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Antiepileptic Drugs
| Question | Answer |
|---|---|
| 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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