Pharmacology

Anxiety• Alcohol withdrawal• Muscle spasms• Preoperative and preprocedure sedation• Seizure disorders• Status epilepticus

acts on central nervous system depressant to:• Stop seizure activity• Reduce anxiety• Cause relaxation and sleep

Drowsiness• Bradycardia• Cardiovascular collapse• Physical or psychological dependence

Do not give subcutaneously. When giving IV, do not mix with other   drugs.• Instruct client to avoid alcohol, driving, or operating machinery.• Monitor for CNS depression.• Keep resuscitation equipment near bedside.• Monitor respirations and other vital signs.

Controlling seizures in epilepsy and status epilepticus.• Sedation• Inducing sleep• Preoperative sedation

Increasing seizure threshold and depressing CNS nerve activity.• Suppressing seizure activity and inducing sedation

Respiratory depression• Apnea• Stevens-Johnson syndrome (fever, rash, necrotizing skin disorder)• Angioedema• Bradycardia

Give IV slowly, and only in emergency situations.• Keep resuscitation equipment near bedside.• Monitor respirations and other vital signs.• Monitor drug level. Therapeutic drug level is 15-40mcg/mL.• Teach client on hormonal contraceptives to use an alternative form    of birth control.

Control partial seizures• Prevent migraine headaches

Control partial seizures• Prevent migraine headaches

Generalized seizures• Paresthesia• Visual disturbances, diplopia • Leukopenia• Tremor• Ataxia• Confusion• Metabolic acidosis

Monitor for metabolic acidosis.• Reduce dose for renal disease.• Encourage fluids if appropriate.• Teach client on hormonal contraceptives to use an alternative form    of birth control.• Teach client to report any visual disturbances.

Controlling partial seizures

May increase GABA, which inhibits nerve transmission, stopping   partial seizures.

Dizziness• Nervousness• Confusion• Nausea

Reduce dose in clients with liver disease.• Take with food.• Advise women to inform health care provider if she is pregnant or    breast feeding.

Controlling partial seizures• Relieving neuralgia post-herpes

acts to prevent partial seizures and relievepost-herpatic neuralgia through unknown means.

Dizziness• Ataxia• Visual disturbances• Leukopenia

Monitor for adverse reactions.• Take only as directed. Do not stop abruptly

Control of partial seizures

increase GABA, which inhibits nervetransmission, stopping partial seizures.

Aplastic anemia• Hepatic failure• Fever• Visual disturbances• Ataxia• Tremors

Monitor CBC, platelets, reticulocyte count, and liver enzymes. Storeaway from heat or sunlight.

Felbamate (Felbatol) has severe toxic effects of aplastic anemia andhepatic failure. Use only in rare cases where other anticonvulsantsare ineffective.

Control of general and mixed seizures• Trigeminal neuralgia• Bipolar affective disorder• Restless leg syndrome

alter the exchange of sodium ionsduring nerve transmission to reduce seizure activity.

Increased seizures• Heart failure• Aplastic anemia• Thrombocytopenia• Stevens-Johnson syndrome (lesions of the oral, vaginal and    conjunctival mucous membranes)

Monitor drug level; therapeutic drug level is 4-12 mcg/mL• Monitor liver functions, CBC, platelets, and reticulocyte counts• Give with food• Advise client to notify health care provider of fever, sore throat,    mouth sores, bruising, or bleeding

Control of partial and grand mal seizures• Prophylactic prevention of seizures during and after neurosurgery• Status epilepticus• Severe preeclampsia• Arrhythmias caused by cardiac glycosides

stop seizure activity by altering theexchange of sodium ions across cell membranes during nerveconduction.

Thrombocytopenia• Leukopenia• Toxic Hepatitis• Confusion• Stevens-Johnson syndrome• Hypotension

Monitor drug level; therapeutic drug level is 10-20 mcg/mL• Monitor liver functions, CBC, platelets, and reticulocyte counts• Give IV medications slowly• Monitor pulse, ECG, blood pressure, and respirations during IV infusion• Monitor for adverse reactions

Too rapid infusion of phenytoin (Dilantin) or fosphenytoin (Cerebyx)may cause severe hypotension and cardiac arrhythmias.

Control of partial or full seizures• Treating bipolar disorder

acts to stop seizures and control mood byinhibiting certain neurotransmitters.

Dizziness• Headache• Ataxia• Seizures• Stevens-Johnson syndrome

Lower dose if used with valproate (Depakene)• Discontinue drug if client develops a rash• Instruct client to avoid sun or cover skin with clothing and sunscreen• Monitor for adverse reactions

Simple and complex absence seizures and complex partial seizures• Mania• Migraine headaches

increase GABA, which inhibits nervetransmission, stopping seizures.

Sedation• Nausea• Pancreatitis• Hemorrhage• Leukopenia• Thrombocytopenia• Hepatotoxicity• Stevens-Johnson syndrome

• Monitor drug level, therapeutic drug level is 50-100 mcg/mL• Monitor liver functions, platelets, and coagulation counts• Give IV medications slowly• Monitor for fatigue, fever, and lethargy that may be early signs to    hepatic toxicity• Do not give to clients with a history of hepatic disease• Monitor for adverse reactions

Absence or petit mal seizures

stop seizure activity by altering theexchange of sodium and calcium ions across cell membranesduring nerve conduction.

Leukopenia• Pancytopenia• Systemic lupus erythematosis• Stevens-Johnson syndrome• Nausea• Drowsiness

Monitor liver functions, platelets, and coagulation counts• Monitor for signs of infection• Give with food• Advise client to notify health care provider of any unusual bruising    or bleeding

• decrease neuron excitability
• increase seizure threshold
• block abnormal nerve stimulus

• Drowsy
• Nausea
• Vomit
• lethargy
• steven johnson syndrome
• lupus erythematosus
• headache
• dysrythmias
• bone marrow supression

• seizure precautions
• avoid driving/ operating machines
• take anticonvulsants at same time of day with meals
•  no crushing or chewing of tabs
• give IM in DEEP muscle!
• give IV slow!
• monitor pulse, BP, RR during infusion
• monitor IV site!

Too rapid infusion of phenytoin (Dilantin) or fosphenytoin (Cerebyx)may cause severe hypotension and cardiac arrhythmias.• Encourage client to wear medic alert bracelet for seizure disorder• Educate client to take anticonvulsants as directed and not to   abruptly stop medications• Advise client to avoid alcohol• Monitor for sore throat, fever (blood dyscrasias), vomiting, Stevens-   Johnson syndrome, or other signs of toxicity