Anticonvulsants
List teaching points you will tell your patient starting on a new anti-seizure med.
What can cause drowsiness, GI upset, increased risk for falls, take med consistently and same time every day, ataxia (incoordination).
An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? A. Carbidopa-levodopa (Sinemet) B. Donepezil (Aricept) C. Rivastigmine (Exelon) D. Tacrine (Cognex)
What is A? Rationale: This patient is exhibiting signs of Parkinson’s disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer’s disease.
The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms? A. Excessive salivation B. Muscle spasms C. Muscle weakness D. Respiratory paralysis
What is C? Rationale: Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic crisis, caused by too much medication. May have difficulty eating, swallowing, ect.
Seizure pads, oxygen and suction set up, call light within reach, bed in lowest position with side rails up.
What are seizure precautions.
The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? A. Administer the dose since the patient is not toxic. B. Contact the provider to discuss decreasing the phenytoin dose. C. Give the drug and monitor closely for adverse effects. D. Report drug toxicity to the providers.
What is A? Rationale: Drowsiness is a common side effect of phenytoin and is not cause for alarm. The patient’s drug level is normal, since 10-20 mcg/mL is the therapeutic range. The nurse should administer the dose. It is not necessary to decrease the dose or monitor the patient more closely than usual.
The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson’s disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will A. counsel the spouse that parkinsonism is a normal part of the aging process in some people. B. recommend exercise, nutritional counseling, and group support to help manage the disease. C. tell the spouse that the disease will not progress if mild symptoms are treated early. D. tell the spouse that medication therapy can be curative if drugs are begun in time.
What is B? Rationale: PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease.
The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient’s last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action? A. Assess the patient for signs of ptosis. B. Notify the provider to discuss an order for intravenous immune globulin (IVIG). C. Obtain an order for atropine sulfate. D. Request an order for an extra dose of pyridostigmine.
What is C? Rationale: Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.
Should not be taking with other CNS (central nervous system) depressants, or alcohol and can cause suicidal ideation.
What are anti-seizure or anti-epileptic drugs.
Good oral hygiene is important to teach because gum hyperplasia can occur.
What is phenytoin (Dilantin)
Agitation, muscle rigidity, tremors, high fever and unstable B/P.
What is neuroleptic malignant syndrome when COMT inhibitors and MAO-B inhibitors are added to dopamine agonist (Carbidopa-Levodopa) in Parkinson's.
What teaching points are you going to discuss with a patient who takes dimethyl fumarate (Tecfidera) an neurologic drug to decrease inflammation on nerves for MS?
Take with food to decrease GI upset and flushing, and watch for signs and symptoms of infection including regular blood work (WBC's).
Drugs used for Alzheimer's (cholinesterase inhibitors). Unfortunately drugs are useful only temporarily and as the diseases progresses, the drug is no longer effective. Know if you need to give at night or with food. Monitor weight loss and hallucinations. True or False.
True
the actions of these drugs are more effective in the early stages of AD and appear to delay or maintain memory loss symptoms.
A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? A. “Continue taking OCPs because phenytoin is not safe during pregnancy.” B. “You should use a backup method of contraception along with OCPs.” C. “You should stop taking OCPs because of drug-drug interactions with phenytoin.” D. “You should take low-dose aspirin while taking these medications to reduce your risk of stroke.”
What is B? Rationale: Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke.
The provider added a MAO-B drug rasagiline (Azilect) to a Parkinson's med regimen. You instruct the patient to avoid foods high in tyramine. What are these foods?
What are Cured or smoked meats, fish and cheeses, Avocadoes, beer or wine, sauerkraut, sour cream , soy sauce, or yogurt.
A autoimmune disease that affects the myelin sheath of the neuron which reduces nerve function.
What is Multiple Sclerosis
What is included in your baseline assessment before giving an anti-seizure medication?
VS, med reconciliation, baseline labs, mental status, any chance you are you pregnant, describe seizure activity, any aura or postictal events, and duration of seizure.
Rash or vision changes
What is call your provider immediately.
The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer’s disease. The patient will be taking a new medication. Which is a realistic goal for this patient? A. Demonstrate improved cognitive function. B. Exhibit improved ability to provide self-care. C. Receive appropriate assistance for care needs and delay impaired cognitive function. D. Show improved memory for recent events.
What is C? Rationale: For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care.
A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (Select all that apply.) A. Bradycardia B. Rash C. Abdominal pain, V/D D. Fever E. Drooling F. Weakness
What is A, C, E, F? Rationale: Bradycardia, drooling, and weakness can all occur with cholinergic crisis. This occurs when too much of the medication is giving.
How do you instruct your patient to take this drug for myasthenia gravis: pyridostigmine Bromide (Mestinon)
What is ive this drug 30min-60min. before meals