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Chp 15 Antiepileptic
Lee College Nursing Program Exam 5 Chp 15:Antiepileptic
| Question | Answer |
|---|---|
| Define: seizure | Excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neuron activity that results in temporary changes in brain function, primarily affecting sensory and motor activity |
| Define:Convulsion | Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles |
| Define: Epilepsy | Chronic, recurrent pattern of seizures |
| Define: Primary epilepsy | Epilepsy in which there is no identifiable cause. aka idiopathic (This occurs in 50% of patients with epilepsy) |
| Define:Secondary epilepsy | Epilepsy where there is a distinct cause such as trauma, infection, cerebrovasular disorder, or other illness. |
| Seizures are classified into different categories based on their presenting features, name the 3 categories. | 1. partial onset 2. generalized onset 3. unclassified |
| Generalized onset seizures were formally known as ______. | Grand mal seizures |
| Which type of seizures have convulsions? | Generalized onset seizures: the subtype tonic-clonic seizures |
| Generalized onset seizures have several subtypes name the 4 listed in the book: | 1. tonic-clonic 2. Atonic aka drop attacks 3. Myoclonic attacks 4. Absence seizures |
| Of the 4 subtypes of a generalized onset seizures, which one is described as brief muscle jerks, but not extreme | Myoclonic |
| Of the 4 subtypes of a generalized onset seizures, which one is described as a brief loss of awareness that commonly occurs with repetitive spasmodic eye blinking for up to 30 seconds. | absence seizures |
| In regards to a tonic-clonic seizure describe the clonic half and the tonic half. | tonic is the rigged/tenseness clonic is the convulsion |
| Name the 3 types of partial onset seizures | 1. simple partial onset seizures aka petit mal seizure 2. complex partial onset seizure 3. secondary generalized tonic-clonic seizures |
| Of the 3 types of partial onset seizures which one is described by a brief loss of awareness (blank stare)without a loss of consciousnesses or spasmodic eye blinking as in absence seizures? | simple partial onset seizure |
| Of the 3 types of partial onset seizures which two are associated with postictal confusion? | complex and secondary generalized tonic-clonic seizures |
| in a complex partial onset seizure in the level of consciousness completely lost? | no only reduced |
| What is a unclassified seizure? | One that does not fit into any of the other categories |
| Describe status epilepticus | multiple seizures occur with no recovery between them usually treated with IV diazapam |
| What is goal of AEDs? | to control or prevent seizures while maintaining a reasonable quality of life to minimize adverse effects and drug induced toxicity |
| AED therapy usually last how long? | life long |
| When starting AED therapy the prescriber will always try ____-drug therapy before _____-drug therapy | single multiple |
| If a patient has been free from seizures for 1-2 years can they stop taking their medicine? | yes, some may be able to discontinue AED therapy |
| what is a febrile seizure? | a seizure caused by fever than occurs in from 6 months to 5 years |
| Do most epileptics take 1 drug or many to treat their condition? | 70% will only take 1 drug |
| Are AEDs needed when a person has only had 1 seizure (isolated episode)? | no, only after 2 or more |
| How do AEDs work? Mechanism of action? AED therapy must: | They reduce excitability They prevent generation and spread of excessive electrical discharge from abnormally functioning nerve cells They protect surrounding normal cells |
| AEDs are thought to alter the movement of sodium, potassium, and calcium ions across nerve cells in the brain which causes: | reduction in the nerve's ability to be stimulated suppresses transmission of impulses from one nerve to the next decreases the speed of nerve impulse conduction within a neuron |
| What is the overall effect of AEDs? | Neurons are stabilized Neuron hyper-excitability is decreased Speed of excessive nerve impulses is decreased |
| Antiepileptic drugs are indicated for? | the prevention or control of seizure activity long term maintenance therapy for chronic, recurring seizures acute treatment of convulsions and status epilepticus |
| In 2008, the FDA put a Black Box warning on AEDs for what? | suicidal thoughts and behavior |
| What are the long-term therapy with phenytoin may cause _____,_____,_____ and _______ | gingival hyperplasia, acne, hirsutism, Dilanin facies |
| What is an auro, when dealing with epileptic patients? | a unique sign/flash/smell that a epileptic person has prior to a seizure |
| When assessing a epileptic patient always ask: | when was your last seizure |
| Nursing Implications: With oral drugs remember they must be taken ______ and with _____ | at the same time every day meals |
| If patient is NPO for a procedure, what do you do regarding AED oral dosage | contact doctor |
| If a patient has a problem swallowing pills, is there a liquid AED? | yes |
| What type of saline is used with IV phenytoin? | normal saline ONLY |
| What adverse effects must a nurse monitor for regardind AEDs? | Mental status changes mood changes changes in the level of consciousness eye problems sore throat fever |
| Patients taking AEDs are encouraged to get what every year? | an eye exam |
| There are three classes of anti-epileptic, what are they? | barbiturates, hydantoins and iminostilbenes as well as valproic acid |
| What type of AED is known to worsen myoclonic or absence seizures, therefore this drug never be given to people with myoclonic or absence seizures | carbamazepine |
| Phenobarbital, phenytoin, carbamazepine and valproic acid are equally effective for what type of seizures? | partial onset seizures |
| What is the drug of choice for convulsions and status epilepticus? | diazepam |
| Patients who undergo brain surgery or who have experienced severe head injuries may receive ________anti-epileptic therapy. | prophylactic |
| Adverse effects of barbiturates | dizziness drowsiness lethargy paradoxical restlessness excitement nausea |
| Adverse effects of hydantoins | nystagmus ataxia dizziness drowsiness rash gingival hyperplasia |
| Adverse effects of carbazepine | nausea headache dizziness drowsiness unusual eye movements visual changes mental and mood changes behavioral changes |
| Adverse effects of valproic acid | dizziness, drowsiness, GI upset, weight gain, hair thinning, ankle edema,hepatotoxicity, pancreatitis |
| Adverse effects of diazapam | apnea (brief pauses in breathing) hypotension somnolence (sleeping for unusually long periods) |
| What is the first line drug used for tonic-clonic and partial seizures? | Dilantin |
| What is the first line drug used for partial and generalized tonic-clonic seizures? **that will worsen myoclonic and absence seizures** | tegretol |
| _______is used to treat absence,myoclonic, and tonic-clonic seizures? | depakote |
| a type of epilepsy with an unknown cause | primary |
| potential adverse effect of valproic acid | hepatotoxicity |
| a brief episode of abnormal electrical activity in the nerve cells of the brain | seizure |
| IV administration of antepileptic drugs should be delivered this way to avoid serious adverse effects | slowly |
| A type of epilepsy with a distinct cause | secondary |
| an involuntary spasmodic contraction of voluntary muscles throughout the body | convulsion |
| this class of drugs is one of the 1st line drugs used to treat status epilepticus | benzodiazapines |
| another name for primary epilepsy | idiopathic |
| a barbiturate used primarily to control tonic-clonic and partial seizures | phenobarbital |
| the metabolic process that occurs when the metabolism of a drug increases over time, which leads to lower than expected drug concentrations | autoinduction |
| recurrent episodes of convulsive seizures | epilepsy |
| a first line antiepileptic drug, the long term use of which can cause gingival hyperplasia | phenytoin |
| A patient has been taking antiepileptic drugs for a year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time? | suicidal thoughts or behavior |
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