycardia, ataxia, dependence & tolerance, REM rebound (vivid dreams & nightmares), hangover effect, skin eruption, constipation, paradoxical effects (anxiety)
• Decreases the effects of oral contraceptives
• Contraindications: pregnancy & with use of other sedative-hypnotics (alcohol, opioids)

Question 5

Clonazepem, Diazepam & Lorazepam

Answer 5

• Enhance action of GABA
• Usually prescribed to treat acute status epilepticus
• Must be administered IV to achieve desired response
• Dose adjust every 6 monthsv
• Benzos Break Seizure IVP

Question 6

Cannbidiol

Answer 6

• CBD oil drop
• Schedule V (marijuana is schedule I)
• Indication: 2 types of rare & severe epilepsy in patients 2 years or older
• Side effects: sleepiness, sedation, lethargy, liver failure, decreased appetite, diarrhea, rash, weakness, no euphoria, no psychoactive

“Some Friends Like Weed. Austin Reed Does Like Smoking.”