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Chap - 22


medications used to reduce the number &/or severity of seizures in patients w/epilepsy anticonvulsants
defined as recurrent paroxysmal disorder of brain function characterized by sudden attacks of altered consciousness, motor activity, or sensory impairment epilepsy
based on type, severity, & cause of seizures treatment of epilepsy
most epilepsy is __ idiopathic
epilepsy can be associated with cerebrovascular disease, cerebral trauma, intracranial trauma, intracranial infection/fever, brain tumor, __ or __ intoxication; chemical imbalance
anticonvulsive medication is not indicated for fever, hypoglycemia, or electrolyte imbalance, which are examples of correctable epilepsy disorders
classifies seizures into 3 main categories International Classification of Epilepsies & Epileptic Syndromes
bilaterally symmetrical & without local onset; includes grand mal and absence seizures generalized seizure
complex symptomatology (temporal lobe/psychomotor seizures) partial seizures
seizures with insufficient data to classify unclassified
grand mal seizures are called tonic-clonic
characterized by loss of consciousness, falling, & generalized tonic-clonic muscle contractions; usually lasts 2-5 min; urinary/fecal incontinence may occur grand mal seizures
initial treatment of grand mal seizures includes __ preventing injury only
if seizures are so frequent that patient does not regain consciousness between seizures, condition is known as status epilepticus
medication treatment of choice for status epilepticus is __ __, or phenytoin, administered slowly IV diazepam (Valium)
sometimes __ __ is given for grand mal seizures IV phenytoin
absence epilepsy was previously called petit mal because of the absence of convulsions
characterized by 10-30 sec. loss of consciousness w/no falling & usually occur initially in children absence seizure
drug of choice for management of __ seizures is ethosuximide (Zarontin), and only effective for this type of epilepsy absence
used in treatment of absence seizures when suximide is ineffective clonazepam & valproic acid
sedation, dizziness/irritability, GI distress incl. anorexia, nausea, vomiting, or diarrhea, and rash & leukopenia are all __ __ of drugs for absence seizures side effects
__ __ w/drugs for absence epilepsy applies to hepatic/renal disease, pregnancy/lactation, and pancreatitis (w/valproate) extreme caution
stopping medications for absence seizures abruptly is contraindicated
caused by lesion in temporal lobe; symptoms: confusion, impaired understanding & judgment, staggering, purposeless movements, bizarre behavior, & unintelligible sounds, but no convulsions psychomotor seizures
__ seizures affect only one side of the body unilateral
some patients have __ __ __ combining more than one type mixed seizure patterns
it is important to observe/report __ & __ of seizures, as well as general responsiveness to medications type; length
__ __ of grand mal & psychomotor seizures usually consists of phenytoin, frequently combined w/phenobarbital or valproic acid, administered orally prophylactic treatment
the aim of drug therapy for epileptic patients is to prevent seizures without __ oversedation
side effects of phenytoin frequently __ with continued treatment decrease
sedation, ataxia, dizziness & headache; blurred vision, nystagmus & diplopia; gingivitis; GI distress incl. nausea, vomiting, anorexia, constipation or diarrhea; rash & dermatitis side effects of phenytoin
life-threatening condition affecting the skin in which cell death causes the epidermis to separate from the dermis; dermatitis associated w/phenytoin use Steven-Johnson syndrome
__ __ is a side effect of phenytoin use, and is treated with folic acid supplements megoblastic anemia
__ is a side effects from phenytoin use, treated with vitamin D supplement osteomalacia
__ is contraindicated, or to be used w/extreme caution, in patients w/kidney/liver disease, diabetes, CHF, bradycardia, heart block, hypertension, pregnant/lactating, hematological disease phenytoin
abrupt DC of phenytoin is contraindicated
used sometimes for partial, generalized, or mixed seizures carbamazepine
cardiac, hematological, kidney, & liver __ are all side effects from carbamazepine complications
carbamazepine with __ __ potentiates action & can increase risk of serious adverse effects grapefruit juice
children are frequently treated with phenobarbital alone, for febrile convulsions
the use of phenobarbital alone, in treatment of a child who is afebrile, is controversial because of cognitive impairment
there is evidence that phenobarbital, phenytoin, & carbamazepine may have an adverse effect on __ & __ in children behavior; cognition
primary advantage of newer formulations, of traditional anticonvulsants, is that there is an increased ease of __ & __ administration; tolerability
anticonvulsants that usually do not require laboratory monitoring of therapuetic levels; fewer overall adverse effects & interactions second-generation
second-generation anticonvulsants require a __ __ __ to avoid CNS adverse effects slow titration period
determination of given component in solution by adding a liquid reagent of known strength until given endpoint reached, indicating that the component has been consumed by reaction w/reagent titration
contraindicated in pregnancy/lactation; should not be abruptly discontinued 2nd-generation anticonvulsants
patients taking anticonvulsants should be instructed: caution w/driving/operating machinery until __ with the medication, because of __ or dizziness regulated; drowsiness
patients taking anticonvulsants should be instructed: careful __ __ until tenderness of gums subsides as treatment progresses oral hygiene
patients taking anticonvulsants should be instructed to always take medication on time & never __ a dose omit
__ __ from anticonvulsants can lead to status epilepticus abrupt withdrawal
patients taking anticonvulsants should be instructed to always wear __ __ at all time in case of accident Medic-Alert tag
1st-generation anticonvulsant; taken for partial/mixes seizures (psychomotor); brand name for carbamazepine Tegretol
1st-generation anticonvulsant; taken for partial/mixes seizures (psychomotor); brand name for carbamazepine extended release form Tegretol XR
1st-generation anticonvulsant; taken for absence seizures; brand name for clonazepam Klonopin
1st-generation anticonvulsant; Caution: possible to confuse w/Celexa/Celebrex; brand name for fosphenytoin Cerebyx
1st-generation anticonvulsant; taken for grand mal, psychomotor, or focal seizures; frequently combined w/phenobarb; brand name for phenytoin Dilantin
1st-generation anticonvulsant; taken for absence seizures; brand name for ethosuximide Zarontin
1st-generation anticonvulsant; taken for absence, partial, & tonic-clonic seizures; brand name for Valproic acid Depakene, Depakote, Depacon
1st-generation anticonvulsant; taken for absence, partial, & tonic-clonic seizures; only one dose/day extended release form; brand name for Valproic acid Depakote ER
2nd-generation anticonvulsant; taken for partial seizures; minimal drug interactions; >dose w/renal dysfunction; brand name for gabapentin Neurontin
2nd-generation anticonvulsant; taken for partial seizures; monitor liver function; Caution do not confuse w/Lamisil; brand name for lamotrigine Lamictal
2nd-generation anticonvulsant; taken for partial seizures; may affect cognitive function at high doses; brand name for topiramate Topamax
common side effects of phenytoin include GI distress, ataxia, & __ gingivitis
in absence epilepsy, convulsions are __ & there is a breif loss of consciousness w/no falling absent
types of generalized seizures include __ & absence grand mal
2nd-generation anticonvulsant Neurontin is indicated for treatment of __ seizures partial
an alternative medication sometimes used for partial, generalized, or mixes seizures is __ (Tegretol) carbamazepine
grand mal seizures usually last from two to __ minutes five
grand mal seizures are characterized by loss of consciousness, falling, & __ muscle contractions tonic-clonic
2nd-generation anticonvulsants have fewer side effects & drug interactions than __ medications 1st-generation
remove objects that may cause trauma, cushion head & turn it to the side, & loosen tight clothing; these are the steps to take initially in the treatment for grand mal seizures
Created by: lfrancois