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Administration alerts for phenytoin (Dilantin)
- mix with saline only to avoid precipitate (can cause emboli)
- use a filtered iv line
- soft-tissue irritant (do not give IM)
- avoid hand veins (large veins or central venous cath preferred)
- Pregnancy category D
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a disturbance of electrical activity in the brain
seizure
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what is epilepsy?
- any disorder characterized by recurrent seizures
- chronic
- related to area of brain with abnormal activity
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involuntary, violent spasms
- convulsion
- some seizures involve, some do not
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What are some causes of seizures?
- infectious disease
- trauma
- metabolic disorders
- vascular diseases
- pediatric disorders
- neoplastic disease
- PTE (post-traumatic epilepsy)
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Other causes of seizures
- medications
- high doses of local anesthetics
- eclampsia
- drug abuse
- withdrawal syndromes from ETOH or sedative-hypnotic drugs
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name some triggers of seizures of unknown etiology
- sleep deprivation
- flickering lights
- fluid and electrolyte imbalances
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type of seizure that occurs:
in limited portion of brain
feeling that location is vague
hallucinations with all senses
extreme emotions
twitching of arms, legs, or face
simple partial (focal) seizure
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what are s/s of a simple partial (focal) seizure?
- feeling that location is vague
- hallucinations with all senses
- extreme emotions
- twitching of arms, legs, or face
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type of seizure that:
occurs in limited portion of brain
altered levels of consciousness
involves sensory, motor, and autonomic symptoms
aura commonly precedes seizure
no memory of seizure
complex partial (focal) seizures
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what are s/s of a complex partial (focal) seizure?
- altered levels of consciousness
- involves sensory, motor, and autonomic symptoms
- aura commonly precedes seizure
- no memory of seizure
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types of generalized seizures?
- absence
- atonic
- tonic-clonic
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type of generalized seizure that is:
common in children
subtle symptoms of staring
transient loss of consciousness
eyelid fluttering
myoclonic jerks
absence seizures
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what are the s/s of absence seizures?
- subtle symptoms of staring
- transient loss of consciousness
- eyelid fluttering
- myoclonic jerks
- *common in children
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what type of generalized seizure that is:
usually preceded by aura
intense muscle contractions
hoarse cry at onset
loss of bowel or bladder
shallow breathing
alternating contraction and relaxation of muscles
drowsiness
disorientation
deep sleep
tonic-clonic seizure (most common)
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what are the s/s of tonic-clonic seizure?
- usually preceded by aura
- intense muscle contractions
- hoarse cry at onset
- loss of bowel or bladder
- shallow breathing
- alternating contraction and relaxation of muscles
- drowsiness
- disorientation
- deep sleep
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What are the special syndromes of classification of seizures?
- febrile
- myoclonic
- status epilepticus
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what type of special syndrome seizure that has s/s of:
lasts one-two minutes
tonic-clonic motor activity
common in 3-5 year olds
occurs with rapid rise in body temp
affects 5% of all children
febrile seizures
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what are the s/s of febrile seizure syndrome?
- lasts one-two minutes
- tonic-clonic motor activity
- common in 3-5 year olds
- occurs with rapid rise in body temp
- affects 5% of all children
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what type of special syndrome seizure that involves:
large, jerking body movements
quick contraction of major muscles
stumbling and falling
similar to normal infantile Moro reflex
myoclonic seizures
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what are the s/s of myoclonic seizure syndrome?
- large, jerking body movements
- quick contraction of major muscles
- stumbling and falling
- similar to normal infantile Moro reflex
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what type of special syndrome seizure involves:
medical emergency
continuously repeating seizure
common with generalized tonic-clonic seizures
continuous muscle contraction
status epilepticus
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what are the s/s of status epilepticus seizure syndrome?
- continuously repeating seizure
- common with generalized tonic-clonic seizures
- continuous muscle contraction
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how is status epilepticus treated immediately?
lorazepman (Ativan) 2mg IV
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diazepam (Valium) treats what type of seizures?
- absence
- tonic-clonic
- myoclonic
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gabapentin (Neurontin) treats what type of seizures?
partial seizures
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lorazepam (Ativan) treats what type of seizure?
tonic-clonic
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phenobarbitol (Luminal) treats what type of seizures?
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phenytoin (Dilantin) treats what type of seizures?
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valproic acid (Depekene) treats what type of seizures?
- partial
- absence
- tonic-clonic
- myoclonic
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ethosuximide (Zarontin) treats what type of seizures?
absence
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what do GABA drugs do?
