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ANTI-EPILEPTIC DRGUS
ANTI-EPILEPTIC DRGUS
ANTI-EPILEPTIC DRGUS
ANTI-EPILEPTIC DRGUS
ANTI-EPILEPTIC DRGUS
300

What is a seizure threshold and why is it important to educate pts about this? 

  • - A seizure threshold is the level of simulation at which your brain will have a seizure. This is our individual level of resistance to seizures. Any one can have a seizure under certain circumstances, but for most people, their natural resistance to having a seizures is high enough to stop that from happening.  
300

How long does it take for Phenobarbital to reach full therapeutic levels? 

-- Takes 2-3 weeks to reach therapeutic levels 

300

Why should you instruct pts taking Phenytoin to not switch between generic and brand forms of this drug?

  • - Possible risk of having more seizures or side effects during the changeover because the body does not absorb the different types the same.
300

What are important nursing considerations when giving a pt IV Phenytoin? 

  • - Infuse slowly to prevent hypotension and dysrhythmias.
  • - Never mix with another IV drug
  • - Monitor closely for extravasation (the leakage of blood, lymph, or other fluid from a blood vessel or tube into the tissue around it).
300

What are some of the major differences between the anti-epileptic drugs? 

  • - Many drug interactions (as a nurse you need to take good drug history and reconcile all drugs taken and report to neurologist).
  • -  MANY BLACK BOX WARNINGS (SEE ABOVE).
400

What is Status Epilepticus and how is it tx in the hospital setting?

  • - Life threatening emergency
  • - Characterized by clonic convulsions lasting for 5 minutes or more without relief.
  • - Hypotension, hypoxia, and cardiac dysrhythmias may occur
  • - Risk for permanent brain damage


  • - Treatment: 
  • -- Cardio and Respiratory support,
  •  -- Benzodiazepine: Lorazepam IV 0.1 mg/kg
  • -- Concurrent Anti-epileptic.
400

What is Phenobarbital used for? 

  • - Seizures (Barbiturate)
  • - Oral: sedative and antiepileptic for general and partial
  • - IV: acute seizure
400

What are the AEs of Phenobarbital? 

  • - CNS: sedation with possible cognitive impairment, agitation, confusion, vertigo, nightmares
  • - Stevens-Johnson Syndrome
  • - Sudden withdraw can lead to status epilepticus
400

What is Phenytoin (Dilantin)? 

  • - Used for both generalized and partial seizures and status epilepticus
  • - Oral: for generalized seizures
  • - IV: acute seizure
400

What are common AEs of Phenytoin? 

  • - CNS: drowsiness, ataxia, lethargy, slurred speech, coma
  • - GI: upset
  • - Heme: thrombocytopenia, agranulocytosis
  • - Gingival hyperplasia
  • - Hepatitis
  • - Long term use may increase risk for osteoporosis
  • - Steven Johnson Syndrome
  • - Purple Glove Syndrome (a rare complication of intravenous phenytoin use that typically presents pain, edema, and discoloration at the injection site that spreads to the distal limb).
500

What are the names of 4 common traditional anti-epileptic drugs? 

  • Traditional AEDs:
  • - Carbamazepine
  • - Phenytoin
  • - Phenobarbital
  • - Primidone
500

What are the names of 5 newer anti-epileptic drugs? 

  •  
  • - Lamotrigine (LaMICtal)
  • - Gabapentin
  • - Levetracetam (Keppra)
  • - Zonisamide (Zonegran)
  • - Carbamazepine
500

What are typical AEs of anti-epileptic drugs?

  • - (Contraindications)!!!! Pregnancy (should be on 2 different kinds of birth control), Known drug allergy
  • - CNS: dizziness, drowsiness, confusing, ataxia, agitation, lethargy, unusual eye movements, behavior changes, hostility, tremor
  • - GI: N/V, GI upset, Abd pain
  • - Vision changes: blurred vision, double vision
  • - Thrombocytopenia, agranulocytosis
  • - Hepatotoxicity, pancreatitis
  • - Rash (Stevens Johnson syndrome)?
  • - Edema
  • - BLACK BOX WARNING: suicidal thoughts and behavior. 
500

What are nursing considerations when administering anti-epileptic drugs? 

  • - These drugs have many adverse effects, so patients do no want to take the medications.
  • - Fine balance between prevent seizures and minimize drug-induced toxicity
  • - these drugs are started on lower doses and slowly increased until seizures are controlled, or toxicities occur.
  • - Takes sometimes weeks to get to a therapeutic level in the body
  • - Often is trial and error before the right drug is found so increasing and tapering of multiple drugs may occur.
  • - Monitor serum drug concentrations
  • - Some drugs for preventing partial seizures and some for preventing generalized seizures
  • - PATIENT EDUCATION IS CRITICAL
500

What are important educational points to share with pts who are taking anti-epileptic drugs? 

  • - Do not change your dose w/ out talking to your doctor
  • - It takes time and patience to get the right drug at the right dose.
  • - These drugs cannot be stopped abruptly
  • - must take the drugs on regular schedule to keep levels steady in the body
  • - Limit alcohol use.
  • - These drugs might cause drowsiness or fainting
  • - use two forms of birth control while taking these drugs
  • - Notify provider if a skin rash develops
  • - wear a medical alert bracelet.
  • - notify provider if seizure occurs
  • - report mood changes to provider.
  • - have serum blood levels and labs checked
  • - take medication with food
  • - don’t crush or chew tablets
  • - use protection from sunlight
  • - have regular eye exam