Lee College Nursing Program Exam 5 Chp 15:Antiepileptic
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| Define: seizure | Excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neuron activity that results in temporary changes in brain function, primarily affecting sensory and motor activity
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| Define:Convulsion | Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles
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| Define: Epilepsy | Chronic, recurrent pattern of seizures
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| Define: Primary epilepsy | Epilepsy in which there is no identifiable cause. aka idiopathic (This occurs in 50% of patients with epilepsy)
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| Define:Secondary epilepsy | Epilepsy where there is a distinct cause such as trauma, infection, cerebrovasular disorder, or other illness.
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| Seizures are classified into different categories based on their presenting features, name the 3 categories. | 1. partial onset
2. generalized onset
3. unclassified
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| Generalized onset seizures were formally known as ______. | Grand mal seizures
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| Which type of seizures have convulsions? | Generalized onset seizures: the subtype tonic-clonic seizures
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| Generalized onset seizures have several subtypes name the 4 listed in the book: | 1. tonic-clonic
2. Atonic aka drop attacks
3. Myoclonic attacks
4. Absence seizures
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| Of the 4 subtypes of a generalized onset seizures, which one is described as brief muscle jerks, but not extreme | Myoclonic
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| Of the 4 subtypes of a generalized onset seizures, which one is described as a brief loss of awareness that commonly occurs with repetitive spasmodic eye blinking for up to 30 seconds. | absence seizures
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| In regards to a tonic-clonic seizure describe the clonic half and the tonic half. | tonic is the rigged/tenseness
clonic is the convulsion
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| Name the 3 types of partial onset seizures | 1. simple partial onset seizures aka petit mal seizure
2. complex partial onset seizure
3. secondary generalized tonic-clonic seizures
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| Of the 3 types of partial onset seizures which one is described by a brief loss of awareness (blank stare)without a loss of consciousnesses or spasmodic eye blinking as in absence seizures? | simple partial onset seizure
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| Of the 3 types of partial onset seizures which two are associated with postictal confusion? | complex and secondary generalized tonic-clonic seizures
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| in a complex partial onset seizure in the level of consciousness completely lost? | no only reduced
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| What is a unclassified seizure? | One that does not fit into any of the other categories
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| Describe status epilepticus | multiple seizures occur with no recovery between them usually treated with IV diazapam
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| What is goal of AEDs? | to control or prevent seizures while maintaining a reasonable quality of life
to minimize adverse effects and drug induced toxicity
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| AED therapy usually last how long? | life long
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| When starting AED therapy the prescriber will always try ____-drug therapy before _____-drug therapy | single
multiple
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| If a patient has been free from seizures for 1-2 years can they stop taking their medicine? | yes, some may be able to discontinue AED therapy
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| what is a febrile seizure? | a seizure caused by fever than occurs in from 6 months to 5 years
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| Do most epileptics take 1 drug or many to treat their condition? | 70% will only take 1 drug
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| Are AEDs needed when a person has only had 1 seizure (isolated episode)? | no, only after 2 or more
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| How do AEDs work? Mechanism of action? AED therapy must: | They reduce excitability
They prevent generation and spread of excessive electrical discharge from abnormally functioning nerve cells
They protect surrounding normal cells
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| AEDs are thought to alter the movement of sodium, potassium, and calcium ions across nerve cells in the brain which causes: | reduction in the nerve's ability to be stimulated
suppresses transmission of impulses from one nerve to the next
decreases the speed of nerve impulse conduction within a neuron
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| What is the overall effect of AEDs? | Neurons are stabilized
Neuron hyper-excitability is decreased
Speed of excessive nerve impulses is decreased
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| Antiepileptic drugs are indicated for? | the prevention or control of seizure activity
long term maintenance therapy for chronic, recurring seizures
acute treatment of convulsions and status epilepticus
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| In 2008, the FDA put a Black Box warning on AEDs for what? | suicidal thoughts and behavior
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| What are the long-term therapy with phenytoin may cause _____,_____,_____ and _______ | gingival hyperplasia, acne, hirsutism, Dilanin facies
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| What is an auro, when dealing with epileptic patients? | a unique sign/flash/smell that a epileptic person has prior to a seizure
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| When assessing a epileptic patient always ask: | when was your last seizure
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| Nursing Implications: With oral drugs remember they must be taken ______ and with _____ | at the same time every day
meals
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| If patient is NPO for a procedure, what do you do regarding AED oral dosage | contact doctor
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| If a patient has a problem swallowing pills, is there a liquid AED? | yes
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| What type of saline is used with IV phenytoin? | normal saline ONLY
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| What adverse effects must a nurse monitor for regardind AEDs? | Mental status changes
mood changes
changes in the level of consciousness
eye problems
sore throat
fever
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| Patients taking AEDs are encouraged to get what every year? | an eye exam
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| There are three classes of anti-epileptic, what are they? | barbiturates, hydantoins and iminostilbenes as well as valproic acid
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| What type of AED is known to worsen myoclonic or absence seizures, therefore this drug never be given to people with myoclonic or absence seizures | carbamazepine
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| Phenobarbital, phenytoin, carbamazepine and valproic acid are equally effective for what type of seizures? | partial onset seizures
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| What is the drug of choice for convulsions and status epilepticus? | diazepam
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| Patients who undergo brain surgery or who have experienced severe head injuries may receive ________anti-epileptic therapy. | prophylactic
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| Adverse effects of barbiturates | dizziness
drowsiness
lethargy
paradoxical restlessness
excitement
nausea
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| Adverse effects of hydantoins | nystagmus
ataxia
dizziness
drowsiness
rash
gingival hyperplasia
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| Adverse effects of carbazepine | nausea
headache
dizziness
drowsiness
unusual eye movements
visual changes
mental and mood changes
behavioral changes
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| Adverse effects of valproic acid | dizziness, drowsiness, GI upset, weight gain, hair thinning, ankle edema,hepatotoxicity, pancreatitis
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| Adverse effects of diazapam | apnea (brief pauses in breathing)
hypotension
somnolence (sleeping for unusually long periods)
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| What is the first line drug used for tonic-clonic and partial seizures? | Dilantin
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| What is the first line drug used for partial and generalized tonic-clonic seizures? **that will worsen myoclonic and absence seizures** | tegretol
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| _______is used to treat absence,myoclonic, and tonic-clonic seizures? | depakote
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| a type of epilepsy with an unknown cause | primary
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| potential adverse effect of valproic acid | hepatotoxicity
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| a brief episode of abnormal electrical activity in the nerve cells of the brain | seizure
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| IV administration of antepileptic drugs should be delivered this way to avoid serious adverse effects | slowly
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| A type of epilepsy with a distinct cause | secondary
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| an involuntary spasmodic contraction of voluntary muscles throughout the body | convulsion
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| this class of drugs is one of the 1st line drugs used to treat status epilepticus | benzodiazapines
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| another name for primary epilepsy | idiopathic
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| a barbiturate used primarily to control tonic-clonic and partial seizures | phenobarbital
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| the metabolic process that occurs when the metabolism of a drug increases over time, which leads to lower than expected drug concentrations | autoinduction
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| recurrent episodes of convulsive seizures | epilepsy
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| a first line antiepileptic drug, the long term use of which can cause gingival hyperplasia | phenytoin
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| A patient has been taking antiepileptic drugs for a year. The nurse is reviewing his recent history and will monitor for which condition that may develop during this time? | suicidal thoughts or behavior
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