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As a class, Barbiturates generally have a ____ margin for safety, a ____ potential for dependance, and they cause profound CNS _____.
Low; high; depression
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Barbiturates intensify the effect of _____ in the brain and generally ____ the firing of CNS neurons.
GABA; depress
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What seizure types are barbiturates effective against?
All major seizure types except absence seizures
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Phenobarbital is the prototype ______ drug.
Barbiturate
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Why shouldn't phenobarbital be used for pain relief?
If may increase a patient's sensitivity to pain.
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Describe the biochemical activity of phenobarbital that makes it effective in treating seizures.
it enhances the action of the GABA neurotransmitter, which is responsible for suppressing abnormal neuronal discharge that causes epilepsy.
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Benzodiazepines intensify the effect of ____ in the brain.
GABA
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_____ bind directly to the GABA receptor, suppressing abnormal neuronal foci.
Benzodiazepines
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What types of seizures can be treated using Benzodiazepines?
- Absence Seizures
- Myoclonic Seizures
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What benzodiazepine may be administered in order to terminate status epilepticus? What route is it administered in this case?
Diazepam by the parenteral route
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When administering benzodiazepines for seizure therapy, the dose must be periodically adjusted.
True or False? Explain.
- True:
- Tolerance may develop after only a few months of therapy
- Seizures may recur
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Hydantoins falls into what class of drugs? What is their general mechanism of action?
- Anti-seizure drugs
- Dampen CNS activity by delaying an influx of sodium ions across neuronal membranes
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___ ion movement is the major factor that determines whether a neuron will undergo an action potential. If these channels are temporarily inactivated, neuronal activity will be suppressed. What drug(s) accomplish(es) this?
- Sodium
- Hydantoin and related anti-seizure drugs
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Hydantoin and phenytoin-like drugs act by blocking sodium channels.
True or False? Explain
- False:
- They are just desensitized. Local anesthetics block sodium channels, completely stopping neuronal activity.
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How do Hydantoin and Phenytoin-like drugs effect their changes ( 3 ways) ?
- Desensitize sodium channels directly
- Affect the threshold of neuronal firing
- Interfere with the transduction of the excitatory neurotransmitter glutamate.
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What is the prototype drug for the Hydantoin class of drugs?
phenytoin (Dilantin)
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What types of epilepsy is Dilantin effective in treating?
All types of epilepsy except absence seizures.
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Hydantoins like phenytoin effect seizure relief but may cause dependance and side effects associated with CNS depression.
True or False? Explain.
- False
- These are characteristics of the Benzodiazepines and Barbiturates. Hydantoins do not have abuse potential or depress the CNS.
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Why must patients be carefully monitored when on Hydantoins or phenytoin like drugs?
--They carry a high potential for abuse
--There is a narrow range between the therapeutic dose and the toxic dose
-- Depression of the CNS by these drugs may cause coma
-- High doses induce seizures
- There is a narrow range between therapeutic dose and toxic dose
- Careful monitoring is especially important since patients vary significantly in their ability to metabolize hydantoins.
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What are the most common adverse affects of the newer anti-seizure drugs (4)?
- Somnolence
- Drowsiness
- Dizziness
- Blurred Vision
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What is the prototype drug for the Benzodiazepine class of drugs?
diazepam (Valium)
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What are the effects of diazepam?
- suppression of neuronal foci that may cause seizures
- calming without strong sedation
- skeletal muscle relaxation
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In terms of seizure therapy, why is Valium used only for short term seizure control or status epilepticus?
Because of tolerance and dependancy.
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Under what conditions should Valium not be administered?
- Shock
- Coma
- Depressed vital signs
- obstetrical patients
- infants less than 30 days old
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Diazepam should not be administered within 7 days of MAOI therapy.
True or False? Explain.
- False
- diazepam (Valium) should not be administered within 14 days of MAOI therapy.
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____ are medications that suppress seizures by delaying calcium influx into neurons.
Succinimides
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What kind of seizures are Succinimides effective in treating?
They are generally only effective against absence seizures.
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What is the general action of Succinimides? By what mechanisms will Succinimides act?
- Succinimides suppress seizures by delaying calcium influx into neurons. They do this in several ways.
- They block low-threshold calcium channels
- They increase electrical threshold of the neuron
- They reduce the likelihood that an action potential will be generated.
