Term
| anti-epileptic medications - MOA and effects |
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Definition
| exact MOA unknown / reduce nerve's ability to be stimulated; suppress transmission of impulses from one nerve to next; decrease speed of impulse conduction w/i neuron |
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Term
| Anti-epileptic meds - adverse effects |
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Definition
| numerous/vary per drug - necessitate change in meds; Blackbox warnings as of 2008 - suicidal thoughts and behavior |
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Term
| phenytoin (Dilantin) - side effects |
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Definition
| may cause gigival hyperplasia, acne, hirutism and Dilantin facies |
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Term
| A patient in long-term care facility has new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction which will result in |
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Definition
| answer: lower than expected drug levels |
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Term
| List of first-line anti-epileptic drugs |
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Definition
| carbamazepine (Tegretol); phenobarbital; phenytoin (Dilantin); primidone (mysoline) valproic acid |
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Term
| List of 2nd-line antiepileptic drugs |
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Definition
| ethosuximide (Zarontin); gabapentin (Neurontin); lamotrigine(Lamictal); diazepam (Valium); clonazepam (Klonopin); clorazepate (Tranxene); acetazolamide (Diamox) levetiracetam (Keppra); topiramate (Topamax); zonisamide (Zonegran) tiagabine (Gabitril); pregabalin (Lyrica) |
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Term
| The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient |
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Definition
| answer: may be taking this drug for neuropathic pain. (Gabapentin is commonly used to treat neuropathic pain) |
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Term
| Nursing Implications - Assessment |
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Definition
| health history, including current meds; drug allergies; liver function studies; CBC; baseline vitals |
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Term
| Before a patient is to receive phenytoin (Dilantin), the nurse practitioner order lab work. Which lab result is of greatest concern? |
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Definition
answer: low serum albumin levels
Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, toxicity may occur |
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Term
| Nursing implications - Oral drugs |
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Definition
| take regularly, same time each day; take w/meals to reduce GI upset, if pt is NPO for procedure, contact prescriber |
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Term
| a pt with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? |
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Definition
| answer: infuse slowly, not exceeding 50 mg/min mixed only with normal saline |
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Term
| Nursing implications - IV forms |
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Definition
follow manufacturer's recommendations for IV delivery - usually given slowly
2. monitor vital signs during administration
3. avoid extravasation of fluids
4. use only normal saline with IV phenytoin |
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Term
| Nursing implicati0ns - general |
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Definition
1. teach pts to keep journal to monitor response to AED, seizure occurrence/description, adverse effects
2. instruct pts to wear a medical alert tag or id
3. AEDs should not be discontinued abruptly
4. follow driving recommendations |
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Term
| Nursing implications - general 2 |
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Definition
teach pts therapy is long-term/ pos life
2. monitor for therapeutic effects - decreased/absent seizures
3. monitor for adverse effects - mental status changes, mood changes, changes in level of consciousness or sensorium, eye problems, visual disorders, sore throat, fever (blood dyscrasias ma occur with hydantoins) others |
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Term
| Which information will the nurse provide to the pt who is receiving anti-epileptic drug therapy? |
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Definition
| Call your health care provider if you are experiencing sore throat / fever, excessive bleeding or bruising, a new onset of nosebleeds. |
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Term
| The goal of antiepileptic drugs is to |
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Definition
| control or prevent seizures while maintaining a reasonable quality of life |
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Term
| What percentage of pts can expect to become seizure free while taking only one drug? |
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Definition
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Term
| Therapeutic drug monitoring of serum drug concentrations provides |
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Definition
| a useful guideline in assessing the effectiveness of and adherence to therapy |
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Term
| Why must phenytoin blood levels be monitored regularly? |
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Definition
| Phenytoin has narrow therapeuric window and phenytoin blood level should be monitored. |
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Term
| What is the first sign of phenytoin toxicity? |
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Definition
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Term
| What is a well-known side effect of phenytoin? |
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Definition
| gingival hyperplasia, so scrupulous dental care is required |
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Term
| What are the drug-drug interactions with carbamazepine? |
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Definition
| warfarin, oral contraceptives, and erythromycin |
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Term
| What is a common side effect that becomes more severe with alcohol in phenobarbital? |
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Definition
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Term
| Gabapentin is used for antiepileptic effects and can also be used for |
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Definition
|
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Term
|
Definition
| myoclonic or absence seizures |
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Term
| phenobarbital, phenytoin, primidone, carbamazepine and balproic acid are equally effective |
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Definition
| for partial onset seizures |
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Term
| diazepam or lorazepam are considered to be drugs of choice for |
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Definition
| acute treatment of status epilepticus |
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Term
| Barbituates: phenobarbital, primidone - adverse effects |
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Definition
| dizziness, drowsiness, lethargy, paradoxical restlessness |
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Term
| Hydantoins: phenytoin, fosphenytoin - adverse effect |
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Definition
| nystagmus, ataxia, drowsiness, rash, gingival hyperplasia, thrombocytopenia, agranulocytosis, hepatitis |
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Term
| Iminostilbenes: carbamazepine, oxcarbazepine - adverse effects |
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Definition
| nausea, headache, dizziness, unusual eye movements, visual change, behavioral changes, rash, abdominal pain, abnormal gait |
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Term
| Valpoic acid and derivatives, including valproate sodium and divalproex sodium = adverse effects |
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Definition
| dizziness, drowsiness, GI upset, weight gain, hepatotoxicity, pancreatitis |
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Term
|
Definition
1. principally used for management of status epilepticus and prophylactic for control of febrile seizures
2. drug of choice in 3rd world/ cheap
3. major advantage...allows for one/day dosing...long half life
4. barbituate schedule IV |
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Term
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Definition
1. barbituate
2. metabolizes in liver to phenobarbitol
3. not a controlled substance
4. only taken orally |
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Term
|
Definition
1. hydantoin
2. indicated for management of tonic-clonic and partial seizures
3. long-term use causes gingival hyperplasia, acne, hirsutism, and hypertrophy of subcutaneous facial tissue resulting in Dilantin facies, osteoporosis
4. slow IV pus not exceeding 50 mg
5. only with normal saline in IV and a filter should be used followed with a flush of saline to prevent irritation |
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Term
|
Definition
1. injectable drug
2. hydantoin
3. does not cause the burning on injections associated with phenytoin |
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Term
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Definition
1. imminostilbenes
2nd most commonly prescribed antiepileptic drug, after phenytoin
3. first line for partial seizures and generalized tonic-clonic seizures
4. associated with autoinduction of hepatic enzymes |
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Term
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Definition
1. miscellaneous drug
2. chemical analogue of GABA/exact MOA unknown
3. indicated as adjunct drug for treatment and prophylaxis of partial seizures |
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Term
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Definition
1.treatment of generalized seizures
2. also used for bipolar disorder
3. available in oral, intramuscular IV |
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