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Anti-Seizure Agents
Seizure Medications
| Question | Answer |
|---|---|
| Epilepsy | Characterized by a sudden discharge of excessive electrical energy from nerve cells located in the brain, which leads to seizures |
| Seizures present in many forms | Convulsions, Lapse in concsciousness, Stimulation of autonomic or sensory nerves |
| Antiepileptics (anti-seizure agents) | Used to manage epilepsy |
| Drug of choice depends on? | The type of seizure, patient, age and tolerability of the drug itself |
| Drug therapy across the lifespan for children | Effect learning and social development. Monitor closely for sedating effects. Start on a ↑ dose (some kids) and then adjust to a ↓ one. Support and educate. |
| Drug therapy across the lifespan for children | Newborn(1-10 days): respond best to intramuscular phenobarbital. 2mo-6yrs: absorb and metabolize quickly so need larger dose. Calculate with age and weight. 10yr-14yr: Standard adult dose |
| Drug therapy across the lifespan for Adults | Regular monitoring, Medic-Alert ID band. Ed. and support for drug effects, lifestyle changes and stigmas. Use birth control. Breast feeding causes sedation in infant. Stopping drug due to pregnancy can cause anoxia to both. |
| Drug therapy across the lifespan for Older Adults | More suseptible to adverse effects. ↓ dose. Monitor for toxic effects and provide safety measure if causes CNS effects. Renal and hepatic baselines if impaired. Medic-Alert ID. Start on ↓ dose. |
| Cultural Considerations | Arab Am. and Asian Am. have different liver enzyme function so do not metabolize as other groups. Show adverse effects at ↓ doses. Monitor closely. |
| Herbal Interactions | Evening primrose- ↑ seizure risk |
| Nature of Seizures (causes) | Caused by abnormal neurons that are sensitive to stimulation and over respond. |
| Primary Seizures | Caused by these abnormal cells with no underlying cause identified |
| Secondary Seizures | Seizures precipitated by outside factor: Head injury, drug overdose, Environmental exposure |
| Seizure Categories: Generalized Seizures | begin in one area of the brain-rapidly spread throughout both hemispheres-usually experience a loss of consciousness |
| Generalized Seizures Tonic-Clonic Seizure (grand mal) | Formally grand-mal. Dramatic muscle contraction followed by relaxation, loss of consciousness, and a recovery period characterized by confusion and exhaustion |
| Generalized Seizures Absence Seizures (petit mal) | Abrupt, brief (3-5 sec)- periods of loss of consciousness-usually NO muscle contractions- 'glazed look' and common in kids |
| Generalized Seizures Febrile Seizures | Due to high temperatures- involve tonic-clonic seizures and are self limiting and do not reappear (common in kids) |
| Generalized Seizures Jacksonian Seizures | Begin in one area of the brain and involve one body part then spread to other areas |
| Generalized Seizures Myoclonic Seizures | Short, sporadic periods of muscle contractions lasting several minutes. Rare secondary seizures |
| Generalized Seizures Psychomotor Seizures | Loss of consciousness with autonomic movements, emotional outbursts, and psychomotor disturbances |
| Generalized Seizures Status Epilepticus | Seizures rapidly reoccur with no recovery in-between seizures. Most dangerous. Brought on by extreme fatigue or pt. has stopped taking |
| Partial (focal) Seizures | Involves one area of the brain and does not spread. Symptoms depend on where in the brain the seizure is occuring |
| Partial (focal) Seizures Simple Partial Seizures | May involve a single muscle movement or sensory alteration like drowysinesss |
| Partial (focal) Seizures Complex Partial Seizures | Series of reactions or emotional (sensory) changes (hallucinations, mental distortion, personality changes, social inhibitions and loss of consciousness). Motor changes- involuntary urination, chewing motions, diarrhea. Onset occurs by late teens. |