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A ____ or a clinically detectably sign of epilepsy is a disturbance of electrical activity in the brain that may affect consciousness, motor activity, and sensation.
Seizure
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A seizure is really symptomatic of an underlying disorder rather than a disease in and of itself.
True or False? Explain
- True.
- Seizures are a detectable sign of epilepsy.
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Triggers for seizures include exposure to strobe or flickering lights or the occurrence of small fluid and electrolyte imbalances. Seizures may also occur when patients are sleep deprived.
True or False?
True.
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Name six types of medical condtions associated with seizures.
- Infections Diseases
- Trauma
- Metabolic Disorders
- Vascular Diseases
- Pediatric Disorders (febrile seizure)
- Neoplastic Disease
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A severe hypertensive disorder of pregnancy characterized by seizures, coma, and perinatal mortality.
Eclampsia
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All convulsions are seizures and all seizures are convulsions.
True or False?
- False.
- All convulsions are seizures, but not all seizures are convulsions.
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This term refers to involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs.
Convulsions
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Most antiseizure drugs are pregnancy category ______.
A
B
D
X
D
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Describe the usual legal policy regarding seizures and the granting of driver's licenses.
Almost all states will not grant, or will take away, a driver's license and require a seizure free period before granting the license.
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The terms grand mal and petit mal, in relation to seizures, have been replaced by more descriptive terms. What are these terms?
- Grand mal has been replaced by "Tonic-Clonic"
- Petite mal has been replaced by "Absence"
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What are the three broad categories of epileptic seizures as described by the International Classification of Epileptic Seizures?
- partial (focal)
- generalized
- special epileptic syndromes
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What types of seizures fall under the category of General seizures according to the International Classification of Epileptic Seizures?
- Absence (petite mal)
- Atonic (drop attacks)
- Tonic-Clonic (grand mal)
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What is the process for taking patients off one antiseizure medication and putting them on another?
A. Just stop the medication and begin substituting a new medication for the one that they are on.
B. Take both at once until the right dose of the new medication is found. Then, stop the old medication. This should take about 8-12 weeks.
C. Gradually increase amounts of the new medication while gradually decreasing the old medication over a period of about 6-12 weeks.
D. The patient must have a cleansing period before beginning the new medication. Stop the old medication and wait for a week, then begin the new medication.
- C.
- Because seizures are likely to occur if antiseizure medication is withdrawn abruptly, the medication is usually discontinued over a period of 6-12 weeks in this manner.
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More than one antiseizure medication is often used in the pharmacotherapy of epilepsy. The most important thing from the nurse's perspective to be aware of is that patients who take two medications may have an increase in unwanted side effects, and to teach this to the patient.
True or False?
- False.
- It is true that more than one antiseizure medication is often used in the pharmacotherapy of epilepsy. However, what is more important than side effects is that some antiseizure drug combinations may actually increase the incidence of seizures. Therefore, the Nurse should consult with current drug guides to determine compatibility
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What sort of seizures fall under the heading of Partial seizures?
- Simple partial
- Complex partial (psychomotor)
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What special epileptic syndromes exist?
- Febrile seizure
- Myoclonic seizure
- Status Epilepticus
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What are the 7 characteristics of a tonic-clonic seizure?
- Aura preceding the event
- Lasts 1-2 minutes
- Intense muscle contraction phase (tonic) followed by alternating contraction and relaxation of muscles (clonic phase)
- Crying as air leaves lungs
- Loss of bowel and bladder control
- Shallow breathing with periods of apnea
- Disorientation and deep sleep after seizure (postictal state)
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What are the 6 characteristics of an absence seizure?
- Lasts a few seconds
- Seen most often in children
- Staring into space
- No response to verbal stimulation
- May have fluttering eyelids or jerking
- Misdiagnosed often in children as ADD or daydreaming
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Describe what happens during an atonic seizure.
The person will fall or stumble for no reason; it lasts only a few seconds.
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What is status epilepticus?
The term describes continuous seizure activity, which can lead to coma or death. It is considered a medical emergency.
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Describe what happens during a myoclonic seizure.
There are large, jerking movements of a major muscle group such as an arm. The person may fall from a sitting position or drop something they are holding.
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What happens during a febrile seizure? Who can be affected by this kind of a seizure?
- Tonic-clonic activity brought on by fever that lasts 1-2 minutes, accompanied by a rapid return to consciousness.
- It occurs in children between 3 months and 5 years of age.
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