Chapter 14 - Antiepileptic Drugs

Question 1

What is epilepsy caused by?

Answer 1

excessive electrical activity of neurons in cerebral cortex

Question 2

What is a seizure?

Answer 2

brief episode of abnormal electrical activity in nerve cells of brain -> may/may not lead to convulsion

Question 3

What is a convulsion?

Answer 3

more severe seizure involuntary spasmodic contractions of any/all voluntary muscles in body, including skeletal, facial, and ocular

Question 4

What is epilepsy?

Answer 4

chronic, recurrent pattern of seizures

Question 5

Primary Epilepsy Another name and what cause

Answer 5

Idiopathic Epilepsy Cause cannot be determined more than 50% of cases

Question 6

Secondary Epilepsy Another name and what cause

Answer 6

Symptomatic Epilepsy Distinct cause identified: trauma, infection, cerebrovascular disorder Infants/children: r/t developmental defects, metabolic disease/injury at birth Adults: acquired brain disorder is major cause

Question 7

What are grand mal seizures now known as?

Answer 7

Generalized onset seizures

Question 8

What is happening in generalized-onset seizures?

Answer 8

neuronal activity originating simultaneously in both hemispheres

Question 9

What are the subtypes of generalized onset seizures?

Answer 9

1. Tonic-clonic
2. tonic
3. clonic
4. atonic (drop attacks)
5. myoclonic
6. absence and infantile spasms

Question 10

Who is generalized onset seizures most often seen in?

Answer 10

children

Question 11

How will a generalized onset seizure present itself to you?

Answer 11

1. loss of consciousness
2. no postical confusion
3. may have rhythmic movements
4. no convulsion

Question 12

What are the 3 types of partial-onset seizures?

Answer 12

1. Simple (used to be “petit mal seizures”)
2. Complex
3. secondary generalized tonic-clonic seizure

Question 13

Characteristics of Simple Partial-onset seizures

Answer 13

brief loss of awareness (blank stare), no LOC

hallucinations

autonomic nervous system responses

personality changes

motor symptoms are commonly at face, arms, and leg

Question 14

What are the classifications of seizures?

Answer 14

1. Partial seizures
   - simple
   - complex
2. Generalized seizures
3. Unclassified seizures

Question 15

Characteristics of Complex Partial-onset Seizures

Answer 15

impaired consciousness

memory impairment

behavioral effect

aura, chewing, swallowing, unreal feelings

tonic, clonic, or tonic-clonic seizures

Question 16

Characteristics of Secondary Generalized Tonic-Clonic Seizure

Answer 16

Partial onset seizures that progress

Occurs in up to 40% of pts

Postictal confusion

Question 17

What is an Unclassified Seizure?

Answer 17

Seizures that do not fit into any other category

Question 18

What can status epilepticus lead to?

Answer 18

hypotension, hypoxia, and cardiac dysrhythmias

which can all lead to brain damage and death

Question 19

What is status epilepticus?

Answer 19

multiple seizures occurring without recovery between

Question 20

What can febrile seizures progress to?

Answer 20

Status epilepticus

Question 21

What drugs are used to treat status epilepticus?

Answer 21

1. diazepam
2. fosphenytoin
3. lorazepam (off label use)
4. phenobarbital
5. phenytoin

Page 221, Table 14-3 has all the doses, onsets, etc.

Question 22

What are Antiepileptic Drugs (AEDs) also known as?

Answer 22

anticonvulsants

Question 23

What are the goals of therapy using AEDs?

Answer 23

control/prevent seizures while maintaining reasonable quality of life

minimize adverse effects/drug-induced toxicity

Question 24

How long does AED therapy last? When can the pt discontinue?

Answer 24

therapy is usually lifelong

Pts who are seizure-free for 1-2 years may be able to discontinue

Question 25

\_\_\_\_\_\_\_ drug therapy started before _______ drug therapy

Answer 25

single drug therapy started before multiple drug therapy

Question 26

Titrate antiepileptic drugs to the lowest effective level. True or false?

Answer 26

True

Question 27

MOA of AEDs

Answer 27

Exact MOA is unknown. AEDs are thought to alter movement of Na, K, and Ca ions across nerve cells in the brain 1. **Increase the threshold** of activity (reduce nerve's ability to be stimulated) 2. **Limit the spread**: suppress transmission of impulses from one nerve to the next 3. **Decrease the speed** of nerve conduction within a neuron

Question 28

Overall effect of MOA and AEDs

Answer 28

Neurons stabilized Neuron hyperexcitability decreased Excessive nerve impulse spread decreased

Question 29

Indications of AEDs

Answer 29

prevention/control of seizure activity long-term maintenance therapy for chronic, recurring seizures acute treatment of convulsions and status epilepticus other uses

Question 30

Adverse effects of AEDs

Answer 30

Numerous - vary per drug often necessitate change in meds Phenytoin: long-term may cause gingival hyperplasia, acne, hirsutism, and dilantin facies black box warning (2008): suicidal thoughts/behavior is twice the risk

Question 31

5 AEDs PGVTP

Answer 31

1. Barbiturates, such as **phenobarbital (Luminal)** 2. **gabapentin (Neurontin)** 3. **valproid acid (Depakene)** 4. **topiramate (Topamax)** 5. Hydantoins, such as **phenytoin (Dilantin)** and fosphenytoin People Grab Vaginas To Please Slide 15-16, I only wrote the yellow ones

Question 32

Nursing Implications: Assessment

Answer 32

Health history, including current meds Drug allergies Renal and Liver function studies CBC baseline levels basline V/S EEG, MRI, CT scans baseline neurologic exam

Question 33

6 rules for taking an oral AED RM(DN)W(OM)

Answer 33

1. take same time everyday 2. take with meals (decrease GI upset) 3. do not crush, chew, or open extended-release forms 4. take with 6-8 oz of water 5. oral suspensions should be mixed 6. if pt is NPO, contact physician Real Men Do Not Water On Men **R**egular **M**eals **D**o **N**ot (crush, chew, open) **W**ater **O**ral **M**ixed

Question 34

4 rules for IV form AEDs

Answer 34

1. follow manufacturer's recommendations for IV delivery, **usually given slowly** 2. monitor V/S 3. **avoid extravasation** of fluids 4. use only **normal saline** with IV phenytoin

Question 35

What to teach pt's regarding AEDs?

Answer 35

1. **keep a journal** to monitor response to AED, seizure occurrence/descriptions, adverse effects 2. wear **med alert tag/ID** 3. **AEDs should not be discontinued abruptly** 4. instruct pt of sedating effect 5. driving may be prohibited 6. teach pts **therapy is long term/possibly lifelong (not a cure)**

Question 36

Nursing Implications: What to monitor for

Answer 36

1. therapeutic effects - decreased/absent seizure activity 2. adverse effects - mental status, mood, LOC, sensorium changes - eye problems, visual disorders - sore throat, fever (hydantoins may cause blood dyscrasias