Question | Answer |
What is a seizure? | A disturbance of electrical activity in the brain.
Affects consciousness, motor activity and sensation |
Epilepsy | Chronic seizure activity |
Convulsion | Involves involuntary violent spasms of skeletal muscles |
Causes of seizures | Infectious disease, trauma, pediatric disorders (febrile), neoplastic disease, medications, drug abuse, withdrawl, idiopathic.
Metobolic disorders- fluid and lyte imb.
Hypoglycemia
Vascular disease-cerebral hypoxia, ischemia |
Risk of anti-seizure meds during pregnancy | Category C or D
contribute to folate deficiency that can cause neural tube defects like spina bifida |
Spina bifida | The more you see the more disability |
What quality of life can seizures affect | there is an increased risk for injury, severe limit to lifestyle-cant drive
Chronic depression r/t imbalance of dopamine and seritonin. |
Partial seizure | Involves one area of brain
begins with aura |
Complex partial seizure | psychomotor or temporal lobe seizure
Altered consciousness
Aura
Sensory, motor, or autonomic symptoms |
Generalized seizures | Involve entire brain
3 types- absence, atonic, tonic-clonic |
Absence seizure | staring
los of responsiveness
slight motor activity |
Atonic seizure | Drop attack
Stumble and fall
No muscle tone |
Tonic-clonic seizure
(Grand mal) | Aura
Tonic contractions
Cry out, incontinence
Postictal state follows- drowsey,fuzzy |
Febrile seizures | Common in children and infants
Related to seizure |
Reflex/Myoclonic epilepsies | Jerky movements of trunk muscles
similar to Maro reflex in infants |
Status Epilepticus | Repeted seizure
Usually tonic-clonic
Hypoxia-hypoglycemia may dev.
Hyperthermia
Acidosis- related to lactic acid
Lasts a long time |
Why would hypoxia and hypoglycemia develop | During the seizure you use alot of oxygen but lack air movement which causes cells to burn through glucose |
Pharmacotherapy | Choice of med depends on:
Type of seizure
history
Pathological processes causing seizures
Indiviualized to each individual |
How to determine dosage | How the meds control seizures
The side effects caused
Serum drug levels |
Why is compliance with seizure medication so important? | If you skip a dose it will cause you to have a seizure. You can also do drug levels to make sure pt is compliant. |
When changing medications what is it important to do? | You must wean slowly from one med to another usually over the course of 1-2 weeks. While tapering one drug the other is increased. |
Things a pt with seizure meds should do- | Keep a journal
If resp under 12 hold med
Avoid hazerdous activity till effect of drug is known (this can take a few weeks) |
What do you report on seizure meds | Dizziness
visual changes
N, V, D, rash jaundice
Take with food if Gi upset occurs |
Goal of anti-seizure pharmacotherapy | Suppress neuron activity by altering the movement of these ions:
chloride
sodium
calcium
GABA-gamma aminobutyric acid |
Drugs that potentiate(increase) GABA
which calms nerves down | Barbiturates
Benzodiazepines |
Barbiturates | Low margin of safety
Can cause CNS depression
High potential for dependance
Can OD if drink alcohol |
Phenobarbital
(Luminal) | Barbiturate
Commonly prescribed
Inexpensive
Long acting
Low incidence of AE
Causes drowsiness-take at bed time
Easy to adjust in liqid form for children |
Things to be aware of in barbiturates | Adverse effects- sedation, respiratory dep
Precautions- impaired hepatic or renal
Perg cat-D
Decrease in effectiveness of hormonal contraceptives- use more than one barrier method
Depleation of vitamins D, B6 and K |
Benzodiazepines | Schedule IV drugs
Uses:
Absence seizures
Myoclonic seizures
In conjuction with other seizure meds |
Examples of Benodiazepines | epam's
clonazepam(Klonopin)-longterm for seizures
lorazepam(Ativan)-also used for anxiety
diazepam(Valium)-also for anxiety
Valium-can be given Iv during satus eplepticus till other drugs start to work. |
diazepam(Valium) | Interacts-
Precipitates when mixed with other meds in same tubing or syringe.