| Drugs For Treating Generalized Seizures | Stabailize nerve membranes by blocking channels in the cell membrane or alter receptor sites. They work on the entire CNS and produce other CNS effects such as sedation. Effect the entire brain and reduce sudden electrical outbursts |
| HYDANTOINS | Generally less sedating than other antiepileptics. May be the drug of choice for patients not willing to tolerate sedation |
| HYDANTOINS DRUG ACTION | Stabilize nerve membranes throughout the CNS by directly influencing ionic channels therefore ↓ excitability to stimulation |
| HYDANTOINS Contraindications and Cautions | Associated with specific birth defects. Do not use in pregnancy or lactation unless risk of seizures outweighs potential risk to fetus. Research has not shown effects of even a minor seizure during pregnancy-must prevent seizures during pregnancy |
| HYDANTOINS Contraindications and Cautions | Elderly or debilitated individuals who may respond adversely to CNS depression, impaired liver/renal toxicity, allergy to drug |
| HYDANTOINS Adverse Effects | Related to CNS depression. Depression, confusion, drowsiness, lethargy, constipation, dry mouth, anorexia, ♥ arrhythmias, change in BP, urinary retention (good to empty bladder prior to taking drug), and loss of libido |
| HYDANTOINS Specific Adverse Effects | Severe liver toxicity, gingival hyperplasia and Stevens-Johnson syndrome (skin condition like a sloughing of skin) which is related to cellular toxicity, and bone marrow suppression |
| HYDANTOINS Drug Interactions | ALCOHOL- CNS depression is ↑ |
| HYDANTOINS- PROTOTYPE PHENTOIN (DILANTIN) | Control tonic-clonic and psychomotor seizures, control of status epilepticus, prevention of seizures during neurosurgery |
| HYDANTOINS- PROTOTYPE PHENTOIN (DILANTIN) | Theraputic serum levels = 10 to 20 mcg/mL (Blood level should be at this) Oral and IV. Adult and Pediactric |
| HYDANTOINS ETHOTOIN (PEGANONE) | Treatment of tonic-clonic and psychomotor seizures. Oral. Adult and Pediatric |
| HYDANTOINS FOSPHENYTOIN (CEREBYX) | Do not confuse with Celebrex. Treatment of short term control of status epilepticus and prevention of seizures after neurosurgery. Adult Drug |
| Drugs For Treating Generalized Seizures Barbiturates and Barbiturate -Like Drugs | Associated with significant CNS depression |
| Barbiturates and Barbiturate -Like Drugs | Inhibit impulse conduction in the RAS (reticular activation system in the brainstem), depress cerebral cortex, alter cerebellar function, depress motor nerve output |
| Barbiturates and Barbiturate -Like Drugs Contraindications and Cautions | Associated with specific birth defects. Do not use in pregnancy or lactation unless risk of seizures outweighs potential risk to fetus. Research has not shown effects of even a minor seizure during pregnancy-must prevent seizures during pregnancy |
| Barbiturates and Barbiturate -Like Drugs Contraindications and Cautions | Elderly or debilitated individuals who may respond adversely to CNS depression, impaired liver/renal toxicity, allergy to drug |
| Barbiturates and Barbiturate -Like Drugs Adverse Effects | Related to CNS depression. Depression, confusion, drowsiness, lethargy, constipation, dry mouth, anorexia, ♥ arrhythmias, change in BP, urinary retention (good to empty bladder prior to taking drug), and loss of libido |
| Barbiturates and Barbiturate -Like Drugs Specific Adverse Effects | Barbiturates depress nerve function and can produce, sedation, hypnosis, anesthesia, deep coma. Degree of depression is dose related. |
| Barbiturates and Barbiturate -Like Drugs Specific Adverse Effects | These drugs block seizure activity below those needed to cause hypnosis |
| Barbiturates and Barbiturate -Like Drugs Drug Interactions | CNS depression is ↑ if taken with alcohol. Associated with physical dependence and drawl |
| Barbiturates and Barbiturate -Like Drugs PROTOTYPE PHENOBARBITOL (SOLFOTON, LUMINAL) | Long term TX of tonic-clonic and focal seizures, emergency control of acute convulsive seizures (status apilepticus, tetanus, eclampsia. Slow onset, long duration |
