Anticonvulsants
- to prevent seizures
- some are given as antipsychotics
- some are given to treat nerve pain
Anticonvulsants to treat seizures
- divalproex sodium, valproic acid
-
phenobarbital, phenytoin
Anticonvulsants
- seizure precautions
- assess for mood changes and suicide
- assess for sedation and drowsiness
- implement safety and fall precautions
- implement safety and fall precautions
Anticonvulsant: phenytoin
gingival hyperplasia
phenytoin: gingival hyperplasia
Teach to floss regularly and use a soft toothbrush
Anticonvulsant: phenytoin
pancytopenia
phenytoin: pancytopenia
Immediate complication
Monitor WBC and platelets - assess for bleeding and infection
Hold med and notify HCP for active bleeding or signs of infection.
What is the therapeutic level of phenytoin?
phenytoin therapeutic level: 10 - 20
Antiparkinsonian drug
- benztropine
- trihexyphenidyl
- carbidopa/levodopa
Antiparkinsonian drug
Anticholinergic side effects (use caution if taking other anticholinergic meds):
- causes blurry vision - implement safety / fall precautions
- causes urinary retention - monitor intake and output
- causes dry mouth - give candy or ice chips
- causes constipation - encourage fluids/fiber/walking
"can't see, can't pee, can't spit, can't shit"
neostigmine, pyridostigmine
Muscle stimulant to treat myasthenia gravis.
neostigmine, pyridostigmine
Prevents breakdown of acetylcholine (a cholinesterase inhibitor)
This prevents muscle weakness.
neostigmine, pyridostigmine
-
take at same time every day - to keep muscle strength consistent
-
assess for signs of overdose and underdose - can be a sign of over- or under-medicated
What are the symptoms of a cholinergic crisis (overmedicated) and myasthenic crisis (undermedicated)?
- muscle weakness
- dyspnea
- dysphagia
- bradycardia
The similar symptoms make it difficult to determine quickly if the client is undermedicated or overmedicated.
What is a myasthenic crisis?
Immediate complication
A myasthenic crisis is when the client doesn't get enough of their medication (undermedicated), causing muscle weakness.
It usually occurs about 3 hours after med administration.
What is a cholinergic crisis?
Immediate complication
A cholinergic crisis is when a client gets too much of their medicine (overmedicated), causing muscle weakness.
It usually occurs about 1 hour after med administration.
What is an edrophonium (Tensilon) test?
An edrophonium (Tensilon) test is used to determine if the client is in a myasthenic crisis or cholinergic crisis:
- it's a myasthenic crisis if edrophonium is given and strength improves
- client needs more medicine
- it's a cholinergic crisis if edrophonium is given and the weakness gets worse.
- client needs less medicine
What is the antidote to a cholinergic crisis?
Antidote to a cholinergic crisis: atropine sulfate (an anticholinergic)
Which medication is an osmotic diuretic used to treat increased intracranial pressure?
mannitol
mannitol
- assess neuro status
- assess intake and output
Medication is used to get extra fluid off the brain.
