Seizures
Initiated by synchronous, high-frequency discharge from a group of hyperexcitable neurons called
Focus
1st generation medication; treats focal-onset and tonic-clonic seizures by selectively inhibiting sodium channels; narrow TI
Phenytoin [Dilantin]
Major education point with a patient taking phenytoin if wanting to stop the medication
Do not stop immediately or patient will have rebound effects
What is the length of time oxcarbazepine must be discontinued and do you take this medication with food or on an empty stomach?
1-6 months
empty stomach
Taking carbamazepine [Tegretol] with these two drugs can increase the effects of the this medication
Warfarin
oral contraceptives
Focal-onset (focal aware; focal impaired awareness; focal to bilateral tonic-clonic seizures)
Generalized-onset (tonic-clonic; absence; atonic; myoclonic; status epilepticus; febrile)
CBC
LFTs
Vit D
IV-telemetry and BP
Grapefruit juice is a drug-food interaction and cannot be taken with this medication
carbamazepine [Tegretol]
80% of this medication prescriptions are written for off label reasons such as prophylaxis of migraines, treatment of fibromyalgia, relief of post menopausal hot flashes, and neuropathic pain
gabapentin [Neurontin]
Used for absence seizures by suppressing neurons in the thalamus and have no significant adverse effect or interactions; must be given with food
ethosuximide [Zarontin]
Syndrome if mixed seizures from both groups of seizures
Lennox-Gastaut Syndrome
Therapeutic uses include seizure disorders, bipolar disorders, migraines
Give the 3 main uses for Phenobarbital
Induction of sleep
Sedation
Epilepsy
Used for restless leg syndrome
Gabapentin encarbil [Horizant]
Give the 5 main adverse effects of valproate [Depakote]
1. GI issues
2. hepatotoxicity
3. pancreatitis
4. teratogenic effects
5. hyperammonemia
Reduce seizures to a level that allows the patient to live as normal a life as possible
Balance the desire for complete seizure control with acceptable side effects
This medication can cause an adverse hematologic effects such as leukopenia, anemia, and thrombocytopenia due to bone marrow suppression
Gingival hyperplasia can be a major side effect of this medication and two actions a patient can do to minimize this complication.
Phenytoin; folic acid and oral hygiene
Hypersensitivity reaction of pregabalin [Lyrica] that is life-threatening
Angioedema of face, lips, throat, and larynx
Medication almost exact to phenobarbital but does not treat absence seizures
primidone [Mysoline]
5 mechanisms of action for antiseizure drugs
1. suppress sodium influx (phenytoin, carbmazepine, lamotrigine)
2. suppress calcium influx (ethosuximide)
3. antagonism of glutamate (perampanel [AMPA] and felbamabte/topiramate [NDMA])
4. potentialtion of gamma-aminobutyric acid (GABA) (Benzodiazapine & barbituates; tiagabine; and vigabatrin)
5. promote potassium efflux (ezogabine)
4 main goals of treatment for management of generalized convulsive status epilepticus
1. maintain ventilation
2. correct hypoglycemia
3. terminate seizures (benzodiazepine or lorazepam or diazepam)
4. initiate or continue LT suppression drugs (phenytoin or fosphenytoin)
MOA for valproate [Depakote] (3 main actions)
1. suppress high-frequence neuronal firing through the blockade of sodium channels
2. suppress calcium influx through T-type calcium channels
3. Augment the inhibitory influence of GABA
2 drugs that are controlled substances
lacosamide [Vimpat] schedule V
pregabalin [Lyrica] schedule IV
5 nursing considerations important with a client on seizure medications?
1. verify dosing/route
2. Know potential adverse effects
3. Client monitoring
4. Client adherence to the medication(s)
5. Client education