seizure medication

All anticonvulsants agents assessment

pre/post neuro assessment orientation X4 and behavioral assessment

All anticonvulsants' agents cause

dizziness and drowsiness = safety (avoid driving)

avoid discontinuing the medication without provider consultation

Benzodiazepines medications

ends with zepam or zepate

ex, diazepam and clorazepate

Benzodiazepines use

clonazepam = absent/ myoclonic (in children)

clobazam = focal <16 years

clorazepate = partial w/ other agents

lorazepam = status epilepticus (require hspitalization)

diazepam = ALL FORM OF SEIZURES

Benzodiazepines nursing (dosages and administration)

lorazepam = no longer than 2 mg per min

diazepam = no longer than 5 mg per min

rapid IV push cause bradycardia ** ECG should be in place

don't mix medications in the same syringe

Benzodiazepines, hydantoins, and succinimide common side effects

sedation. drossiness. dizziness. fatigue. lethargy. blurred vision

succinimide = all except blurred vision

Benzodiazepines serious side effects

behavior disturbance

blood dyscrasias = monitor CBC

hepatoxicity = Montier liver function

Benzodiazepines drug interactions

warfarin

prednisone

dexamethasone

oral birth control

other antiepileptic medications

hydantoins

ends with phenytoin

ex fosphenytoin and phenytoin

hydantoins used

fosphenytoin = status epilepticus

phenytoin = lower tonic in tonic /clonic

both used for focal and generalized tonic clonic

hydantoins common side effects

gingival hyperplasia = oral hygiene requires

nystagam = overdose

sedation. drossiness. dizziness. fatigue. lethargy. blurred vision

hydantoins serious side effects

hyperglycemia = monitor glucose level

blood dyscrasisas

hepatoxicity

dermatological reaction **= rash (withhold medication and notify the provider)

hydantoins

notify the provider if new meds added = multiple drugs interactions

Succinimides

ends with suximide

ex, ethosuzimide and methsuximide

Succinimides use

treat absent seizure **

drug interactions from succinimides

CNS depressant = increase sedation

antihistamine

succinimide common side effects

N/V indigestions

sedation. drossiness. dizziness. fatigue. lethargy.

miscellaneous antiepileptic agents

carbamazepine

gabapentin

lamotrigine

levetiracetam

oxcarbazepine

phenobarbital

pregabalin

topiramate

valproic acid

miscellaneous antiepileptic agents use

in combination with other antiepileptic agents

carbamazepine use

control tonic-clonic

tegminal neuralgia

manic depressive = when lithium not optional

carbamazepine actions *

block norepinephrine reuptake

decrease the release of norepinephrine

lower the rate of dopamine

lower GABA turnover

common side effects of carbamazepine

N/V

dizziness + drowsiness

Serious Adverse Effects of carbamazepine

fatal skin reaction = B1502 * = genetic testing required

orthostatic hypotension

dyspnea, edema = daily weight in HF patients*

hepatoxicity = monitor liver lab

nephrotoxicity= monitor Cr labs

slurred speech, confusion, sedation = signs of toxicity

Carbamazepine and oxcarbazepine nursing considerations

multiple drugs interaction*

monitor Na* level

slow increase in dosage to prevent adverse effects

oxcarbazepine action

metabolize into active carbamazepine

interact w/Na+. K+. Ca+2 to prevent repetitive firing

oxcarbazepine use

mono or combine = treat partial seizure

oxcarbazepine common side effects

confusion

dizziness

drowsiness

gabapentin and pregabalin action

both chemically related = do not enhance GABA

oxcarbazepine serious side effects

nausea

headache

lethargy

confusion

obtundation

malaise

blood dyscrasias

skin rash= B1502

gabapentin and pregabalin use KEY DIFFERENT

both control partial (focal) seizure in combine w/other anticonvulsant

gabapentin = treat postherpetic neuralgia

pregabalin = treat postherpetic neuralgia, fibromyalgia, diabetic neuropathy

gabapentin and pregabalin common side effects

sedation

drowsiness

dizziness

blurred vision

gabapentin serious side effects

slurred speech

lethargy

confusion

gabapentin teaching

take 2 hours post anti acid

monitor ↓ respiratory with opioid use

pregabalin serious side effects

confusion

disorientation

excessive use or abuse = gradual discontinue * ↓ withdrawal symptoms

pregabalin interaction

CNS depressant

lamotrigine action

block voltage sensitive Na+ and Ca+2 in neuro membrane

lamotrigine use

treat patrial seizure and bipolar disorder

side effect of lamotrigine and valproic acid

N/V - indigestion = take w food or milk 6

sedation

drowsiness

dizziness

blurred vision

serious adverse effects of lamotrigine

10% develop skin rash

neurological

aseptic meningitis

aseptic meningitis s/s

ever. headache. skin sensitivity. neck stiffness. N/V

(must be reported)

levetiracetam action

pyrrolidine derivative

unrelated to other antiepileptic

levetiracetam use

adult partial onset seizure

levetiracetam side effects

common = weakness. dizziness. drowsiness

serious = confusion. disorientation

phenobarbital

long acting

↑ seizure threshold = prevent spread of seizure

phenobarbital use

primarily alternative when other single meds unsuccessful *

partial and generalized tonic- clonic/ myoclonic

or in combine w/ other meds

phenobarbital common side effects

hangover

sedation

lethargy diminish alertness

phenobarbital serious side effects

excessive use or abuse

paradoxical respond in elderly

hypersensitivity = rash must be reported

blood dyscarasias

phenobarbital infraction

warfarin

oral birth control

corticosteroids

antidepressant

topiramate use

tonic- clonic

prevent migraines

topiramate

block Na+ channel = ↑ GABA activity

topiramate side effects

common = sedation. drowsiness. dizziness

serious

neurological

↓ sweats and overheating in children's

cleft palate in newborn

topiramate teaching

increase fluids intake before activities = overheating

notify provider if pregnant = clef palate

avoid CNS depressant = increase sedation

valproic acid

enhance GABA activity = inhibit neurotransmitter

for tonic- clonic = single

all other seizures = combine w/other meds

treat acute mania and bipolar

serious adverse effects of valproic acid

blood dyscarasias

birth defect = use birth control

hepatoxic

pancreatitis

all seizure medication teaching

avoid driving

avoid sudden discontinuation w/out provider

avoid CNS depressant = enhance sedation