| Barbiturates and Barbiturate -Like Drugs PROTOTYPE PHENOBARBITOL (SOLFOTON, LUMINAL) | Theraputic serum levels = 15 to 40 mcg/mL CNS depressants, insomnia, vertigo, nightmares, anxiety, diarrhea. Oral, IM, IV, SC. Metabolized liver/excreted urine. Adult and Pediatric |
| Barbiturates and Barbiturate -Like Drugs MEPHOBARBITAL (MEBARAL) | Tx of tonic-clonic and absence seizures and used as sedative/hypnotic. Oral drug metabolized liver/excreted urine. Adult and Pediatric |
| Barbiturates and Barbiturate -Like Drugs PRIMIDONE (MYSOLINE) | Alternative choice in TX of tonic-clonic partial, febrile and refractory seizures. Oral only. Adult and Pediatric |
| Drugs For Treating Generalized Seizures Benzodiazephhines | These potentiate the effects of GABA, an inhibitory neurotransmitter that stabilizes nerve cell membranes |
| Drugs For Treating Generalized Seizures Benzodiazephhines | Act primarily in the limbic system and the RAS (reticular activation system), cause muscle relaxation and relieve anxiety w/o affecting cortical functioning substantially. |
| Drugs For Treating Generalized Seizures Benzodiazephhines | Limited toxicity and well tolerated by most people. |
| Drugs For Treating Generalized Seizures Benzodiazephhines Contraindications and Cautions | Associated with specific birth defects. Do not use in pregnancy or lactation unless risk of seizures outweighs potential risk to fetus. Research has not shown effects of even a minor seizure during pregnancy-must prevent seizures during pregnancy |
| Benzodiazephhines Contraindications and Caution | Elderly or debilitated individuals who may respond adversely to CNS depression, impaired liver/renal toxicity, allergy to drug |
| Benzodiazephhines Adverse Effects | Related to CNS depression. Depression, confusion, drowsiness, lethargy, constipation, dry mouth, anorexia, ♥ arrhythmias, change in BP, urinary retention (good to empty bladder prior to taking drug), and ↓ of libido |
| Benzodiazephhines Drug Interactions | Associated with physical dependence and drawl. CNS depression ↑ with alochol |
| Benzodiazephhines- PROTOTYPE DIAZEPAM (VALIUM) | Indicated in anxiety disorders, acute alcohol withdrawal, muscle relaxant, TX of tetanus, mgt. of epilepsy (but not long term) |
| Benzodiazephhines- PROTOTYPE DIAZEPAM (VALIUM) | Acts in the limbic system and reticular formation. ORAL, IM, IV, Rectal. Metabolized in liver/excreted urine. Pediatric, adult and geriatric doses |
| Benzodiazephhines CLONAZEPAM (KLONOPIN) | TX of absence and myoclonic seizures. Ongoing studies to TX panic attacks, restless leg syndrome. Oral (disintegrating tablet for Pt's with diff. swallowing). Adult/Pediatric |
| Drugs For Treating Generalized Seizures SUCCINIMIDES | Most frequently used toTX absence seizures |
| Drugs For Treating Generalized Seizures SUCCINIMIDES ACTION | The exact mechanism of action is not understood. Believed to surpress the abnormal electrical activity in the brain associated with absence seizures |
| SUCCINIMIDES Contraindications and Cautions | Intermittent porphyria (accumulation of porphyrins in the body). Renal/hepatic disease. Crosses placenta into breast milk so do not take while pregnant or lactating |
| SUCCINIMIDES Adverse Effects | Few compared to other anti-epileptics. Depressant effects on CNS depression, drowsy, fatigue, insomnia. Decreased GI activity nausea, vomit, anorexia, GI pain |
| SUCCINIMIDES Adverse Effects | Bone marrow suppression, including potentially fatal pancytopenia and dermatological reactions like pruritis, utricaria, alopecia and Stevens Johnson syndrome. All due to direst chemical irritation of the skin |
| SUCCINIMIDES PROTOTYPE- ETHOSUXIMIDE (ZARONTIN) | DRUG OF CHOICE FOR TX OF ABSENCE SEIZURES. Oral. Metabolized liver/excreted urine. Caution if using with primidone as causes a ↓ in serum level of primidone |
| SUCCINIMIDES PROTOTYPE- ETHOSUXIMIDE (ZARONTIN) | Theraputic serum level = 40-100mcg/mL |
