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CARBAMAZEPINE
(kar-ba-maz-e-peen)
(Tegretol, Tegretol XR)
Anticonvulsant
- SIDE EFFECTS:
- Myelosuppression, Dizziness, drowsiness, ataxia, diplopia, rash, photosensitivity
- NURSING CONSIDERATIONS:
- Management of seizures, trigeminal neuropathy
- Avoid driving and other activities requiring alertness the first 3 days
- Monitor blood levels, CBC, regularity, esp. during first 2 months, periodic eye exams
- Take with food or milk to decrease GI upset; tablets (nonextended release) may be crushed, extended release capsules may be opened, mixed with juice or soft food.
- Urine may turn pink to brown
- avoid abrupt withdrawal: discontinue use with alcohol, other CNS depressants
- RX: Preg Cat C
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DIVALPROEX SODIUM
(dye-val-proe-ex)
(Depakote, Depokote ER)
Anticonvulsant
- SIDE EFFECTS:
- Sedation, drowsiness, dizziness, mental status and behavioral changes, nausea, vomiting, constipation, diarrhea, heartburn, prolonged bleeding time.
- NURSING CONSIDERATIONS:
- Management of seizuers, manic episodes associated with bipolar disorder (delayed release only), migraine prophylaxis (delayed and extended release only) Take with or immediately after meals to lessen GI upset.
- Swallow tablets or capsules whole (no crushing, chweing)
- Avoid abrupt withdrawal after long term use; discontinue gradually to prevent convulsions.
- Monitor blood levels, platelets, bleeding time, and liver function test.
- Delayed release products peak blood level 3-5 hours, duration 12-24 hours
- Extended release prducts: onset 2-4 days, peak blood level 7-14 hours, duration 24 hours
- Wear medical information tag
- RX: Preg Cat D
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GABAPENTIN
(gab-ah-pen-tin)
(Neurontin)
Anticonvulsant
- SIDE EFFECTS:
- Drowsiness, Ataxia, diplopia, rhinitis, constipation
- NURSING CONSIDERATIONS:
- Used for management of seizures and postherpetic neuralgia.
- Do not take within 2 hrs of antacid.
- Avoid abrupt withdrawal after long term use.
- discontinue gradually over a week to prevent convulsions.
- Give without regard to meals; can open capsules and put in juice or apple sauce.
- Do not crush or chew capsules.
- Use caution with hazardous activities
- Wear medical information tag
- RX: Preg Cat C
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LAMOTRIGINE
(lah-moe-tri-jeen)
(Lamictal)
Anticonvulsant
- SIDE EFFECTS:
- Ataxia, dizziness, headache, nausea, vomiting, anorexia, diplopia, blurred vision, abd. pain, dysmenorrhea
- NURSING CONSIDERATIONS:
- Used for management of seizures
- In pediatric patients, stop at first sign of rash; all patients should notify clinician of rashes.
- Take divided doses with meals or just after to decrease adverse effects.
- Use caution with hazardous activities until stabilized.
- Avoid abrupt withdrawal: stop gradually to prevent increase in frequency of seizures.
- Wear medical information tag
- RX: Preg Cat C
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PHENOBARBITAL
(fee-noe-bar-bi-tal)
(Luminal)
Anticonvulsant
- SIDE EFFECTS:
- Drowsiness, lethargy, rash, GI upset, initially constricts pupils, respiratory depression, ataxia
- NURSING CONSIDERATIONS:
- Management of epilepsy, febrile seizures in children, sedation, insomnia.
- IV: Slow rate-- resuscitation equipment should be available
- IM: Inject deep into large muscle mass to prevent tissue sloughing; can give subQ, onset 10-30 minutes
- PO: onset 20-60 minutes, peak 8-12 hours, duration 6-10 hours
- Use caution with hazardous activities until stabilized drowsiness usually diminishes after initial weeks of therapy.
- Nystagmus may indicate early toxicity
- Long-term use withdrawal symptoms: vomiting, sweating, abdominal muscle cramps, tremors, and possibly convulsions.
- Vitamin D supplements are indicated for long-term use
- RX: Schedule C-IV; Preg Cat D
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PHENYTOIN
(fen-i-toyn)
(Dilantin)
Anticonvulsant
- SIDE EFFECTS:
- Drowsiness, Ataxia, Nystagmus, blurred vision, hirsutism, lethargy, GI upset, Gingival hypertrophy
- NURSING CONSIDERATIONS:
- Management of seizures, migraines, trigeminal neurlgia, bell's palsy
- PO: Take divided doses, with or immediately after meals, to decrease adverse effects.
- May color urine and sweat pink/red/brown
- IV: administration may lead to cardiac arrest-- have resuscitation equipment available: never mix in IV with any other drug or dextrose.
- Avoid abrupt withdrawals to prevent convulsions.
- Do not use antacids or antidiarrheals within 2 hours of med
- Use caution with hazardous activities until stabilized
- Folic acid supplements are indicated for long-term use
- Wear medical information tag
- RX: Preg Cat C
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PREGABALIN
(pree-gab-ah-lin)
(Lyrica)
Anticonvulsant
- SIDE EFFECTS:
- Tiredness, dizziness, headache, dry mouth, nausea, vomiting, constipation, gas, bloating, elevated mood confusion, forgetfulness
- NURSING CONSIDERATIONS:
- Treatment of epileptic seizures, neuropathic pain for people with diabets, shingles, fibromyalgia
- Avoid use of alcohol, may increase drowsiness.
- May be habit forming.
- Withdrawal symptoms such as insomnia or seizures, if sudden discontinuation.
- Diabetics should pay attention to skin condition, and report sores, redness or other skin problems.
- Contact prescriber if changes in eyesight, chest pain or wheezing.
- RX: Preg Cat C
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TOPIRAMATE
(toh-pire-ah-mate)
(Topamax)
Anticonvulsant
- SIDE EFFECTS:
- Dizziness, drowsiness, fatigue, inpaired concentration/memory, nervousness, speech problems, nausea, weight loss, vision problems, ataxia, photosensitivity
- NURSING CONSIDERATIONS:
- Used for mangement of seizures
- Give without regard to meals; can open capsules and put in juice or apple sauce.
- Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent seizures and status epilepticus.
- Use caution with hazardous activities until stabilized
- Increased fluid intake to prevent formation of kidney stones.
- Stop drug immediately if eye problems; could lead to permanet loss of vision.
- Use sunscreen and protective clothing to prevent photosensitivity
- Wear medical information tag.
- RX: Preg Cat C
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VALPROATE, VALPROIC ACID
(val-proe-ate, val-proe-ic as-id)
(Depacon, Depakene)
Anticonvulsant
- SIDE EFFECTS:
- Sedation, drowsiness, dizziness, Mental status and behavioral changes. Nausea, vomiting, constipation, diarrhea, heartburn, prolonged bleeding time.
- NURSING CONSIDERATIONS:
- Used for management of seizures.
- Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions.
- Monitor blood levels, platelets, bleeding time, and liver function tests.
- Duration of anticonvulsant effect: 6-24 hours (varies with age)
- RX: Preg Cat D
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