*Never mix*
*Fluse tubing with NORMAL saline prior and after giving*
Muscle relaxer
IVP may cause-apnea,hypotension,bradycardia,cardiac arrest |
Other GABA potentiating agents | gabapentin(Neurontin) antiseizure,nerve pain
primidone(Mysoline)
topiramate(Topamax)-sometimes mental health and migraines
Pregabalin(Lyrica)-Turns into Gaba-controled drug-more for neuropathy |
Drugs that suppress sodium influx
(Sodium channel blockers) | Hydantoins and phenytoin
Na channels desensitized-dec neuron activity
ex- phenytoin (Dilantin) |
phenytoin
(Dilantin) | Used mainly for seizures
Sometimes used in cardiac to stop dysrythmias |
Examples of phenytoin like drugs | carbamazipine(Tegretol)- seizure, little mental ability
valproic acid(Depakene, Depakote)-seizures
lamotrigine(Lamictal)-mental health(bipolar) |
phenytonin
(Dilantin) | Req a loading dose
Has a dysrhythmic effect(on cardiac monitor while IV)
DO NOT GIVE IM
*When IV prime with ns follow with ns*
Infuse 50mg per min or slower in large vein if given too fast heart will stop |
valproic acid
(Depakene) | Many drug interactions
Used in migrane prevention and bipolar disorder |
Nursing considerations | Monitor for toxicity-
Dizziness,ataxia(difficulty walking), diplopia(blurred vision),lethargy
Blood dyscrasias r/t alteration of vit K metab
Urine color may change
liver toxicity |
Drugs that suppress calcium influx
(Calcium channel blockers) | Succinimides
-act by delaying calcium influx into neurons
Raise seizure threshold-muscles and nerves do not react quickly
Interact with other seizure meds that lower seizure threshold
Ex- ethosuximide(Zarontin)-not for bp |
Pt ed for drugs that suppress calcium influx | Report-change in mood,depression,suicidal ideation, signs of infection,weight loss, anorexia
Do not perform hazardous activities before effect is known
Do not d/c abruptly
take with food if gi upset
Sympt of overdose |
Degenerative diseases of the central nervous system | Multiple etiologies
Medications are only used to treat the symptoms but do not cure the diseases |
Parkinsons Characteristics | Progressive destruction of substantia nigra
(too little dopamine too much AcH)
No cure |
Symptoms of Parkinsons | Tremors
Muscle twitching and blepharospasms(eye twitching) are eary symptoms
muscle rigidity
bradykinesia
postural instability |
Parkinsonism | Not Parkinsons but mimic symptoms
Usually side effect of psychiatric drugs
Also called EPS's |
Anti-parkinsonism Drugs | Dopaminergic drugs tell nerves to make more dopamine.
amantadine(Symmetrel)-does not turn in too dopamine
bromocriptine(Parlodel)-does not turn into dopamine
carbidopa-levodopa(Sinemet)-turns into dopamine |
What are anti-parkinsonism drugs used for? | Given for side effects of parkinsons or pshchiatric meds |
Anti-parkinsonism drug effects | Restore balance of dopamine and AcH in the brain(boosts dopamine)
S/E- involuntary movements, anxiety,pshc problems,blurred vision,n,v,hepatotoxicity
Interactions-Caffine,MAOI,anesthetics,phenothiazines (mental health),pyridoxine(vitamins) |
Nursing considerations of anti-parkinsonism drugs | VS, dysrhythmias
Provide safety
monitor mental health
monitor glucose in DM
monitor kidney and liver function
May cause darkining of urin and perspiration |
levodopa(Larodopa) | Crosses blood brain barier
Becomes dopamine
comb with carbidopa to slow met of med so it works better and longer
can take 6 months to have full effect
Do not withdrawl abruptly
S.E. uncontrolled movements,anxiety |
levodopa(Larodopa) drug interactions | Pyridoxine(Vit B6)
phenytoin(Dilantin)
antihypertensives |
Anticholinergics for Parkinsons | 2nd half if increasing dopamine doesent work
Improves balance of AcH and dopamine
Many side effects
Ex-
trihexyphenidyl(Artane)
benztropine(Cogentin) |
Side effects of anticholinergics | Dry mouth,nose and throat
Constipation
Drowsiness
flushing and overheating
Confusion and memory loss
Blurred vision |
Drug holiday | Meds eventually lose effectiveness
Tapper off med