| SUCCINIMIDES METHSUXIMIDE (CELONTIN) | TX of absence seizures refractory to other agents. Oral. Adult and pediatric |
| Other drugs for Treating Absence Seizures that do not fit into specific classes. | These drugs modulate the inhibitory neurotransmitter gamma-aminobutyric acid. |
| Other drugs for Treating Absence Seizures Contraindications and Cautions | Caution with hepatic/renal impairment. Do not use during pregnancy. Known allergy to any component of the drug or to sulfonamides. Pt should stay well hydrated(renal calculi) |
| Other drugs for Treating Absence Seizures Adverse Effects | CNS effects related to CNS suppression, weakness, drowsy, weak, dizzy |
| Other drugs for Treating Absence Seizures PROTOTYPE VALPROIC ACID (DEPAKENE) | Drug of choice for myoclonic seizures, second choice for absence seizures, mania, migraines. Oral. Absorbed in GI, metabolized in liver/excreted urine |
| Other drugs for Treating Absence Seizures ACETAZOLAMIDE (DIAMOX) | TX of absence seizures especially in children. Open angle glaucoma, decrease edema in ♥ failure, motion sickness. Oral, IM, IV. Absorbed in GI tract, excreted unchanged in urine. Adult/Peds |
| Other drugs for Treating Absence Seizures ZONISAMIDE (ZONEGRAN) | Taper off over 2 weeks. Adjunct for TX of absence seizures. Oral. Absorbed in GI/excreted unchanged in urine. Adults only |
| Nursing Considerations For Generalized Seizure Drugs Assess For the following | Allergy to hydantoins(↑♥ arrhythmias, hypotension, diabetes, coma) HX of renal/hepatic dysfunction. Pregnancy/lactation |
| Nursing Considerations For Generalized Seizure Drugs Assess For the following | Allergy to succinimides. HX of porphyria(resembles a skin problem). Renal/hepatic dysfunction. Pregnancy/lactation |
| Nursing Considerations For Generalized Seizure Drugs Assess For the following | Obtain a description of seizures, onset, aura, duration, recovery to determine type and establish a baseline. Perform physical to establish baseline |
| Nursing Considerations For Generalized Seizure Drugs Assess For the following | Inspect skin color,♡, BP, auscultate♥, level of orientation, affect, grip, bowels, urine output, gums, mucous membranes, renal/hepatic and obtain electroencephalogram(brain scan) |
| Nursing Diagnoses For Generalized Seizure Drugs (related to drug therapy) | Acute discomfort R/T GI, CNS, GU effects. Disturbed thought process R/T CNS effects. Risk for infection R/T bone marrow suppression. |
| Nursing Diagnoses For Generalized Seizure Drugs (related to drug therapy) | Impaired skin integrity R/T dermatological effects. Deficient knowledge of drug therapy |
| Nursing Implementation with Rationale For Generalized Seizure Drugs | Discontinue if reaction, liver dysfunction, severe skin rash,bone marrow suppression, depression. Give with food if GI upset. Monitor and support. CBC before and during to detect bone marrow suppression |
| Nursing Implementation with Rationale For Generalized Seizure Drugs | Discontinue drug slowly as rapid withdrawal may precipitate absence seizures. Monitor for drug to drug interactions. Council child bearing age women. Patient teaching. MedicAlert band. |
| Nursing Evaluation For Generalized Seizure Drugs | Monitor pt. response to drug and therapeutic blood levels. Monitor all adverse effects, patient comfort and effectiveness of plan |
| Drugs For Treating Partial Seizures | Partial seizures may be simple(single muscle) or complex(series of reactions). ALL DRUGS ARE GIVEN ORALLY |
| Drugs For Treating Partial Seizures | Drugs stabilize nerve membranes in one of two ways: -Directly: by altering sodium and calcium channels -Indirectly: by ↑activity of GABA (inhibitory neurotransmitter) |
| Drugs For Treating Partial Seizures Contraindications and Cautions | Bone marrow suppression, severe liver dysfunction. Pregnancy/Lactation- data indicates dangerous➔use caution. |
| Drugs For Treating Partial Seizures Adverse Effects | Can be directly toxic to liver and bone marrow CNS depression |