- potentiates GABA
- helps inhibit neurotransmitter
- suppress firing ability of neurons
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what classes of drugs potentiate GABA action?
- barbiturates
- benzodiazepines
- other GABA mimetics
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what is the action of phenobarbital (Luminal)?
suppress abnormal neuronal discharges without causing sedation
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what are the adverse effects of phenobarbital (Luminal)?
- dependence
- drowsiness
- vitamin deficiencies, laryngospasm
- Stevens-Johnson
- agranulocytosis
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what are the therapeutic drug ranges of phenobarbital (Luminal)?
15-40 mcg/mL
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what is the antidote for benzodiazepine overdose?
flumazenil (Romazicon)
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action of lorazepam (Ativan)?
intensify effect of GABA (binds to GABA receptor-chloride channel molecule)
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what are the adverse effects of lorazepam (Ativan)?
- drowsiness
- dizziness
- coma
- respiratory depression
- CV collapse
- addiction
- contraindicated in preg/breast feeding, narrow-angle glaucoma, liver/renal issues
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what type of drug is a sodium influx inhibitor?
hydantoins
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what is the action of phenytoin (Dilantin)?
to desensitize sodium channels
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what are the adverse effects of phenytoin (Dilantin)?
- CNS reactions (HA, nystagmus, confusion, ataxia, slurred speech)
- gingival hyperplasia
- skin rash
- cardiac dysrhythmias
- hypotension
- Stevens-Johnson syndrome
- interferes with oral birth control
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what are the drug-drug interactions with phenytoin (Dilantin)?
- anti-coagulants
- glucocoritcosteroids
- TB drugs
- folic acid
- calcium
- Vitamin D
- Digoxin
- Lasix
- oral contraceptives
- tricyclic anti-depressants
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what are some blood dyscrasias that may occur with phenytoin (Dilantin)?
- agranulocytosis
- aplastic anemia
- thrombocytopenia
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what is the therapeutic range of phenytoin (Dilantin)?
10-20 mcg/mL
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what is the FDA concerned with for anti-epilepsy meds?
concern of suicidal ideations
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what are labs to pay special attention with phenytoin (Dilantin) therapy?
- CBC
- PT, INR, PTT (interferes with vit K metabolism, warfarin & causes blood dyscrasias)
- blood glucose
- alkaline phosphatase
- LFT's
- Renal FT
- UA for hematuria
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what is Stevens-Johnson Syndrome?
- prompted by anticonvulsants, antibiotics, some OTC's
- nonspecific URI with chills, fever, malaise
- generalized blister-like lesions follow within a few days
- skin sloughing may occur on 10% of the body
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what is the action of valproic acid (Depakene)?
to desensitize sodium channels
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what are the side effects of valproic acid (Depakene)?
- limited CNS depression
- visual disterbances
- ataxia
- vertigo
- HA
- thrombocytopenia
- leukopenia
- GI issues
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what are the black box warnings of valproic acid (Depakene)?
- hepatotoxicity
- pancreatitis
- teratogenic effects (spina bifida)
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what labs should be monitored for valproic acid (Depakene)?
- CBC
- serum folate
- PT
- platelets
- vitamin D
- LFT's
- bilirubin
- UA
- BUN
- creatinine
- GFR
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nursing considerations for valproic acid (Depakene)
- know OTC's
- avoid ETOH
- use additional birth control
- depression, suicide ideations
- anorexia
- yellowing of skin or eyes
- Stevens-Johnson s/s
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herbal/food interactions with anti-seizure meds?
- may reduce or increase therapeutic effectiveness of drug
- may potentiate sedation
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what is the action of ethosuximide (Zarontin)?
delays or blocks calcium
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what are the common side effects or ethosuximide (Zarontin)?
- drowsiness
- dizziness
- lethargy
- gingival hyperplasia
- N & V
- weight loss
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what are the adverse effects of ethosuximide (Zarontin)?
- SLE
- pancytopenia
- leukopenia
- aplastic anemia
- agranulocystosis
- Stevens-Johnson syndrome
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what are the considerations pertaining to children when prescribing ethosuximide (Zarontin)?
safety in children younger than 3 yo has not been established
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what is the action of gabapentin (Neurontin)
suppresses firing ability of neurons (GABA)
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side effects of gabapentin (Neurontin)?
- not a lot of lasting side effects
- tiredness
- dizziness
- effects usually resolve with time
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what type of medication cannot be taken with carbamazepine (Tegretol) - it can be fatal?
- MAOI's
- can be fatal when taken within 14 days
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How long must a patient be seizure-free before weaning off of anti-seizure meds?
3 years
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