Exam 3 - Neuro (Anti-seizure Meds)

  1. 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
  2. a disturbance of electrical activity in the brain
    seizure
  3. what is epilepsy?
    • any disorder characterized by recurrent seizures
    • chronic
    • related to area of brain with abnormal activity
  4. involuntary, violent spasms
    • convulsion
    • some seizures involve, some do not
  5. What are some causes of seizures?
    • infectious disease
    • trauma
    • metabolic disorders
    • vascular diseases
    • pediatric disorders
    • neoplastic disease
    • PTE (post-traumatic epilepsy)
  6. Other causes of seizures
    • medications
    • high doses of local anesthetics
    • eclampsia
    • drug abuse
    • withdrawal syndromes from ETOH or sedative-hypnotic drugs
  7. name some triggers of seizures of unknown etiology
    • sleep deprivation
    • flickering lights
    • fluid and electrolyte imbalances
  8. 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
  9. 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
  10. 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
  11. 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
  12. types of generalized seizures?
    • absence
    • atonic
    • tonic-clonic
  13. type of generalized seizure that is:
    common in children
    subtle symptoms of staring
    transient loss of consciousness
    eyelid fluttering
    myoclonic jerks
    absence seizures
  14. what are the s/s of absence seizures?
    • subtle symptoms of staring
    • transient loss of consciousness
    • eyelid fluttering
    • myoclonic jerks
    • *common in children
  15. 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)
  16. 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
  17. What are the special syndromes of classification of seizures?
    • febrile
    • myoclonic
    • status epilepticus
  18. 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
  19. 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
  20. 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
  21. 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
  22. what type of special syndrome seizure involves:
    medical emergency
    continuously repeating seizure
    common with generalized tonic-clonic seizures
    continuous muscle contraction
    status epilepticus
  23. what are the s/s of status epilepticus seizure syndrome?
    • continuously repeating seizure
    • common with generalized tonic-clonic seizures
    • continuous muscle contraction
  24. how is status epilepticus treated immediately?
    lorazepman (Ativan) 2mg IV
  25. diazepam (Valium) treats what type of seizures?
    • absence
    • tonic-clonic
    • myoclonic
  26. gabapentin (Neurontin) treats what type of seizures?
    partial seizures
  27. lorazepam (Ativan) treats what type of seizure?
    tonic-clonic
  28. phenobarbitol (Luminal) treats what type of seizures?
    • partial
    • tonic-clonic
  29. phenytoin (Dilantin) treats what type of seizures?
    • partial 
    • tonic-clonic
  30. valproic acid (Depekene) treats what type of seizures?
    • partial
    • absence
    • tonic-clonic
    • myoclonic
  31. ethosuximide (Zarontin) treats what type of seizures?
    absence
  32. what do GABA drugs do?
    • potentiates GABA
    • helps inhibit neurotransmitter
    • suppress firing ability of neurons
  33. what classes of drugs potentiate GABA action?
    • barbiturates
    • benzodiazepines
    • other GABA mimetics
  34. what is the action of phenobarbital (Luminal)?
    suppress abnormal neuronal discharges without causing sedation
  35. what are the adverse effects of phenobarbital (Luminal)?
    • dependence
    • drowsiness
    • vitamin deficiencies, laryngospasm
    • Stevens-Johnson
    • agranulocytosis
  36. what are the therapeutic drug ranges of phenobarbital (Luminal)?
    15-40 mcg/mL
  37. what is the antidote for benzodiazepine overdose?
    flumazenil (Romazicon)
  38. action of lorazepam (Ativan)?
    intensify effect of GABA (binds to GABA receptor-chloride channel molecule)
  39. 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
  40. what type of drug is a sodium influx inhibitor?
    hydantoins
  41. what is the action of phenytoin (Dilantin)?
    to desensitize sodium channels
  42. 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
  43. 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
  44. what are some blood dyscrasias that may occur with phenytoin (Dilantin)?
    • agranulocytosis
    • aplastic anemia
    • thrombocytopenia
  45. what is the therapeutic range of phenytoin (Dilantin)?
    10-20 mcg/mL
  46. what is the FDA concerned with for anti-epilepsy meds?
    concern of suicidal ideations
  47. 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
  48. 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
  49. what is the action of valproic acid (Depakene)?
    to desensitize sodium channels
  50. what are the side effects of valproic acid (Depakene)?
    • limited CNS depression
    • visual disterbances
    • ataxia
    • vertigo
    • HA
    • thrombocytopenia
    • leukopenia
    • GI issues
  51. what are the black box warnings of valproic acid (Depakene)?
    • hepatotoxicity
    • pancreatitis
    • teratogenic effects (spina bifida)
  52. what labs should be monitored for valproic acid (Depakene)?
    • CBC
    • serum folate
    • PT
    • platelets
    • vitamin D
    • LFT's
    • bilirubin
    • UA
    • BUN
    • creatinine
    • GFR
  53. 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
  54. herbal/food interactions with anti-seizure meds?
    • may reduce or increase therapeutic effectiveness of drug
    • may potentiate sedation
  55. what is the action of ethosuximide (Zarontin)?
    delays or blocks calcium
  56. what are the common side effects or ethosuximide (Zarontin)?
    • drowsiness
    • dizziness
    • lethargy
    • gingival hyperplasia
    • N & V
    • weight loss
  57. what are the adverse effects of ethosuximide (Zarontin)?
    • SLE
    • pancytopenia
    • leukopenia
    • aplastic anemia
    • agranulocystosis
    • Stevens-Johnson syndrome
  58. what are the considerations pertaining to children when prescribing ethosuximide (Zarontin)?
    safety in children younger than 3 yo has not been established
  59. what is the action of gabapentin (Neurontin)
    suppresses firing ability of neurons (GABA)
  60. side effects of gabapentin (Neurontin)?
    • not a lot of lasting side effects
    • tiredness
    • dizziness
    • effects usually resolve with time
  61. what type of medication cannot be taken with carbamazepine (Tegretol) - it can be fatal?
    • MAOI's
    • can be fatal when taken within 14 days
  62. How long must a patient be seizure-free before weaning off of anti-seizure meds?
    3 years
Author
cbennett
ID
329269
Card Set
Exam 3 - Neuro (Anti-seizure Meds)
Description
Chapter 15
Updated