| Drugs For Treating Partial Seizures PROTOTYPE CARBAMAZAPINE (TEGRETOL) | DRUG OF CHOICE FOR PARTIAL SEIZURES. TX of partial, tonic clonic, bipolar disorder and trigeminal neuralgia. Related to tricyclic antidepressants. Absorbed in GI/metabolized in liver/excreted in urine. Dangerous to fetus |
| Drugs For Treating Partial Seizures PREGABALIN (LYRICA) | Indicated in seizures, nueropthic pain, fibromyalgia. ↓ infertility in men. Has a controlled sub rating of V so it can cause feeling of wellbeing and euphoria. Limit in pt's with HX of alcohol/drug abuse. Oral, not metabolized/ excreted unchanged. Adult |
| Drugs For Treating Partial Seizures CLORAZEPATE (TRANEXENE, GEN-XENE) | TX of partial seizures, anxiety disorders, alcohol withdrawal. Adult/Pediatric |
| Drugs For Treating Partial Seizures FELBAMATE (FELBATOL) | TX of partial seizures, adjuctive therapy for Lennox-Gastaut syndrome in kids. Adults/Pediatric |
| Drugs For Treating Partial Seizures GABAPENTIN (NEURONTIM) | Adjunct in TX partial seizures, postherpetic pain in adults and kids (3-12 yrs). Orphan drug status of amyotrophic lateral sclerosis, migraine, bipolar. Adult/Pediatric |
| Drugs For Treating Partial Seizures LAMOTRIGINE (LAMICTAL) | Adjunct or monotherapy in TX partial seizures and Lenox Gault syndrome in adults and children ≥2 yrs. Long term bipolar TX. Absorbed GI/metabolized liver/excreted urine. Serious life threatening rash poss. |
| Drugs For Treating Partial Seizures LEVETIRACETAM (KEPPRA) | Newer drug. Adjunctive TX of partial seizure in adults and children ≥4 yrs. Rapidly absorbed GI/ little metabolism/excreted urine. |
| Drugs For Treating Partial Seizures OXCARBAZEPINE (TRILEPTAL) | Monotherapy or adjunctive therapy in TX of partial seizures adult and children 4-16 yrs. Being studied for TX bipolar disease. Absorbed GI/metabolized liver/excreted urine. Adult and Pediatric |
| Drugs For Treating Partial Seizures TIAGABINE (GABITRIL) | Adjunct in TX partial seizures in adults and children 12-18 yrs. Absorbed GI/metabolized liver/excreted urine |
| Drugs For Treating Partial Seizures TOPIRAMATE (TOPAMAX) | Adjunct in TX partial seizures in adults and children 2-16 yrs. Approved for tonic-clonic and prevention of migraines. Rapidly absorbed from GI/widely distributed/excreted unchanged in urine |
| Nursing Considerations For Partial Seizure Drugs Assess For the following | Any known allergies to drugs, HX of bone marrow suppression, renal stones, renal/hepatic dysfunction, pregnancy, lactation. |
| Nursing Considerations For Partial Seizure Drugs Assess For the following | Perform physical to establish baseline. Assess♡, BP, skin color, auscultate ♥, orientation, affect, reflexes, strength, bowels, urinary output, renal, liver, CBC |
| Nursing Considerations For Partial Seizure Drugs Nursing Diagnoses | Acute pain R/T GI and CNS effects Disturbed thought processes R/T CNS effects Risk for Injury R/T CNS effects Risk for infection R/T bone marrow suppression Deficient Knowledge regarding drug therapy |
| Nursing Considerations For Partial Seizure Drugs Implementation with Rationale | Administer drug with food. Monitor CBC before and during therapy, prevent exposure to infection. Stop if skin rash, bone marrow suppression, depression. Stop drug slowly as quick stop can bring on seizures. Council women of child bearing age. |
| Nursing Considerations For Partial Seizure Drugs Implementation with Rationale | Evaluate for therapeutic blood levels of carbamazepine (4 to 12 mcg/mL). Provide safety measures from falls if CNS changes occur. Pt. teaching. Medic Alert band and offer support |
| Nursing Considerations For Partial Seizure Drugs Evaluation | Monitor pt. response to the drug(↓or↑ in seizures). Monitor for adverse effects, CNS changes, GI depression, bone marrow suppression, skin reactions, liver toxicity, renal stones. And effectiveness of teaching plan and compliance of regime. |
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gretchencox
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