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Antiepileptic Drugs

Describe a Partial/Focal Seizure Involves a limited area of hyper-excitability. Symptoms include staring into space, lack of attention, "day dreaming"
Describe a Generalized Seizure (Tonic-Clonic) The tonic phase is extreme rigidity, and the clonic phase is rhythmic extremity jerking. Symptoms include immediate loss of consciousness and a post-ictal state that lasts hours
What is Status epilepticus? When a seizure lasts for longer than 20 minutes
How do anticonvulsant drugs work? Inhibit sodium or calcium influx to decrease impulse conduction. Or they potentiate GABA, a neuroinhibitory neurotransmitter
How does Dilantin (phenytoin) work? Inhibits sodium influx
What is Dilantin (phenytoin) Used for? second-line therapy for status epilepticus
What should Dilantin NOT be used for? absence seizures (not effective), preventative measures
Describe how IV phenytoin should be administered? Why should it be administered in this manner? Very slowly, 25mg/min. If given faster, bradycardia & hypotension can occur. Phenytoin also must be given in normal saline, anything else will cause the drug to precipitate.
What should you do if your patient is on enteral feeding and also receiving phenytoin? Hold the enteral feeding 1 hour prior to administering phenytoin, as enteral feeding decreased the bioavailability of phenytoin
What are the first side effects of Phenytoin to appear (2-4 weeks)? drowsiness, sedation, severe N/V
Name the side effects associated with extended use of phenytoin. bone marrow depression, decreased WBC (esp. neutrophils, agranulocytosis), gingival hyperplasia (overgrowth of the gums), endocrine SEs (hair loss, weight gain, gynecomastia), folic acid deficiency anemia
List Symptoms of Phenytoin Toxicity. ataxia (distrubed gait), slurred speech, sedation, double vision, Nystagmus (lateral eye jerking), EKG changes, hypotension
List drugs that can decrease the absorption of oral Dilantin. antacids, sucralafate (carafate), Metamucil, Bile Acid Sequestrants. These drugs should be given 1 hour before or 4 hours after phenytoin
List drugs that increase the metabolism of Dilantin. Phenobarbital, Chronic alcohol ingestion, Tegretol (carbamazepine)
Dilantin decreases the metabolism of what drugs? Estrogen-containing contraceptives, Lasix
What actions are important when caring for your patient on Dilantin? Check CBC for decreased WBCs and anemia. When administering a loading dose, make sure the patient is on a cardiac monitor b/c bradycardia & hypotension can occur.
What are important things to teach your patient on Dilantin? Appropriate birth control alternatives, Seizures caused by abruptly stopping meds, Urine discoloration is normal, Remind about importance of dental check-ups, inform them that alcohol decreases the effectiveness of phenytoin
How is Cerebyx (fosphenytoin) related to Dilantin (phenytoin)? Cerebyx is a prodrug that is metabolized to phenytoin.
What is Cerebyx used for that Dilantin is not? Status epilepticus
How long can Cerebyx be used? no longer than 5 days
What is the only route of administration for Cerebyx? IV
How does Tegretol (carbamazepine) work? suppresses influx of sodium
What is Tegretol used for? seizures, bipolar disorder, alcohol/drug withdrawal, restless leg syndrome, phantom limb pain
What conditions is Tegretol NOT used for? absence seizures, status epilepticus
Tegretol is considered a unique CYP450 inducer...why? Tegretol will increase the metabolism of other drugs AND itself
Tegretol decreased the effectiveness of what drugs? estrogen contraceptives, theophylline, Dilantin
What drugs/substances can cause Tegretol toxicity? CYP450 inhibitors such as Grapefruit juice, and Tagamet (cimetidine)
What are the side effects of Tegretol? agranulocytosis, aplastic anemia, photosensitivity, seizure w/ abrupt discontinuation
What are important lab associated with Tegretol therapy? CBC (during first 4wks), Liver function testing, Tegretol blood level, glucose (for diabetes patients)
What pregnancy category is Tegretol? D
What pregnancy category is Dilantin? D
How does Valproic Acid (Depakote/Dapakene/Depacon) work? decreases sodium & calcium influx and potentiates GABA
What is Valproic Acid Used for? general and partial seizures, status epilepticus, manic episodes, migraine headaches, and even depression
Valproic Acid often causes toxicity when it is taken with what? CYP450 Inducers, such as Dilantin
Who is most at risk of Hepatotoxicity associated with Valproic Acid? children under 2 years old
Side Effects of Valproic Acid. bleeding (caused by decreased platelets), hepatotoxicity, hemorrhagic pancreatitis
What are symptoms of Hemorrhagic pancreatitis? mid epigastic pain, N/V, anorexia, bluish discoloration of the flank, bleeding, tachycarida, hypotension
As an awesome nurse, you know to monitor what for patients on Valproic Acid? Liver function
How do Benzodiazepines (anxiolytic drugs) work? Potentiate GABA
What are Benzodiazepines used for? First line drugs for status epilepticus
Name specific Benzodiazepines. Ativan (lorazepam), Valium (diazepam)
Side Effects of Benzodiazepines. Respiratory depression, hypotension
Created by: littlejohnson



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