05 Seizures & Antiseizure Drugs

[Seizures] What is the overall goal of antiseizure treatment?

Prevent seizures with minimal adverse effects and maintain safety/adherence.

[Seizures] What are focal versus generalized seizures?

Focal begin in one brain region; generalized involve both hemispheres from onset.

[Antiseizure drugs] What two broad generations are in slides?

Traditional agents (e.g., phenytoin/valproate) and newer agents (e.g., levetiracetam).

[Antiseizure drugs] What is universal patient teaching?

Never discontinue abruptly; seizures may recur or worsen.

[Antiseizure drugs] What serious rash should be reported immediately?

Stevens-Johnson syndrome/toxic epidermal necrolysis: blistering, painful rash, mucosal lesions.

[Phenytoin] Class, use, mechanism?

Traditional antiseizure drug; blocks voltage-gated sodium channels for focal/tonic-clonic seizures.

[Phenytoin] What is the usual total therapeutic level?

10–20 mcg/mL; interpret with albumin/free level and clinical status.

[Phenytoin] Common dose-related toxicity signs?

Nystagmus, ataxia, diplopia, sedation, and confusion.

[Phenytoin] What notable chronic side effect requires teaching?

Gingival hyperplasia; emphasize brushing, flossing, and dental care.

[Phenytoin] What drug interaction matters with contraception?

Enzyme induction may reduce hormonal contraceptive effectiveness.

[Phenytoin] What needs monitoring?

Drug level when indicated, neurologic status, CBC/LFTs, and skin reactions.

[Fosphenytoin] What is it?

Injectable prodrug of phenytoin used when parenteral loading is needed.

[Carbamazepine] How does it prevent seizures?

Blocks sodium channels, reducing repetitive neuronal firing.

[Carbamazepine] What serious toxicities/labs matter?

Aplastic anemia/agranulocytosis, liver injury, severe rash; monitor CBC/LFTs.

[Carbamazepine] What sodium abnormality can occur?

Hyponatremia from SIADH.

[Valproate] What are major uses?

Multiple seizure types; also acute mania/bipolar mood stabilization.

[Valproate] What serious adverse effects?

Hepatotoxicity, pancreatitis, thrombocytopenia, and fetal harm.

[Valproate] Which labs are important?

Liver function, CBC/platelets, and drug level as ordered.

[Ethosuximide] What seizure type is it especially used for?

Absence seizures; reduces thalamic T-type calcium currents.

[Phenobarbital] Which drug class and key adverse effect?

Barbiturate antiseizure drug; causes sedation and respiratory depression.

[Oxcarbazepine] What important electrolyte adverse effect?

Hyponatremia; check serum sodium when indicated.

[Lamotrigine] What serious skin reaction is associated?

Stevens-Johnson syndrome; slow titration helps reduce risk.

[Gabapentin] What are common uses and adverse effects?

Adjunct focal-seizure therapy/neuropathic pain; dizziness, sedation, edema.

[Pregabalin] What are uses and major nursing considerations?

Neuropathic pain, fibromyalgia, focal-seizure adjunct; sedation, edema, weight gain.

[Levetiracetam] What behavior change is worth monitoring?

Irritability, agitation, mood or behavior changes.

[Topiramate] What adverse effects are distinctive?

Cognitive slowing, paresthesias, weight loss, kidney stones, and metabolic acidosis.

[Status epilepticus] What is the immediate nursing priority?

Protect airway and breathing, check glucose, obtain emergency assistance.

[Status epilepticus] Which medication is first line in the slide?

IV lorazepam; diazepam is an alternative when needed.

[Status epilepticus] What follows the initial benzodiazepine?

A longer-acting antiseizure load such as fosphenytoin/phenytoin, per protocol.

[Seizure disorders] What basic seizure precautions should the nurse use?

Protect from injury, keep suction/oxygen available as appropriate, time seizures; never restrain or place objects in mouth.

[Antiseizure drugs] What common class side effects require fall precautions?

Dizziness, drowsiness, and impaired coordination; assess safety.

[Carbamazepine] Which labs and levels should be followed?

Serum drug concentration as ordered, CBC, liver tests, and sodium.

[Valproate] Which major contraindication and pregnancy risk matter?

Avoid in significant liver disease; pregnancy exposure can cause serious fetal harm.