Stay off for a period of time
resume at much lower dose
Drug becomes effective again |
Alzheimers Characteristics | Impaired memory, confussion, aggressivess, depression, psycoses, anxiety
Dementia
Unable to perform tasks that require AcH
(Not enough Ach getting to cells)
Hippocampus-learning and memory |
Alzheimers etiology | Early onset is genetic (10% of cases) and is more rapid
Chronic inflammation/oxidative damage
-amyloid plaques(goo on nerves)
-neurofibrillary tangles(wind up and tangle) |
What is the differance between Alzhiemers and dementia | Alzhiemers is nerve based and Demitia is vascular |
Meds for Alzhiemers | Action-Inhibit AchE and increase Ach effect
Slows progression of Alzheimers
Side effects-N,V,D
Also called Acetocholinase inhibitors
Indirect parasympathomimetic |
Examples of Alzheimers meds | donepezil hydrochloride(Aricept)
Reminyl,Exelon,Cognex
Nemenda |
Why is aggitation a side effect | The meds keep the nerves firing longer so they can get past the plaques and tangles which can cause more anxiety |
Nursing considerations for alzheimers | Monitor pt condition
Agitation may require
-antipsycotics
-anti-anxiety meds
-mood stabilizers |
Alzheimers pt drug edcation | Meds will not cure
Goals are to improve function
ADL's
Behavior
Cognition
Contraindications-Glaucoma,renal or hepatic disease,COPD,history of GI bleed |
donepezil(Aricept) | Stabalizes memory for a period of time
Administer HS(at bedtime)unless keeps them awake
SE-N,V,D,darkened urine,insomnia,syncope,depression,HA,
irritability,muscle cramps,arthritis, inc libido,many drug interactions
*Do not stop abruptly pt will crash |
Attention Deficit Hyperactivity Disorder
(ADHD) | Poor attention span
Poor behavior control
Inc motor activitytalk excessively
anxiety,mood swings |
ADHD Meds | CNS stimulants-
Reverse symptoms
schedual II drug
Action-heighten alertness,inc focus
AE-insomnia,weight loss,anorexia,nervousness
depression,N,abdominal pain
Nursing considerations- give in am
Preg cat C
Can give with food |
methylphenidate(Ritalin) | S.E.-irr heart beat, HTN, Liver toxicity,
A.E.-dependance
Contraindications- Hyperthiroidism,psycosis, glaucoma, motor tics, CV disease, HTN, DM, seizures
Many interactions-MAOI's
Check BP regularly |
Other ADHD meds | Dosed less frequantly because they tend to get sold
pemoline(Cylert)
amphetamine mixture(Adderall)
atamoxetine(Strattera)-non-CNS stimulant |
Pt education ADHD meds | Keep behavior diary
Report-increase motor behavior, change in sesorium, sadness,rapid pulse, palpitations, dizziness, bruising,SOB
Take in am with food, avoid caffine
Weekly weight & report any loss
Taper prior to drug holiday
Take last dose before 1 |
Migraines | Symptoms- Throbbing, pulsating, one side of head, may have aura,N, V, photophobia
Triggers- MSG, nitrates, red wine, perfumes, caffine, chocolate, aspartame, aged cheese, beer, pickled foods, tyramine containing foods |
Abortive drugs for Migraines | Act on serotonin receptor sites
-ergot alkaloids(found in european mines)
Triptans
They constrict intracranial blood vessels
Avilable po,im, intranasal,SL,supp,SQ |
Examples of Migraine drugs | sumatriptan(Imitrex) safer
ergotamine tartrate (Ergostat)- Can be SL, only so many per day or week or will poision |
Migrane prevention(prophylaxis) | beta blockers
calcium channel blockers
antidepressants
anti-seizure drugs
(anything used for hypertension in a much lower dose) |
sumatriptan(Imitrex) | Constricts intracranial blood vessels, usually does not inc systemic blood vessels
Best if taken at the begining of attack
AE-cardiac ischimia,MI,seizures
Peg cat C
Use cautiously in pt with heart disease,DM
Interact with MAOI,SSRI's, *test at office |
Antianxiety meds | Mediate GABA (inhibitory neurotransmitter)
AE-sedation, orthostatic hypotension, dry mouth, blurred vision
Interactions- alcohol, digoxin |
Examples of anxiety meds | Benzodiazepines
-Alprazolam(Xanax)
-Diazepam(Valium)
-Lorazepam(Ativan)
buspirone(BuSpar)-not addicting
Beta blockers |